title: Imaging for improved prediction of myelotoxicity after radioimmunotherapy.
abstract: BACKGROUND
  The severity of myelotoxicity after radioimmunotherapy has been predicted from body and blood radiation doses to marrow. However, marrow radiation can be increased substantially if the marrow or skeleton contains the malignancy targeted by the radiolabeled monoclonal antibodies. A study of 29 patients treated with iodine-131 (131I)-Lym-1 showed that radiation doses to marrow from body and blood had little correlation with myelotoxicity. The purpose of the present study was to assess the significance of marrow targeting and other factors for prediction of myelotoxicity.
  
  
  METHODS
  Injected radioactivity and nontargeted radiation doses to marrow were compared with peripheral blood cell counts after the first therapy dose of 131I-Lym-1 in 16 heavily pretreated patients with non-Hodgkin's lymphoma (NHL). Bone marrow biopsy, targeted marrow radiation doses, marrow image uptake scores, age, Karnofsky performance score (KPS), previous chemotherapy, and tumor burden were also compared with blood counts.
  
  
  RESULTS
  Myelotoxicity was not predicted well by injected radioactivity, total body radiation, or body and blood radiation doses contributed to marrow (P > 0.1). Biopsy-proven bone marrow lymphoma also failed to predict myelotoxicity (P > 0.1). Thrombocytopenia and leukopenia were predicted well by targeted radiation dose to marrow (P < 0.05) obtained by 131I imaging. Similarly, marrow image scores predicted decreases in platelets and white blood cells (WBCs; P < 0.05). Prediction of myelotoxicity using marrow radiation dose methods was slightly improved when serum lactic dehydrogenase (LDH), age, KPS, and prior chemotherapy were included in the analysis (P < or = 0.01).
  
  
  CONCLUSIONS
  Prediction of myelotoxicity was improved in this group of patients by assessment of the targeting component of marrow radiation and was better predicted and obtained more easily by semiquantitative marrow image scores. Further improvement in prediction was slight when other factors were considered.
authors.affiliation: University of California Davis Medical Center, Sacramento, Martinez, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: DeNardo
authors.forename: G L
authors.initials: GL
authors.lastname: DeNardo
authors.forename: R T
authors.initials: RT
authors.lastname: O'Donnell
authors.forename: S M
authors.initials: SM
authors.lastname: Lim
authors.forename: S
authors.initials: S
authors.lastname: Shen
authors.forename: A
authors.initials: A
authors.lastname: Yuan
authors.forename: S J
authors.initials: SJ
authors.lastname: DeNardo
mesh_terms: D001853:Bone Marrow / Q000528:radiation effects*; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000378:metabolism; D008228:Lymphoma, Non-Hodgkin / Q000532:radiotherapy*; D016499:Radioimmunotherapy / Q000009:adverse effects*; D011879:Radiotherapy Dosage
chemical_list: D007770:L-Lactate Dehydrogenase