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AML patients: New way to gauge treatment response
Potential exists to adjust treatment strategy early
Preliminary findings suggest that positron emission tomography/CT (PET/CT), using the radiotracer fluoro-L-thymidine (FLT), might be able to quickly show whether chemotherapy is working in patients with acute myelogenous leukemia (AML). This is according to investigators from the University of Wisconsin (UW) in Madison, who presented their research at the recent annual meeting of the American Association of Physicists in Medicine (AAPM).
The research team was lead by Robert Jeraj, PhD, an assistant professor in the departments of medical physics, human oncology, and biomedical engineering at UW, and Mark Juckett, MD, an attending physician in UW's bone marrow transplant program and director of UW's stem cell processing laboratory.
They looked at the value of using FLT-PET/CT in six patients with AML, and they found that could determine treatment response as early as one day after the beginning of chemotherapy treatment. The approach could have profound implications, according to researchers, given that AML patients typically go through an entire week of chemotherapy before learning whether their treatment was effective.
Currently, treatment response typically is determined through use of a bone marrow biopsy within 10-15 days of the initiation of treatment, according to Jeraj. Another bone marrow biopsy around day 30 then is used to determine whether the patient is in remission. However, the long wait for such information is clearly not ideal, and researchers point out that bone marrow biopsy is a relatively weak predictor of treatment response.
Since FLT is a marker for cellular proliferation, however, researchers report that they were able to determine that chemotherapy was working when the bone marrow appeared dark on the PET scan, indicating that treatment was resulting in successful bone marrow ablation. Alternatively, in patients who were not responding to treatment, the FLT would result in brightness and non-conformity on the PET scans, indicating that there was some bone marrow activity present.
While the study was small, clinicians are excited about the potential for a new approach that could enable them to alter treatment that is not working at a very early stage. "The response has been extremely enthusiastic and encouraging, which is not surprising given the powerful results and strong potential benefits," says Jeraj. Researchers are planning to test the approach in a large, multi-center clinical trial, although the details have not yet been worked out.