CXCR4-Targeted PET Imaging in Hematologic Malignancies
Mohammadreza Chavoshi, Seyed Ali Mirshahvalad, Andrés Kohan, Claudia Ortega, Ur Metser, Adam Farag, Robert Kridel, David Hodgson, Sita Bhella, Vishal Kukreti, Patrick Veit‐Haibach
Abstract
PURPOSE: The aims of this study were to perform a comprehensive review and meta-analyses and to report pooled diagnostic results on CXCR4-targeted PET, particularly considering detection, visualization, and prognostication. PATIENTS AND METHODS: This study followed PRISMA-DTA. A systematic search was conducted on major medical literature databases up to March 1, 2024. The search strategy was designed to include CXCR4 PET studies in hematologic malignancies. A random-effects model combined sensitivity values derived from 2-by-2 contingency tables. Pooled means for SUV max were computed. Analyses were performed by R software. RESULTS: The initial search resulted in a total of 1428 studies. Ultimately, 18 were eligible for systematic review and meta-analytic calculations. Twelve studies (320 patients) included B-cell lymphoma. The pooled detection rate of CXCR4 PET was 99.4% (95% confidence interval [CI]: 88.3%-100%). Marginal zone lymphoma was investigated in 5 studies (209 patients), with a pooled sensitivity of 97.6% (95% CI: 79.7%-99.8%). In studies on central nervous system lymphoma, CXCR4 PET demonstrated 100% accuracy at both patient and lesion levels. Also, it demonstrated a significantly higher tumor-to-background ratio than 18 F-FDG PET. For multiple myeloma, 5 studies (116 patients) showed a patient-level pooled sensitivity of 77.8% (95% CI: 64.4%-87.2%), whereas 18 F-FDG PET had 65.0% (95% CI: 55.2%-73.7%). The pooled SUV max for CXCR4 PET was 13.6 (95% CI: 9.3-17.8) versus 9.0 (95% CI: 6.3-11.7) for 18 F-FDG PET. Additionally, CXCR4 PET-derived parameters were significant predictors of survival in multiple myeloma. CONCLUSIONS: CXCR4 PET can be a helpful imaging tool for evaluating hematologic malignancies, particularly in B-cell lymphoma and multiple myeloma patients. In specific clinical scenarios, it appears to be superior compared with the current standard-of-care imaging.