title: Myeloid neoplasms after chemotherapy and PRRT: myth and reality.
abstract: Peptide receptor radionuclide therapy (PRRT) with (90)Y-octreotide or (177)Lu-octreotate is an effective treatment for inoperable or metastatic neuroendocrine tumors (NETs), particularly well-differentiated gastroenteropancreatic or bronchopulmonary NETs. PRRT is generally extremely well tolerated, with modest toxicity to target organs, kidney and bone marrow. Nevertheless, a priori concerns regarding long-term effects lead clinicians such as Brieau and coworkers, in this ERC issue, to ascribe to the combination of alkylating agents and PRRT the apparently high occurrence (n=4) of myeloproliferative events (therapy-related myeloid neoplasms (t-MNs)) in a small cohort of 20 progressive, advanced digestive NETs treated with PRRT after chemotherapy. Anecdotal reports of myelotoxic events should be placed in the correct perspective of larger series, where the reported incidence of these events is ~2%, with the aim of promoting a balanced awareness of the issue and unbiased and reasonable overall conclusions. For a comprehensive definition of the issue, we provide an evaluation of the occurrence of t-MN in patients treated with various myelotoxic treatments.
authors.affiliation: Department of RadiologyMemorial Sloan Kettering Cancer Center, New York, New York, USA LuGenIum Consortium for Independent ResearchMilan, Rotterdam, Bad Berka, London bodeil@mskcc.org.
authors.forename: Lisa
authors.initials: L
authors.lastname: Bodei
authors.affiliation: LuGenIum Consortium for Independent ResearchMilan, Rotterdam, Bad Berka, London Emeritus Professor Gastroenterological SurgeryYale University, School of Medicine, New Haven, Connecticut, USA.
authors.forename: Irvin M
authors.initials: IM
authors.lastname: Modlin
authors.affiliation: Department of Nuclear MedicineUniversity Hospital Marburg, Marburg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Luster
authors.affiliation: Nuclear MedicineCantonal Hospital, St. Gallen, Switzerland.
authors.forename: Flavio
authors.initials: F
authors.lastname: Forrer
authors.affiliation: Division of Health PhysicsEuropean Institute of Oncology, Milan, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Cremonesi
authors.affiliation: Centre for Cancer ImagingThe Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, Australia.
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Hicks
authors.affiliation: Department of Nuclear MedicineSaarland University Hospital, Homburg, Saarland, Germany.
authors.forename: Samer
authors.initials: S
authors.lastname: Ezziddin
authors.affiliation: Wren LaboratoriesBranford, Connecticut, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Kidd
authors.affiliation: Humanitas UniversityMilan, Italy.
authors.forename: Arturo
authors.initials: A
authors.lastname: Chiti
mesh_terms: D019337:Hematologic Neoplasms / Q000209:etiology*; D006801:Humans; D008187:Lutetium / Q000009:adverse effects* / Q000627:therapeutic use; D018358:Neuroendocrine Tumors / Q000378:metabolism / Q000532:radiotherapy*; D015282:Octreotide / Q000009:adverse effects* / Q000627:therapeutic use; D019275:Radiopharmaceuticals / Q000009:adverse effects* / Q000627:therapeutic use; D018000:Receptors, Peptide / Q000378:metabolism; D015021:Yttrium Radioisotopes / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D019275:Radiopharmaceuticals; D018000:Receptors, Peptide; D015021:Yttrium Radioisotopes; D008187:Lutetium; D015282:Octreotide
keywords: PRRT; alkylating chemotherapy; myeloid neoplasms; neuroendocrine tumors