Journal of Clinical Oncology, Vol 16, 173-180, Copyright © 1998 by American Society of Clinical Oncology
Preclinical and clinical studies of bone marrow uptake of fluorine-1- fluorodeoxyglucose with or without granulocyte colony-stimulating factor during chemotherapy
Y Sugawara, SJ Fisher, KR Zasadny, PV Kison, LH Baker and RL Wahl
Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109-0028, USA.
PURPOSE: To evaluate the effect of granulocyte colony-stimulating factor
(G-CSF) and granulocyte-macrophage colony-stimulating factor (GM- CSF) on
bone marrow glucose metabolism in rodents and in patients, as assessed by
2-[fluorine-18]-fluoro-2-deoxy-D-glucose (FDG) uptake measured directly or
by positron-emission tomography (PET) scanning. MATERIALS AND METHODS:
Groups of three rats received either daily saline, G-CSF, or GM-CSF
injections for 7 days. After treatment, FDG was injected and F-18
activities in tissues measured 1 hour later. Twenty-two breast cancer
patients treated with multiagent chemotherapy were sequentially studied
with PET. Eleven patients received G-CSF therapy as an adjunct to
chemotherapy, while 11 received chemotherapy only. The standardized uptake
value-lean (SUL) of bone marrow FDG uptake was measured and compared.
RESULTS: In rats, bone marrow F-18 activity was significantly higher in
both CSF groups than in the saline group (G-CSF, 0.44 +/- 0.08; GM-CSF,
0.33 +/- 0.02; saline, 0.18 +/- 0.02% injected dose [ID]/g x kg; P <
.05), but the other normal tissues had comparable biodistributions to
controls. In breast cancer patients, the FDG uptake of bone marrow did not
change with chemotherapy alone; however, marrow uptake was increased after
treatment with G-CSF. The dose of G-CSF and duration of treatment were
correlated with the extent of increase in FDG uptake. The SUL of bone
marrow was as follows: baseline, 1.56 +/- 0.23; after one cycle, 3.13 +/-
1.40 (P < .01); after two cycles, 2.22 +/- 0.85 (P < .05); and after
three cycles, 2.14 +/- 0.79 (P < .05), respectively. Although the FDG
uptake of bone marrow declined after G-CSF treatment was completed, it was
higher than the baseline level for up to 4 weeks postcompletion of G-CSF
and the elevated marrow FDG uptake was sustained longer than the period of
blood neutrophil count elevation. CONCLUSION: Substantial increases in bone
marrow FDG uptake are rapidly induced by CSF treatments and should not be
misinterpreted as diffuse bone marrow metastases.
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