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OtherTheranostics

Improved primary staging of marginal zone lymphoma by addition of CXCR4-directed PET/CT

Johannes Duell, Franziska Krummenast, Andreas Schirbel, Philipp Klassen, Samuel Samnick, Hilka Rauert-Wunderlich, Leo Rasche, Andreas K. Buck, Hans-Jürgen Wester, Andreas Rosenwald, Hermann Einsele, Max S Topp, Constantin Lapa and Malte Kircher
Journal of Nuclear Medicine February 2021, jnumed.120.257279; DOI: https://doi.org/10.2967/jnumed.120.257279
Johannes Duell
1 Department of Internal Medicine II, University Hospital Würzburg;
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Franziska Krummenast
1 Department of Internal Medicine II, University Hospital Würzburg;
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Andreas Schirbel
2 Comprehensive Cancer Center (CCC) Mainfranken, Germany;
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Philipp Klassen
3 3. Department of Nuclear Medicine, University Hospital Würzburg;
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Samuel Samnick
2 Comprehensive Cancer Center (CCC) Mainfranken, Germany;
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Hilka Rauert-Wunderlich
2 Comprehensive Cancer Center (CCC) Mainfranken, Germany;
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Leo Rasche
1 Department of Internal Medicine II, University Hospital Würzburg;
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Andreas K. Buck
2 Comprehensive Cancer Center (CCC) Mainfranken, Germany;
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Hans-Jürgen Wester
4 Pharmaceutical Radiochemistry, Technische Universität München
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Andreas Rosenwald
2 Comprehensive Cancer Center (CCC) Mainfranken, Germany;
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Hermann Einsele
1 Department of Internal Medicine II, University Hospital Würzburg;
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Max S Topp
1 Department of Internal Medicine II, University Hospital Würzburg;
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Constantin Lapa
2 Comprehensive Cancer Center (CCC) Mainfranken, Germany;
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Malte Kircher
2 Comprehensive Cancer Center (CCC) Mainfranken, Germany;
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Abstract

Positron emission tomography/computed tomography (PET/CT) with 18F-fluorodesoxyglucose (FDG) is an integral component in the primary staging of most lymphomas. However, its utility is limited in marginal zone lymphoma (MZL) due to inconsistent FDG avidity. One diagnostic alternative could be the targeting of CXC-motif chemokine receptor 4 (CXCR4), shown to be expressed by MZL cells. This study investigated the value of adding CXCR4-directed 68Ga-Pentixafor PET/CT to conventional staging. Methods: 22 newly diagnosed MZL patients were staged conventionally and with 68Ga-Pentixafor PET/CT. Lesions exclusively identified by 68Ga-Pentixafor PET/CT were biopsied as standard of reference and compared to imaging results. The impact of CXCR4-directed imaging on staging results and treatment protocol was assessed. Results: 68Ga-Pentixafor PET/CT correctly identified all patients with viable MZL and was superior to conventional staging (P < 0.001). CXCR4-directed imaging results were validated by confirmation of MZL in 21/24 PET-guided biopsy samples. Inclusion of 68Ga-Pentixafor PET/CT in primary staging significantly impacted staging results in almost half, and treatment protocols in one third of patients (upstaging, n = 7; downstaging, n = 3; treatment change, n = 8; P < 0.03). Conclusion: 68Ga-Pentixafor PET/CT is a suitable tool in primary staging of MZL and holds the potential to improve existing diagnostic algorithms.

  • Hematology
  • Molecular Imaging
  • Oncology: Lymphoma
  • PET/CT
  • CXCR4
  • PET
  • molecular imaging
  • primary diagnosis
  • theranostics
  • Copyright © 2021 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

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Journal of Nuclear Medicine: 62 (3)
Journal of Nuclear Medicine
Vol. 62, Issue 3
March 1, 2021
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Improved primary staging of marginal zone lymphoma by addition of CXCR4-directed PET/CT
Johannes Duell, Franziska Krummenast, Andreas Schirbel, Philipp Klassen, Samuel Samnick, Hilka Rauert-Wunderlich, Leo Rasche, Andreas K. Buck, Hans-Jürgen Wester, Andreas Rosenwald, Hermann Einsele, Max S Topp, Constantin Lapa, Malte Kircher
Journal of Nuclear Medicine Feb 2021, jnumed.120.257279; DOI: 10.2967/jnumed.120.257279

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Improved primary staging of marginal zone lymphoma by addition of CXCR4-directed PET/CT
Johannes Duell, Franziska Krummenast, Andreas Schirbel, Philipp Klassen, Samuel Samnick, Hilka Rauert-Wunderlich, Leo Rasche, Andreas K. Buck, Hans-Jürgen Wester, Andreas Rosenwald, Hermann Einsele, Max S Topp, Constantin Lapa, Malte Kircher
Journal of Nuclear Medicine Feb 2021, jnumed.120.257279; DOI: 10.2967/jnumed.120.257279
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Keywords

  • Hematology
  • molecular imaging
  • Oncology: Lymphoma
  • PET/CT
  • CXCR4
  • PET
  • primary diagnosis
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