Wayne Kasecamp
Johns Hopkins University
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The Journal of Nuclear Medicine | 2007
Heather A. Jacene; Ross Filice; Wayne Kasecamp; Richard L. Wahl
We retrospectively evaluated our single-center clinical experience with 90Y-ibritumomab tiuxetan and 131I-tositumomab for therapy of refractory non-Hodgkins lymphoma (NHL). We evaluated the hypothesis that the patient-specific dosing regimen used with 131I-tositumomab results in less bone marrow toxicity than does the weight-based dosing regimen used with 90Y-ibritumomab tiuxetan. Methods: Thirty-eight patients (25 male and 13 female; median age, 64 y) received radioimmunotherapy for NHL (20 received 90Y-ibritumomab tiuxetan; 18 received 131I-tositumomab). Patient and disease characteristics were evaluated to determine whether any were prognostic indicators of short- or long-term clinical response. The 12-wk response rate and clinical and hematologic toxicities attributable to each therapy were assessed. The response rate at 12 wk was correlated with long-term overall survival. Results: Twenty-six patients received full-radiation-dose radioimmunotherapy and 12 received attenuated doses because of hematologic concerns. The 12-wk overall response rate for all patients was 47%, and the complete response rate was 13%. The 12-wk overall response rate did not significantly differ between the 90Y-ibritumomab tiuxetan and 131I-tositumomab groups. Responses at 12 wk were more frequent in patients with normal levels of serum lactate dehydrogenase, no bone marrow involvement, and International Prognostic Index scores of no more than 2 (P ≤ 0.04). Grade 3 or 4 thrombocytopenia occurred in 57% and 56% of patients treated with 90Y-ibritumomab tiuxetan and 131I-tositumomab, respectively. Grade 3 or 4 neutropenia was observed in 57% and 50%, respectively. The time to the absolute neutrophil count nadir was shorter for the 90Y-ibritumomab tiuxetan group than for the 131I-tositumomab group (36 ± 9 vs. 46 ± 14 d, P = 0.01). The mean percentage decline in platelet count after radioimmunotherapy was greater in the 90Y-ibritumomab tiuxetan group than in the 131I-tositumomab group (79% ± 17% vs. 63% ± 28%, P = 0.04). Overall survival was longer in responders than in nonresponders 12 wk after therapy (P ≤ 0.05). Conclusion: Both 90Y-ibritumomab tiuxetan and 131I-tositumomab were well tolerated. We observed response rates at the lower range of those reported in the literature, possibly because of referral bias, dose attenuation, and reasonably liberal acceptance criteria for a patient to receive therapy. Initial response assessments 12 wk after radioimmunotherapy predict longer-term response. 131I-tositumomab caused significantly less severe declines in platelet counts than did 90Y-ibritumomab tiuxetan and may be a more appropriate choice for patients with limited bone marrow reserve, but large, randomized, prospective trials are needed to better compare the performance of these 2 treatments.
The Journal of Nuclear Medicine | 2008
Heather A. Jacene; Ross Filice; Wayne Kasecamp; Richard L. Wahl
We retrospectively evaluated 18F-FDG PET/CT for monitoring the response of non-Hodgkins lymphoma to radioimmunotherapy. Methods: A total of 33 clinical patients received 131I-tositumomab (n = 23) or 90Y-ibritumomab tiuxetan (n = 10) and underwent 18F-FDG PET/CT scans before radioimmunotherapy and at 12 wk after radioimmunotherapy. A third scan was performed on 13 patients at 24 wk after radioimmunotherapy, 12 of whom did not receive interval therapy. Tumor metabolic activity was assessed before and after radioimmunotherapy visually and quantitatively by lean maximum standardized uptake value (SUVlean max). Response was assessed by the International Workshop Criteria (IWC) and Revised IWC, which includes 18F-FDG PET (IWC-PET). Results: Mean SUVlean max decreased from baseline in 244 target lesions 12 wk after radioimmunotherapy (from 6.51 ± 4.05 to 3.94 ± 4.41; P < 0.01), regardless of response at 12 wk after radioimmunotherapy (P ≤ 0.02). After radioimmunotherapy, SUVlean max was lower for responders than for nonresponders (P ≤ 0.01). Median percentage change in SUVlean max of target lesions per patient was −51% (−95% to 97%). No significant difference in decline in SUVlean max between patients who received 131I-tositumomab and those who received 90Y-ibritumomab tiuxetan was demonstrated (−31% ± 51% vs. −47% ± 46%; P = 0.38). Patients with greater than a 52% decline in SUVlean max tended toward longer survival (P = 0.09) than those with lesser declines. The 12-wk overall response rate to radioimmunotherapy based on IWC was 42% (14/33); complete response rate was 15% (5/33). Eleven of 12 patients with progression at 12 wk had new disease sites, and in 4 patients, new disease sites were the only sites of progression. Of 108 lesions evaluated at 12 and 24 wk after radioimmunotherapy, 49 resolved at 12 wk and remained resolved at 24 wk, 17 gradually declined in SUV over 24 wk, and 37 initially decreased at 12 wk but increased at 24 wk. PET showed disease progression at 24 wk in 10 of 13 patients; 7 patients had new lesions and 1 was reclassified from partial response to complete response. Conclusion: In non-Hodgkins lymphoma, 18F-FDG uptake in tumors typically drops significantly after radioimmunotherapy. A continued decline in tumor SUVlean max between 12 and 24 wk without additional therapy can occur, suggesting a need for delayed-response assessment. In patients who progress after radioimmunotherapy, new sites of disease commonly develop, rather than recurrence or progression at previous disease sites. Large declines in 18F-FDG uptake tend to be seen in those with the longest progression-free survival.
Medical Physics | 2009
Bin He; Richard Wahl; George Sgouros; Yong Du; Heather A. Jacene; Wayne Kasecamp; Ian W. Flinn; Richard J. Hammes; Jay Bianco; Brad S. Kahl; Eric C. Frey
The estimation of organ residence time is essential for high-dose myeloablative regimens in radioimmunotherapy (RIT). Frequently, this estimation is based on a series of simple planar scans and planar processing. The authors previously performed a simulation study which demonstrated that the accuracy of this methodology is limited compared to a hybrid planar/SPECT residence time estimation method. In this work the authors applied this hybrid method to data from a clinical trial of high-dose myeloablative yttrium-90 ibritumomab tiuxetan therapy. Image data acquired from 18 patients were comprised of planar scans at five time points ranging from 1 to 144 h postinjection and abdominal and thoracic SPECT/CT scans obtained at 24 h postinjection. The simple planar processing method used in this work was based on the geometric mean method with energy window based scatter compensation. No explicit background subtraction nor object or source thickness corrections were performed. The SPECT projections were reconstructed using iterative reconstruction with compensations for attenuation, scatter, and full collimator-detector response. Large differences were observed when residence times were estimated using the simple planar method compared to the hybrid method. The differences were not constant but varied in magnitude and sign. For the dose-limiting organ (liver), the average difference was -18% and variation in the difference was 19%, similar to the differences observed in a previously reported simulation study. The authors also looked at the relationship between the weight of the patient and the liver residence time and found that there was no meaningful correlation for either method. This indicates that weight would not be an adequate proxy for an experimental estimate of residence time when choosing the activity to administer for therapy. The authors conclude that methods such as the simple planar method used here are inadequate for RIT treatment planning. More sophisticated methods, such as the hybrid SPECT/planar method investigated here, are likely to be better predictors of organ dose and, as a result, organ toxicities.
European Journal of Nuclear Medicine and Molecular Imaging | 1990
Petra J. Jeffery; Samuel Sostre; L R. Scherer; Wayne Kasecamp; Edwaldo E. Camargo
We report a case of massive cerebrospinal fluid (CSF) leakage where the tracer injected intra-thecally for radionuclide cisternography was later visualized in the bowel as well as the nasopharynx. We discuss the potential implications of this finding in patients with CSF leaks. A brief review of the diagnosis of CSF leaks is included.
American Journal of Cardiology | 1985
Dean F. Wong; T. K. Natarajan; Warren R. Summer; Paul Tibbits; Thomas J. Beck; Daniel W. Koller; Wayne Kasecamp; James Lamb; Joseph Olynyk; Mary Sue Philp; Marshall Bryan; Henry N. Wagner
Study of the effects of various diseases and therapeutic manipulation of pulmonary vascular resistance on the right ventricle has been restricted by methodologic limitations. The radioactive gas in solution, krypton-81m was used to study the right ventricle and the technique was compared with a technetium-99m method. In 22 subjects, first-pass krypton-81m right ventricular ejection fraction, acquired both in list mode and electrocardiogram-gated frame mode, correlated well (r = 0.81 and 0.86, respectively, p less than 0.01) with that determined by technetium-99m first-pass studies over a broad range of ventricular function. The reproducibility of the technique was excellent (r = 0.84 and 0.95 for each acquisition mode, respectively). Krypton-81m first-pass studies provide accurate and reproducible estimates of right ventricular function. Use of krypton allows multiple measurements, with or without perturbations, over a short period of time.
European Journal of Nuclear Medicine and Molecular Imaging | 1982
Kenneth H. Douglass; Paul Tibbits; Wayne Kasecamp; Sun Tak Han; Daniel W. Koller; Jonathan M. Links; Henry N. Wagner
A fully automated program developed by us for measurement of left ventricular ejection fraction from equilibrium gated blood pool studies was evaluated in 130 additional patients. Both 6-min (130 studies) and 2-min (142 studies in 31 patients) gated blood pool studies were acquired and processed. The program successfully generated ejection fractions in 86% of the studies. These automatically generated ejection fractions were compared with ejection fractions derived from manually drawn regions of interest. When studies were acquired for 6-min with the patient at rest, the correlation between automated and manual ejection fractions was 0.92. When studies were acquired for 2-min, both at rest and during bicycle exercise, the correlation was 0.81. In 25 studies from patients who also underwent contrast ventriculography, the program suceessfully generated regions of interest in 22 (88%). The correlation between the ejection fraction determined by contrast ventribulography and the automatically generated radionuclide ejection fraction was 0.79.
The Journal of Nuclear Medicine | 2006
Hong Song; Bin He; Andrew Prideaux; Yong Du; Eric C. Frey; Wayne Kasecamp; Paul W. Ladenson; Richard L. Wahl; George Sgouros
The Journal of Nuclear Medicine | 1979
Ace Lipson; Eileen Nickoloff; Tah Hsiung Hsu; Wayne Kasecamp; Helen Drew; Ramleth Shakir; Henry N. Wagner
The Journal of Nuclear Medicine | 1978
Shirley Yang; Eileen Nickoloff; Patricia A. McIntyre; Willis C. Maddrey; Helen H. Mikesell; Ursula Scheffel; Wayne Kasecamp; Niall P. MacAllister
Archive | 2007
Heather A. Jacene; Ross Filice; Wayne Kasecamp; Richard Wahl; Russell H. Morgan