[18F]FDG PET imaging retains its role as the standard modality for detection, staging, and treatment monitoring in patients suffering from lymphoma. However, [18F]FDG uptake is influenced by several metabolic and pathological factors, such as inflammation, which highlights the need for more specific radiotracers. For example, CXCR4-directed imaging with the cyclic pentapeptide [68Ga]Ga-Pentixafor has shown high uptake in several lymphoproliferative diseases and, together with its therapeutic analogues [177Lu]Lu- Pentixather and [90Y]Y-Pentixather, holds great promise for lymphoma theranostics. Another interesting approach is CD20-targeted PET imaging. [89Zr]Zr-rituximab demonstrates a strong correlation with CD20 expression and supports individualized radioimmunotherapy strategies. Targeting the tumor microenvironment with FAP inhibitors enables to visualize activated fibroblasts within the tumor microenvironment, although these tracers have shown limited performance in lymphoma so far. The αvβ3 integrin–targeting tracer [18F]RGD-K5 may provide prognostic information, particularly in Hodgkin lymphoma, by identifying persistent neo-angiogenesis in non-responders and predicting the efficacy of antiangiogenetic therapies. The nucleoside analogue [18F]Fludarabine has shown promising specificity in chronic lymphocytic leukemia and indolent non-Hodgkin lymphoma and might help in distinguishing malignant from reactive, inflammatory tissue, in particular after systemic antineoplastic therapy. Proliferation imaging with the thymidine analogue [18F]FLT offers high tumor-to-background contrast, but low sensitivity for the detection of liver lesions as well as high bone marrow uptake. Altogether, these novel tracers may complement [18F]FDG in the management of lymphoproliferative diseases by exploiting more specific targets and uptake mechanisms.

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Novel Radiopharmaceuticals for Lymphoma

  • Stefan Schmitl,
  • Raffaella Calabretta

摘要

[18F]FDG PET imaging retains its role as the standard modality for detection, staging, and treatment monitoring in patients suffering from lymphoma. However, [18F]FDG uptake is influenced by several metabolic and pathological factors, such as inflammation, which highlights the need for more specific radiotracers. For example, CXCR4-directed imaging with the cyclic pentapeptide [68Ga]Ga-Pentixafor has shown high uptake in several lymphoproliferative diseases and, together with its therapeutic analogues [177Lu]Lu- Pentixather and [90Y]Y-Pentixather, holds great promise for lymphoma theranostics. Another interesting approach is CD20-targeted PET imaging. [89Zr]Zr-rituximab demonstrates a strong correlation with CD20 expression and supports individualized radioimmunotherapy strategies. Targeting the tumor microenvironment with FAP inhibitors enables to visualize activated fibroblasts within the tumor microenvironment, although these tracers have shown limited performance in lymphoma so far. The αvβ3 integrin–targeting tracer [18F]RGD-K5 may provide prognostic information, particularly in Hodgkin lymphoma, by identifying persistent neo-angiogenesis in non-responders and predicting the efficacy of antiangiogenetic therapies. The nucleoside analogue [18F]Fludarabine has shown promising specificity in chronic lymphocytic leukemia and indolent non-Hodgkin lymphoma and might help in distinguishing malignant from reactive, inflammatory tissue, in particular after systemic antineoplastic therapy. Proliferation imaging with the thymidine analogue [18F]FLT offers high tumor-to-background contrast, but low sensitivity for the detection of liver lesions as well as high bone marrow uptake. Altogether, these novel tracers may complement [18F]FDG in the management of lymphoproliferative diseases by exploiting more specific targets and uptake mechanisms.