RT Journal Article
SR Electronic
T1 Chemokine Receptor PET/CT Provides Relevant Staging and Management Changes in Marginal Zone Lymphoma
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP 1889
OP 1894
DO 10.2967/jnumed.123.266074
VO 64
IS 12
A1 Duell, Johannes
A1 Buck, Andreas K.
A1 Hartrampf, Philipp E.
A1 Schlötelburg, Wiebke
A1 Schneid, Simone
A1 Weich, Alexander
A1 Dreher, Niklas
A1 Lapa, Constantin
A1 Kircher, Malte
A1 Higuchi, Takahiro
A1 Samnick, Samuel
A1 Serfling, Sebastian E.
A1 Raderer, Markus
A1 Rasche, Leo
A1 Einsele, Hermann
A1 Topp, Max S.
A1 Kosmala, Aleksander
A1 Werner, Rudolf A.
YR 2023
UL http://jnm.snmjournals.org/content/64/12/1889.abstract
AB Because of gastral and extranodal manifestations, guideline-compatible diagnostic work-up of marginal zone lymphoma is challenging. We aimed to determine the diagnostic performance of C-X-C motif chemokine receptor 4 (CXCR4)–directed PET/CT compared with routine diagnostics, along with PET/CT-based retrospective changes in therapeutic management. The predictive potential of the PET signal was also investigated, and the number of patients eligible for CXCR4-directed radioligand therapy in a theranostic setting was determined. Methods: For this study, 100 marginal zone lymphoma patients underwent CXCR4-directed PET/CT. We compared staging results and treatment decisions from molecular imaging with respective results from guideline-compatible work-up (CT, esophagogastroduodenoscopy, and bone marrow–derived biopsy). Prognostic performance of the in vivo CXCR4 PET signal for progression-free survival (PFS) was evaluated (using log-rank test and Kaplan–Meier curves). Results: Relative to CT, CXCR4-directed imaging led to Ann Arbor (AA) staging changes for 27 of 100 patients (27.0%). Among those, clinically relevant upstaging from AA I or AA II to AA III or AA IV was observed for 23 patients (85.2%), along with respective changes in therapeutic management (escalation, 6/23 [26.1%]; deescalation, 17/23 [73.9%]). CXCR4 PET/CT yielded diagnostic accuracy of 94.0% relative to esophagogastroduodenoscopy and 76.8% relative to bone marrow–derived biopsy. An increased CXCR4 PET signal was linked to shorter PFS (707 d vs. median PFS not reached; hazard ratio, 3.18; 95% CI, 1.37–7.35; P = 0.01). CXCR4-directed radioligand therapy would have been feasible for 18 of 100 patients (18.0%). Conclusion: Relative to CT, CXCR4-directed PET/CT led to AA changes for 27 of 100 patients. Chemokine receptor PET/CT may improve current diagnostic algorithms and influence management relative to CT alone, potentially obviating some biopsies.