Three Methods Assessing Red Marrow Dosimetry in Lymphoma Patients Treated With Radioimmunotherapy

BACKGROUND: Maximum injected activity in radioimmunotherapy (RIT) is limited by bone marrow toxicity. Many dosimetric approaches have been proposed, leading to high variability in the results and elusive absorbed dose-effect relations. This study presents the results of red marrow (RM) absorbed dose estimates performed with 3 methods. METHODS: Five patients received 2 co-infusions of Y-90-labeled (370 MBq/m2) and In-111- labeled (120 MBq) epratuzumab (1.5 mg/kg) 1 week apart. RM-absorbed dose was estimated by 3 methodologies. The first approach (M1) used L-2-L-4 lumbar vertebrae imaging. M2 and M3 methods used different red marrow to blood ratios (RMBLR) to assess RM-absorbed dose. RMBLR was set to a fixed value of 0.36 in M2 or assessed according to each patient's hematocrit in M3. RESULTS: Median RM-absorbed doses were 4.1 (2.9-8.4), 2.3 (2.0-2.7), and 2.3 (1.6-2.5) mGy/MBq for M1, M2, and M3, respectively. No trend could be found between total RM-absorbed dose and toxicity for M2 and M3. Conversely, M1 seemed to provide the best absorbed dose-effect relation. The 4 patients with the highest RM-absorbed doses exhibited grade 4 toxicity. The fifth patient, with the lowest RB absorbed dose, exhibited only a mild (grade 2) toxicity. CONCLUSIONS: Image-based methodology (M1) seems to better predict hematological toxicity as compared with blood-based methods. Only this method provides for bone marrow involvement. Cancer 2010;116(4 suppl):1093-100. (C) 2010 American Cancer Society.