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[18F]-Fludarabine for Hematological Malignancies.

Louisa Barré1, Narinée Hovhannisyan1, Caroline Bodet-Milin2

  • 1LDM-TEP Group, UMR6030 Imagerie et Stratégies Thérapeutiques des Pathologies Cérébrales et Tumorales, Caen, France.

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Summary

A new PET imaging probe, 18F-fludarabine, shows higher specificity for lymphoma detection than 18F-FDG. This novel tracer offers improved accuracy in diagnosing and monitoring hematological malignancies, reducing false positives from inflammation.

Keywords:
18F-fludarabinePET—positron emission tomographydiagnosisimaginglymphoma

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Area of Science:

  • Nuclear Medicine
  • Oncology
  • Radiochemistry

Background:

  • 18F-FDG PET/CT is standard for lymphoma management but suffers from false positives due to uptake in benign conditions.
  • Limitations in 18F-FDG specificity necessitate development of more accurate molecular imaging probes for hematological malignancies.

Purpose of the Study:

  • To evaluate 18F-fludarabine as a novel PET imaging probe for hematological malignancies.
  • To compare the diagnostic performance of 18F-fludarabine with 18F-FDG in preclinical and clinical settings.

Main Methods:

  • Developed an automated radiosynthesis for 18F-fludarabine.
  • Conducted preclinical studies in murine models of lymphoma and multiple myeloma, comparing with 18F-FDG.
  • Performed a first-in-human study with 10 patients across different lymphoma subtypes (DLBCL, CLL).

Main Results:

  • 18F-fludarabine demonstrated tumor-specific targeting with weaker uptake in inflammatory processes.
  • Quantitative analysis showed a stronger correlation between 18F-fludarabine uptake and histology than 18F-FDG.
  • Clinical studies indicated high specificity for lymphoma tissues, with discrepancies from 18F-FDG in some cases and a lower effective dose.

Conclusions:

  • 18F-fludarabine exhibits superior specificity for lymphoma detection compared to 18F-FDG.
  • This novel tracer shows potential to improve quantitative assessment of hematological malignancies, minimizing false-positive results.
  • 18F-fludarabine represents an innovative approach for molecular imaging in oncology.