Theranostics 2017; 7(1):205-212. doi:10.7150/thno.16576

Research Paper

[68Ga]Pentixafor-PET/CT for imaging of chemokine receptor CXCR4 expression in multiple myeloma - Comparison to [18F]FDG and laboratory values

Constantin Lapa1*✉, Martin Schreder2*, Andreas Schirbel1, Samuel Samnick1, Klaus Martin Kortüm2, Ken Herrmann1,3, Saskia Kropf4, Herrmann Einsele2, Andreas K. Buck1, Hans-Jürgen Wester5, Stefan Knop2, Katharina Lückerath1

1. Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany.
2. Department of Internal Medicine, University Hospital Würzburg, Würzburg, Germany.
3. Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, USA.
4. Scintomics GmbH, Fürstenfeldbruck, Germany.
5. Pharmaceutical Radiochemistry, Technische Universität München, Munich, Germany.
* equal contribution

This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY-NC) License. See for full terms and conditions.
Lapa C, Schreder M, Schirbel A, Samnick S, Kortüm KM, Herrmann K, Kropf S, Einsele H, Buck AK, Wester HJ, Knop S, Lückerath K. [68Ga]Pentixafor-PET/CT for imaging of chemokine receptor CXCR4 expression in multiple myeloma - Comparison to [18F]FDG and laboratory values. Theranostics 2017; 7(1):205-212. doi:10.7150/thno.16576. Available from

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Chemokine (C-X-C motif) receptor 4 (CXCR4) is a key factor for tumor growth and metastasis in several types of human cancer including multiple myeloma (MM). Proof-of-concept of CXCR4-directed radionuclide therapy in MM has recently been reported. This study assessed the diagnostic performance of the CXCR4-directed radiotracer [68Ga]Pentixafor in MM and a potential role for stratifying patients to CXCR4-directed therapies.

Thirty-five patients with MM underwent [68Ga]Pentixafor-PET/CT for evaluation of eligibility for endoradiotherapy. In 19/35 cases, [18F]FDG-PET/CT for correlation was available. Scans were compared on a patient and on a lesion basis. Tracer uptake was correlated with standard clinical parameters of disease activity.

[68Ga]Pentixafor-PET detected CXCR4-positive disease in 23/35 subjects (66%). CXCR4-positivity at PET was independent from myeloma subtypes, cytogenetics or any serological parameters and turned out as a negative prognostic factor. In the 19 patients in whom a comparison to [18F]FDG was available, [68Ga]Pentixafor-PET detected more lesions in 4/19 (21%) subjects, [18F]FDG proved superior in 7/19 (37%). In the remaining 8/19 (42%) patients, both tracers detected an equal number of lesions. [18F]FDG-PET positivity correlated with [68Ga]Pentixafor-PET positivity (p=0.018).

[68Ga]Pentixafor-PET provides further evidence that CXCR4 expression frequently occurs in advanced multiple myeloma, representing a negative prognostic factor and a potential target for myeloma specific treatment. However, selecting patients for CXCR4 directed therapies and prognostic stratification seem to be more relevant clinical applications for this novel imaging modality, rather than diagnostic imaging of myeloma.

Keywords: multiple myeloma, FDG, molecular imaging, CXCR4, PET, radionuclide therapy, theranostics.