First-in-Human Experience of CXCR4-Directed Endoradiotherapy with 177Lu- and 90Y-Labeled Pentixather in Advanced-Stage Multiple Myeloma with Extensive Intra- and Extramedullary Disease

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FIGURE 1.
(A) In patient 3 before pentixather therapy, maximum-intensity projections of ⁶⁸Ga-pentixafor and ¹⁸F-FDG PET/CT indicate high CXCR4 expression in multiple extra- and intramedullary ¹⁸F-FDG–avid myeloma lesions. Corresponding ¹⁸F-FDG PET/CT image 2 wk after ⁹⁰Y-pentixather shows complete metabolic response. (B) Scintigraphic images of patient 1 at 24 h and 15 d after 15.2 GBq of ¹⁷⁷Lu-pentixather confirm binding to CXCR4 target. Visual difference in tumor-to-background ratios is due to reduced background uptake at later time point and longer emission times due to lower count rates.

TABLE 1

Patient Characteristics

↵* Time from primary diagnosis to endoradiotherapy.
↵† Including novel agents.
LC = (immunoglobulin) light chains; EMD = extramedullary disease; LN = lymph nodes; Tx = therapy; PAD = bortezomib, doxorubicin, dexamethasone; pom = pomalidomide; dex = dexamethasone; VCD = bortezomib, cyclophosphamide, dexamethasone; est = estimate based on pretherapy kinetics (nephron-protection unconsidered); PR = partial remission; NA = not applicable; CR = complete remission.