ПЭТ/КТ с 18F-фтордезоксиглюкозой и 11C-метионином у больных множественной миеломой после трансплантации аутологичных стволовых клеток
ПЭТ/КТ с 18F-фтордезоксиглюкозой и 11C-метионином у больных множественной миеломой после трансплантации аутологичных стволовых клеток
Соловьев М.В., Менделеева Л.П., Фирсова М.В. и др. ПЭТ/КТ с 18F-фтордезоксиглюкозой и 11C-метионином у больных множественной миеломой после трансплантации аутологичных стволовых клеток. Терапевтический архив. 2019; 91 (7): 75–82. DOI: 10.26442/00403660.2019.07.000328
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Solovev M.V., Mendeleeva L.P., Firsova M.V., et al. PET/CT with 18F-fluorodeoxyglucose and 11C-methionine after autologous stem cell transplantation in multiple myeloma patients. Therapeutic Archive. 2019; 91 (7): 75–82. DOI: 10.26442/00403660.2019.07.000328
ПЭТ/КТ с 18F-фтордезоксиглюкозой и 11C-метионином у больных множественной миеломой после трансплантации аутологичных стволовых клеток
Соловьев М.В., Менделеева Л.П., Фирсова М.В. и др. ПЭТ/КТ с 18F-фтордезоксиглюкозой и 11C-метионином у больных множественной миеломой после трансплантации аутологичных стволовых клеток. Терапевтический архив. 2019; 91 (7): 75–82. DOI: 10.26442/00403660.2019.07.000328
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Solovev M.V., Mendeleeva L.P., Firsova M.V., et al. PET/CT with 18F-fluorodeoxyglucose and 11C-methionine after autologous stem cell transplantation in multiple myeloma patients. Therapeutic Archive. 2019; 91 (7): 75–82. DOI: 10.26442/00403660.2019.07.000328
Цель исследования: сопоставить результаты визуализации опухолевого поражения методом позитронно-эмиссионной томографии, совмещенной с компьютерной томографией (ПЭТ/КТ) с 18F-фтордезоксиглюкозой (18F-ФДГ) и 11C-метионином у больных множественной миеломой (ММ) после трансплантации аутологичных гемопоэтических стволовых клеток (ауто-ТГСК). Материалы и методы. В проспективное исследование включено 27 больных ММ, которым на 100-й день после ауто-ТГСК выполнялась ПЭТ/КТ с 18F-ФДГ и 11C-метионином. Полученные изображения оценивали визуально и полуколичественно. Выявляли очаги повышенного накопления каждого из препаратов (очаги гиперметаболизма), не связанные с его физиологическим распределением. В патологическом очаге по каждому из препаратов в автоматическом режиме рассчитывалось максимальное стандартизированное значение накопления радиофармпрепаратов (SUVmax). Проводили сопоставление результатов ПЭТ/КТ и противоопухолевого ответа, достигнутого после ауто-ТГСК согласно критериям международной рабочей группы по изучению ММ. Результаты. После выполнения ауто-ТГСК у большинства больных (16/60%) достигнута полная ремиссия (ПР) заболевания. При использовании 18F-ФДГ патологическое накопление отмечено в 37% (n=10) случаев, ПЭТ-негативные результаты получены у 63% (n=17) больных. Очаги гиперметаболизма после применения 11C-метионина выявлены в 67% (n=18) случаев, отсутствие накопления определено у 33% (n=9) больных. При исследовании с 11C-метионином у больных ММ в 1,8 раза чаще определялись очаги патологического накопления радиофармпрепарата (p<0,02). При использовании 18F-ФДГ среднее значение SUVmax составило 1,02, в то время как среднее значение SUVmax для 11C-метионина – 2,29. При использовании 11C-метионина получены значения SUVmax, достоверно превышающие аналогичный показатель после применения 18F-ФДГ (р=0,02). Заключение. Использование 11C-метионина при ПЭТ/КТ позволяет преодолеть ограниченные возможности 18F-ФДГ и увеличить частоту обнаружения опухолевого поражения костного мозга у больных ММ после ауто-ТГСК.
Ключевые слова: множественная миелома, позитронно-эмиссионная томография, совмещенная с компьютерной томографией, трансплантация аутологичных стволовых клеток крови.
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Aim: to compare the results of tumor visualization when using 18F-FDG and 11C-methionine PET/CT after auto-HSCT in MM patients. Materials and methods. A prospective study included 27 MM patients subjected to 18F-FDG and 11C-methionine PET/CT on day 100 after auto-HSCT. Obtained images were visually and semi-quantitatively analyzed. Focal areas of increased uptake for every radiopharmaceutical agent (hypermetabolic foci) not associated with its physiological distribution were registered. Maximum Standardized Uptake Values (SUVmax) in pathological foci were automatically calculated for every radiopharmaceutical agent separately. PET/CT findings were compared to antitumor response achieved after auto-HSCT according to International MM Working Group criteria. Results. After auto-HSCT, the majority of patients (16/60%) achieved a complete response. Abnormal 18F-FDG uptake was registered in 37% (n=10) of patients, negative PET findings were obtained in 63% (n=17) of patients. 11C-methionine PET/CT revealed hypermetabolic foci in 67% (n=18) of patients, and there was no 11C-methionine uptake in 33% (n=9). Pathological foci of radiopharmaceutical agent uptake were 1.8 times more frequently revealed using PET/CT with 11C-methionine (p<0.02). The mean SUVmax for 18F-FDG was 1.02, whereas the mean SUVmax for 11C-methionine was 2.29. The SUVmax value for 11C-methionine significantly exceeded that for 18F-FDG (р=0.02). Conclusion. 11C-methionine PET/CT was superior to 18F-FDG overcoming its limitations and increasing the tumor detection rate in bone marrow in MM patients after auto-HSCT.
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1. [Luchinin AS, Semochkin SV, Minaeva NV, Pozdeev NM, Paramonov IV. Epidemiology of Multiple Myeloma According to the Кirov Region Population Registers. Oncohematology. 2017;12(3):50-6 (In Russ.)]. doi: 10.17650/1818-8346-2017-12-3-50-56
2. Поспелова Т.И., Скворцова Н.В., Нечунаева И.Н. Множественная миелома: 7 лет таргетной терапии и ее результаты в Новосибирске. Клиническая онкогематология. 2015;8(3):267-73 [Pospelova TI, Skvortsova NV, Nechunaeva IN. Multiple Myeloma: 7-Year Experience of Applying Targeted Therapy in Novosibirsk and Its Results. Klin Onkogematol. 2015;8(3): 267-73 (In Russ.)]. http://bloodjournal.ru/wp-content/uploads/2015/11/4-Stra nitsy-iz-ONCO_3_20151-4.pdf
3. Dimopoulos MA, Leleu X, Palumbo A, Moreau P, Delforge M, Cavo M, Ludwig H, Morgan GJ, Davies FE, Sonneveld P, Schey SA, Zweegman S, Hansson M, Weisel K, Mateos MV, Facon T, Miguel JF. Expert panel consensus statement on the optimal use of pomalidomide in relapsed and refractory multiple myeloma. Leukemia. 2014;28(8):1573-85. doi:10.1038/leu.2014.60
4. Dytfeld D, Jasielec J, Griffith KA, Lebovic D, Vesole DH, Jagannath S, Al-Zoubi A, Anderson T, Detweiler-Short K, Stockerl-Goldstein K, Ahmed A, Jobkar T, Durecki DE, McDonnell K, Mietzel M, Couriel D, Kaminski M, Vij R, Jakubowiak AJ. Carfilzomib, lenalidomide, and low-dose dexamethasone in elderly patients with newly diagnosed multiple myeloma. Haematologica. 2014; 99(9):162-4. doi:10.3324/haematol.2014.110395
5. Gay F, Oliva S, Petrucci MT, Montefusco V, Conticello C, Musto P, Catalano L, Evangelista A, Spada S, Campbell P, Ria R, Salvini M, Offidani M, Carella AM, Omedé P, Liberati AM, Troia R, Cafro AM, Malfitano A, Falcone AP, Caravita T, Patriarca F, Nagler A, Spencer A, Hajek R, Palumbo A, Boccadoro M.Autologous transplant vs oral chemotherapy and lenalidomide in newly diagnosed young myeloma patients: a pooled analysis. Leukemia. 2017;31(8):1727-34. doi: 10.1038/leu.2016.381
6. Lonial S, Vij R, Harousseau JL, Facon T, Moreau P, Mazumder A, Kaufman JL, Leleu X, Tsao LC, Westland C, Singhal AK, Jagannath S. Elotuzumab in combination with lenalidomide and low-dose dexamethasone in relapsed or refractory multiple myeloma. J Clin Oncol. 2012;30(16):1953-9. doi: 10.1200/JCO.2011.37.2649
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1 ФГБУ «Национальный медицинский исследовательский центр гематологии» Минздрава России, Москва, Россия;
2 ФГБУ «Национальный медицинский исследовательский центр сердечно-сосудистой хирургии им. А.Н. Бакулева» Минздрава России, Москва, Россия