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European Journal of Nuclear Medicine and Molecular Imaging

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Open Access 01-03-2016 | Original Article

Subacute haematotoxicity after PRRT with ¹⁷⁷Lu-DOTA-octreotate: prognostic factors, incidence and course

Authors: Hendrik Bergsma, Mark W. Konijnenberg, Boen L. R. Kam, Jaap J. M. Teunissen, Peter P. Kooij, Wouter W. de Herder, Gaston J. H. Franssen, Casper H. J. van Eijck, Eric P. Krenning, Dik J. Kwekkeboom

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 3/2016

Abstract

Purpose

In peptide receptor radionuclide therapy (PRRT), the bone marrow (BM) is one of the dose-limiting organs. The accepted dose limit for BM is 2 Gy, adopted from ¹³¹I treatment. We investigated the incidence and duration of haematological toxicity and its risk factors in patients treated with PRRT with ¹⁷⁷Lu-DOTA⁰-Tyr³-octreotate (¹⁷⁷Lu-DOTATATE). Also, absorbed BM dose estimates were evaluated and compared with the accepted 2 Gy dose limit.

Methods

The incidence and duration of grade 3 or 4 haematological toxicity (according to CTCAE v3.0) and risk factors were analysed. Mean BM dose per unit (gigabecquerels) of administered radioactivity was calculated and the correlations between doses to the BM and haematological risk factors were determined.

Results

Haematological toxicity (grade 3/4) occurred in 34 (11 %) of 320 patients. In 15 of the 34 patients, this lasted more than 6 months or blood transfusions were required. Risk factors significantly associated with haematological toxicity were: poor renal function, white blood cell (WBC) count <4.0 × 10⁹/l, age over 70 years, extensive tumour mass and high tumour uptake on the OctreoScan. Previous chemotherapy was not associated. The mean BM dose per administered activity in 23 evaluable patients was 67 ± 7 mGy/GBq, resulting in a mean BM dose of 2 Gy in patients who received four cycles of 7.4 GBq ¹⁷⁷Lu-DOTATATE. Significant correlations between (cumulative) BM dose and platelet and WBC counts were found in a selected group of patients.

Conclusion

The incidence of subacute haematological toxicity after PRRT with ¹⁷⁷Lu-DOTATATE is acceptable (11 %). Patients with impaired renal function, low WBC count, extensive tumour mass, high tumour uptake on the OctreoScan and/or advanced age are more likely to develop grade 3/4 haematological toxicity. The BM dose limit of 2 Gy, adopted from ¹³¹I, seems not to be valid for PRRT with ¹⁷⁷Lu-DOTATATE.

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Title: Subacute haematotoxicity after PRRT with 177Lu-DOTA-octreotate: prognostic factors, incidence and course
Authors: Hendrik Bergsma
Mark W. Konijnenberg
Boen L. R. Kam
Jaap J. M. Teunissen
Peter P. Kooij
Wouter W. de Herder
Gaston J. H. Franssen
Casper H. J. van Eijck
Eric P. Krenning
Dik J. Kwekkeboom
Publication date: 01-03-2016
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 3/2016
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-015-3193-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Subacute haematotoxicity after PRRT with ¹⁷⁷Lu-DOTA-octreotate: prognostic factors, incidence and course

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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