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Comparison of pretherapeutic osseous tumor volume and standard hematology for prediction of hematotoxicity after PSMA-targeted radioligand therapy
Purpose Hematotoxicity is a potentially dose-limiting adverse event in patients with metastasized castration-resistant prostate cancer (mCRPC) undergoing prostate-specific membrane antigen (PSMA)-directed radioligand therapy (RLT). We aimed to identify clinical or PSMA-targeted imaging-derived param...
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| Published in: | European journal of nuclear medicine and molecular imaging 2021-11, Vol.48 (12), p.4077-4088 |
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| container_end_page | 4088 |
| container_issue | 12 |
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| container_title | European journal of nuclear medicine and molecular imaging |
| container_volume | 48 |
| creator | Widjaja, Liam Werner, Rudolf A. Ross, Tobias L. Bengel, Frank M. Derlin, Thorsten |
| description | Purpose
Hematotoxicity is a potentially dose-limiting adverse event in patients with metastasized castration-resistant prostate cancer (mCRPC) undergoing prostate-specific membrane antigen (PSMA)-directed radioligand therapy (RLT). We aimed to identify clinical or PSMA-targeted imaging-derived parameters to predict hematological adverse events at early and late stages in the treatment course.
Methods
In 67 patients with mCRPC scheduled for
177
Lu-PSMA-617 RLT, pretherapeutic osseous tumor volume (TV) from
68
Ga-PSMA-11 PET/CT and laboratory values were assessed. We then tested the predictive capability of these parameters for early and late hematotoxicity (according to CTCAE vers. 5.0) after one cycle of RLT and in a subgroup of 32/67 (47.8%) patients after four cycles of RLT.
Results
After one cycle, 10/67 (14.9%) patients developed leukocytopenia (lymphocytopenia, 39/67 [58.2%]; thrombocytopenia, 17/67 [25.4%]). A cut-off of 5.6 × 10
3
/mm
3
for baseline leukocytes was defined by receiver operating characteristics (ROC) and separated between patients with and without leukocytopenia (
P
|
| doi_str_mv | 10.1007/s00259-021-05412-1 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8484194</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2577917079</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-25f72c1945180c24016facc53ab1b03792e27f5c729b8e690916c648e852e0d63</originalsourceid><addsrcrecordid>eNp9kc1u1DAUhSNERUvhBVggS2y6CfVvbG-QqhEFpCKQgLXlcW4yrpI42E7FvAZPjIeU4WfBxrZ0v3uO7z1V9YzglwRjeZkwpkLXmJIaC05oTR5UZ6QhupZY6YfHt8Sn1eOUbjEmiir9qDplHHMiGn5Wfd-EcbbRpzCh0KE5Qt5BtDMs2TsUUoKwJJSXMUR0F4ZlBGSnFqVcThtbtIPR5jCEfo-6gpT-1rvsV7W1mMM373zeI9tliOjjp_dXdbaxhwwtirb1YfD9QXR13j-pTjo7JHh6f59XX65ff968rW8-vHm3ubqpHZc811R0kjqiuSAKO8oxaTrrnGB2S7aYSU2Byk44SfVWQaOxJo1ruAIlKOC2YefVq1V3XrYjtA6mHO1g5uhHG_cmWG_-rkx-Z_pwZxRXvPgWgYt7gRi-LpCyGX1yMAx2OmzNUMEYI5xpVdAX_6C3YYlTGa9QUmpSUtKFoivlYtl8hO74GYLNIXKzRm5K5OZn5IaUpud_jnFs-ZVxAdgKpFKaeoi_vf8j-wNHUrq8</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2577917079</pqid></control><display><type>article</type><title>Comparison of pretherapeutic osseous tumor volume and standard hematology for prediction of hematotoxicity after PSMA-targeted radioligand therapy</title><source>Springer Nature</source><creator>Widjaja, Liam ; Werner, Rudolf A. ; Ross, Tobias L. ; Bengel, Frank M. ; Derlin, Thorsten</creator><creatorcontrib>Widjaja, Liam ; Werner, Rudolf A. ; Ross, Tobias L. ; Bengel, Frank M. ; Derlin, Thorsten</creatorcontrib><description>Purpose
Hematotoxicity is a potentially dose-limiting adverse event in patients with metastasized castration-resistant prostate cancer (mCRPC) undergoing prostate-specific membrane antigen (PSMA)-directed radioligand therapy (RLT). We aimed to identify clinical or PSMA-targeted imaging-derived parameters to predict hematological adverse events at early and late stages in the treatment course.
Methods
In 67 patients with mCRPC scheduled for
177
Lu-PSMA-617 RLT, pretherapeutic osseous tumor volume (TV) from
68
Ga-PSMA-11 PET/CT and laboratory values were assessed. We then tested the predictive capability of these parameters for early and late hematotoxicity (according to CTCAE vers. 5.0) after one cycle of RLT and in a subgroup of 32/67 (47.8%) patients after four cycles of RLT.
Results
After one cycle, 10/67 (14.9%) patients developed leukocytopenia (lymphocytopenia, 39/67 [58.2%]; thrombocytopenia, 17/67 [25.4%]). A cut-off of 5.6 × 10
3
/mm
3
for baseline leukocytes was defined by receiver operating characteristics (ROC) and separated between patients with and without leukocytopenia (
P
< 0.001). Baseline leukocyte count emerged as a stronger predictive factor in multivariate analysis (hazard ratio [HR], 33.94,
P
= 0.001) relative to osseous TV (HR, 14.24,
P
= 0.01). After four cycles, 4/32 (12.5%) developed leukocytopenia and the pretherapeutic leukocyte cut-off (HR, 9.97,
P
= 0.082) tended to predict leukocytopenia better than TV (HR, 8.37,
P
= 0.109). In addition, a cut-off of 1.33 × 10
3
/mm
3
for baseline lymphocytes separated between patients with and without lymphocytopenia (
P
< 0.001), which was corroborated in multivariate analysis (HR, 21.39,
P
< 0.001 vs. TV, HR, 4.57,
P
= 0.03). After four cycles, 19/32 (59.4%) developed lymphocytopenia and the pretherapeutic cut-off for lymphocytes (HR, 46.76,
P
= 0.007) also demonstrated superior predictive performance for late lymphocytopenia (TV, HR, 5.15,
P
= 0.167). Moreover, a cut-off of 206 × 10
3
/mm
3
for baseline platelets separated between patients with and without thrombocytopenia (
P
< 0.001) and also demonstrated superior predictive capability in multivariate analysis (HR, 115.02,
P
< 0.001 vs.TV, HR, 12.75,
P
= 0.025). After four cycles, 9/32 (28.1%) developed thrombocytopenia and the pretherapeutic cut-off for platelets (HR, 5.44,
P
= 0.048) was also superior for the occurrence of late thrombocytopenia (TV, HR, 1.44,
P
= 0.7).
Conclusions
Pretherapeutic leukocyte, lymphocyte, and platelet levels themselves are strong predictors for early and late hematotoxicity under PSMA-directed RLT, and are better suited than PET-based osseous TV for this purpose.</description><identifier>ISSN: 1619-7070</identifier><identifier>EISSN: 1619-7089</identifier><identifier>DOI: 10.1007/s00259-021-05412-1</identifier><identifier>PMID: 34041564</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adverse events ; Antigens ; Cardiology ; Castration ; Computed tomography ; Dipeptides ; Hematology ; Heterocyclic Compounds, 1-Ring ; Humans ; Imaging ; Leukocytes ; Leukopenia ; Lymphocytes ; Lymphopenia ; Male ; Medicine ; Medicine & Public Health ; Multivariate analysis ; Nuclear Medicine ; Oncology ; Oncology – Genitourinary ; Original ; Original Article ; Orthopedics ; Parameter identification ; Patients ; Performance prediction ; Platelets ; Positron Emission Tomography Computed Tomography ; Prostate ; Prostate cancer ; Prostatic Neoplasms, Castration-Resistant - radiotherapy ; Radiology ; Retrospective Studies ; Subgroups ; Thrombocytopenia ; Treatment Outcome ; Tumor Burden ; Tumors</subject><ispartof>European journal of nuclear medicine and molecular imaging, 2021-11, Vol.48 (12), p.4077-4088</ispartof><rights>The Author(s) 2021</rights><rights>2021. The Author(s).</rights><rights>The Author(s) 2021. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-25f72c1945180c24016facc53ab1b03792e27f5c729b8e690916c648e852e0d63</citedby><cites>FETCH-LOGICAL-c474t-25f72c1945180c24016facc53ab1b03792e27f5c729b8e690916c648e852e0d63</cites><orcidid>0000-0002-8786-4105</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27922,27923</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34041564$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Widjaja, Liam</creatorcontrib><creatorcontrib>Werner, Rudolf A.</creatorcontrib><creatorcontrib>Ross, Tobias L.</creatorcontrib><creatorcontrib>Bengel, Frank M.</creatorcontrib><creatorcontrib>Derlin, Thorsten</creatorcontrib><title>Comparison of pretherapeutic osseous tumor volume and standard hematology for prediction of hematotoxicity after PSMA-targeted radioligand therapy</title><title>European journal of nuclear medicine and molecular imaging</title><addtitle>Eur J Nucl Med Mol Imaging</addtitle><addtitle>Eur J Nucl Med Mol Imaging</addtitle><description>Purpose
Hematotoxicity is a potentially dose-limiting adverse event in patients with metastasized castration-resistant prostate cancer (mCRPC) undergoing prostate-specific membrane antigen (PSMA)-directed radioligand therapy (RLT). We aimed to identify clinical or PSMA-targeted imaging-derived parameters to predict hematological adverse events at early and late stages in the treatment course.
Methods
In 67 patients with mCRPC scheduled for
177
Lu-PSMA-617 RLT, pretherapeutic osseous tumor volume (TV) from
68
Ga-PSMA-11 PET/CT and laboratory values were assessed. We then tested the predictive capability of these parameters for early and late hematotoxicity (according to CTCAE vers. 5.0) after one cycle of RLT and in a subgroup of 32/67 (47.8%) patients after four cycles of RLT.
Results
After one cycle, 10/67 (14.9%) patients developed leukocytopenia (lymphocytopenia, 39/67 [58.2%]; thrombocytopenia, 17/67 [25.4%]). A cut-off of 5.6 × 10
3
/mm
3
for baseline leukocytes was defined by receiver operating characteristics (ROC) and separated between patients with and without leukocytopenia (
P
< 0.001). Baseline leukocyte count emerged as a stronger predictive factor in multivariate analysis (hazard ratio [HR], 33.94,
P
= 0.001) relative to osseous TV (HR, 14.24,
P
= 0.01). After four cycles, 4/32 (12.5%) developed leukocytopenia and the pretherapeutic leukocyte cut-off (HR, 9.97,
P
= 0.082) tended to predict leukocytopenia better than TV (HR, 8.37,
P
= 0.109). In addition, a cut-off of 1.33 × 10
3
/mm
3
for baseline lymphocytes separated between patients with and without lymphocytopenia (
P
< 0.001), which was corroborated in multivariate analysis (HR, 21.39,
P
< 0.001 vs. TV, HR, 4.57,
P
= 0.03). After four cycles, 19/32 (59.4%) developed lymphocytopenia and the pretherapeutic cut-off for lymphocytes (HR, 46.76,
P
= 0.007) also demonstrated superior predictive performance for late lymphocytopenia (TV, HR, 5.15,
P
= 0.167). Moreover, a cut-off of 206 × 10
3
/mm
3
for baseline platelets separated between patients with and without thrombocytopenia (
P
< 0.001) and also demonstrated superior predictive capability in multivariate analysis (HR, 115.02,
P
< 0.001 vs.TV, HR, 12.75,
P
= 0.025). After four cycles, 9/32 (28.1%) developed thrombocytopenia and the pretherapeutic cut-off for platelets (HR, 5.44,
P
= 0.048) was also superior for the occurrence of late thrombocytopenia (TV, HR, 1.44,
P
= 0.7).
Conclusions
Pretherapeutic leukocyte, lymphocyte, and platelet levels themselves are strong predictors for early and late hematotoxicity under PSMA-directed RLT, and are better suited than PET-based osseous TV for this purpose.</description><subject>Adverse events</subject><subject>Antigens</subject><subject>Cardiology</subject><subject>Castration</subject><subject>Computed tomography</subject><subject>Dipeptides</subject><subject>Hematology</subject><subject>Heterocyclic Compounds, 1-Ring</subject><subject>Humans</subject><subject>Imaging</subject><subject>Leukocytes</subject><subject>Leukopenia</subject><subject>Lymphocytes</subject><subject>Lymphopenia</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Multivariate analysis</subject><subject>Nuclear Medicine</subject><subject>Oncology</subject><subject>Oncology – Genitourinary</subject><subject>Original</subject><subject>Original Article</subject><subject>Orthopedics</subject><subject>Parameter identification</subject><subject>Patients</subject><subject>Performance prediction</subject><subject>Platelets</subject><subject>Positron Emission Tomography Computed Tomography</subject><subject>Prostate</subject><subject>Prostate cancer</subject><subject>Prostatic Neoplasms, Castration-Resistant - radiotherapy</subject><subject>Radiology</subject><subject>Retrospective Studies</subject><subject>Subgroups</subject><subject>Thrombocytopenia</subject><subject>Treatment Outcome</subject><subject>Tumor Burden</subject><subject>Tumors</subject><issn>1619-7070</issn><issn>1619-7089</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kc1u1DAUhSNERUvhBVggS2y6CfVvbG-QqhEFpCKQgLXlcW4yrpI42E7FvAZPjIeU4WfBxrZ0v3uO7z1V9YzglwRjeZkwpkLXmJIaC05oTR5UZ6QhupZY6YfHt8Sn1eOUbjEmiir9qDplHHMiGn5Wfd-EcbbRpzCh0KE5Qt5BtDMs2TsUUoKwJJSXMUR0F4ZlBGSnFqVcThtbtIPR5jCEfo-6gpT-1rvsV7W1mMM373zeI9tliOjjp_dXdbaxhwwtirb1YfD9QXR13j-pTjo7JHh6f59XX65ff968rW8-vHm3ubqpHZc811R0kjqiuSAKO8oxaTrrnGB2S7aYSU2Byk44SfVWQaOxJo1ruAIlKOC2YefVq1V3XrYjtA6mHO1g5uhHG_cmWG_-rkx-Z_pwZxRXvPgWgYt7gRi-LpCyGX1yMAx2OmzNUMEYI5xpVdAX_6C3YYlTGa9QUmpSUtKFoivlYtl8hO74GYLNIXKzRm5K5OZn5IaUpud_jnFs-ZVxAdgKpFKaeoi_vf8j-wNHUrq8</recordid><startdate>20211101</startdate><enddate>20211101</enddate><creator>Widjaja, Liam</creator><creator>Werner, Rudolf A.</creator><creator>Ross, Tobias L.</creator><creator>Bengel, Frank M.</creator><creator>Derlin, Thorsten</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-8786-4105</orcidid></search><sort><creationdate>20211101</creationdate><title>Comparison of pretherapeutic osseous tumor volume and standard hematology for prediction of hematotoxicity after PSMA-targeted radioligand therapy</title><author>Widjaja, Liam ; Werner, Rudolf A. ; Ross, Tobias L. ; Bengel, Frank M. ; Derlin, Thorsten</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-25f72c1945180c24016facc53ab1b03792e27f5c729b8e690916c648e852e0d63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adverse events</topic><topic>Antigens</topic><topic>Cardiology</topic><topic>Castration</topic><topic>Computed tomography</topic><topic>Dipeptides</topic><topic>Hematology</topic><topic>Heterocyclic Compounds, 1-Ring</topic><topic>Humans</topic><topic>Imaging</topic><topic>Leukocytes</topic><topic>Leukopenia</topic><topic>Lymphocytes</topic><topic>Lymphopenia</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Multivariate analysis</topic><topic>Nuclear Medicine</topic><topic>Oncology</topic><topic>Oncology – Genitourinary</topic><topic>Original</topic><topic>Original Article</topic><topic>Orthopedics</topic><topic>Parameter identification</topic><topic>Patients</topic><topic>Performance prediction</topic><topic>Platelets</topic><topic>Positron Emission Tomography Computed Tomography</topic><topic>Prostate</topic><topic>Prostate cancer</topic><topic>Prostatic Neoplasms, Castration-Resistant - radiotherapy</topic><topic>Radiology</topic><topic>Retrospective Studies</topic><topic>Subgroups</topic><topic>Thrombocytopenia</topic><topic>Treatment Outcome</topic><topic>Tumor Burden</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Widjaja, Liam</creatorcontrib><creatorcontrib>Werner, Rudolf A.</creatorcontrib><creatorcontrib>Ross, Tobias L.</creatorcontrib><creatorcontrib>Bengel, Frank M.</creatorcontrib><creatorcontrib>Derlin, Thorsten</creatorcontrib><collection>SpringerOpen</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing and Allied Health Source</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest - Health & Medical Complete保健、医学与药学数据库</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>Advanced Technologies & Aerospace Database (1962 - current)</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Biological Sciences</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>European journal of nuclear medicine and molecular imaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Widjaja, Liam</au><au>Werner, Rudolf A.</au><au>Ross, Tobias L.</au><au>Bengel, Frank M.</au><au>Derlin, Thorsten</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of pretherapeutic osseous tumor volume and standard hematology for prediction of hematotoxicity after PSMA-targeted radioligand therapy</atitle><jtitle>European journal of nuclear medicine and molecular imaging</jtitle><stitle>Eur J Nucl Med Mol Imaging</stitle><addtitle>Eur J Nucl Med Mol Imaging</addtitle><date>2021-11-01</date><risdate>2021</risdate><volume>48</volume><issue>12</issue><spage>4077</spage><epage>4088</epage><pages>4077-4088</pages><issn>1619-7070</issn><eissn>1619-7089</eissn><abstract>Purpose
Hematotoxicity is a potentially dose-limiting adverse event in patients with metastasized castration-resistant prostate cancer (mCRPC) undergoing prostate-specific membrane antigen (PSMA)-directed radioligand therapy (RLT). We aimed to identify clinical or PSMA-targeted imaging-derived parameters to predict hematological adverse events at early and late stages in the treatment course.
Methods
In 67 patients with mCRPC scheduled for
177
Lu-PSMA-617 RLT, pretherapeutic osseous tumor volume (TV) from
68
Ga-PSMA-11 PET/CT and laboratory values were assessed. We then tested the predictive capability of these parameters for early and late hematotoxicity (according to CTCAE vers. 5.0) after one cycle of RLT and in a subgroup of 32/67 (47.8%) patients after four cycles of RLT.
Results
After one cycle, 10/67 (14.9%) patients developed leukocytopenia (lymphocytopenia, 39/67 [58.2%]; thrombocytopenia, 17/67 [25.4%]). A cut-off of 5.6 × 10
3
/mm
3
for baseline leukocytes was defined by receiver operating characteristics (ROC) and separated between patients with and without leukocytopenia (
P
< 0.001). Baseline leukocyte count emerged as a stronger predictive factor in multivariate analysis (hazard ratio [HR], 33.94,
P
= 0.001) relative to osseous TV (HR, 14.24,
P
= 0.01). After four cycles, 4/32 (12.5%) developed leukocytopenia and the pretherapeutic leukocyte cut-off (HR, 9.97,
P
= 0.082) tended to predict leukocytopenia better than TV (HR, 8.37,
P
= 0.109). In addition, a cut-off of 1.33 × 10
3
/mm
3
for baseline lymphocytes separated between patients with and without lymphocytopenia (
P
< 0.001), which was corroborated in multivariate analysis (HR, 21.39,
P
< 0.001 vs. TV, HR, 4.57,
P
= 0.03). After four cycles, 19/32 (59.4%) developed lymphocytopenia and the pretherapeutic cut-off for lymphocytes (HR, 46.76,
P
= 0.007) also demonstrated superior predictive performance for late lymphocytopenia (TV, HR, 5.15,
P
= 0.167). Moreover, a cut-off of 206 × 10
3
/mm
3
for baseline platelets separated between patients with and without thrombocytopenia (
P
< 0.001) and also demonstrated superior predictive capability in multivariate analysis (HR, 115.02,
P
< 0.001 vs.TV, HR, 12.75,
P
= 0.025). After four cycles, 9/32 (28.1%) developed thrombocytopenia and the pretherapeutic cut-off for platelets (HR, 5.44,
P
= 0.048) was also superior for the occurrence of late thrombocytopenia (TV, HR, 1.44,
P
= 0.7).
Conclusions
Pretherapeutic leukocyte, lymphocyte, and platelet levels themselves are strong predictors for early and late hematotoxicity under PSMA-directed RLT, and are better suited than PET-based osseous TV for this purpose.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>34041564</pmid><doi>10.1007/s00259-021-05412-1</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-8786-4105</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1619-7070 |
| ispartof | European journal of nuclear medicine and molecular imaging, 2021-11, Vol.48 (12), p.4077-4088 |
| issn | 1619-7070 1619-7089 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8484194 |
| source | Springer Nature |
| subjects | Adverse events Antigens Cardiology Castration Computed tomography Dipeptides Hematology Heterocyclic Compounds, 1-Ring Humans Imaging Leukocytes Leukopenia Lymphocytes Lymphopenia Male Medicine Medicine & Public Health Multivariate analysis Nuclear Medicine Oncology Oncology – Genitourinary Original Original Article Orthopedics Parameter identification Patients Performance prediction Platelets Positron Emission Tomography Computed Tomography Prostate Prostate cancer Prostatic Neoplasms, Castration-Resistant - radiotherapy Radiology Retrospective Studies Subgroups Thrombocytopenia Treatment Outcome Tumor Burden Tumors |
| title | Comparison of pretherapeutic osseous tumor volume and standard hematology for prediction of hematotoxicity after PSMA-targeted radioligand therapy |
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