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CXCR4-targeted Imaging in DLBCL: A Prospective Head-to-head Comparison of 68Ga-Pentixafor and 18F-FDG PET/CT
Address for correspondence: Dr. Dhanapathi Halanaik, Department of Nuclear Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India. E-mail: dhanapathih@gmail.com
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Received: ,
Accepted: ,
This article was originally published by Wolters Kluwer - Medknow and was migrated to Scientific Scholar after the change of Publisher.
Abstract
Background:
While 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) remains the gold standard for staging diffuse large B-cell lymphoma (DLBCL), it is limited by nonspecific uptake and physiological artifacts. This study explores the potential of the novel C-X-C chemokine receptor type 4 (CXCR4)-targeted tracer 68Ga-Pentixafor as a complementary receptor-specific imaging modality.
Methods:
In this prospective single-center study, 27 treatment-naïve patients with histopathologically confirmed DLBCL underwent 68Ga-Pentixafor and 18F-FDG PET/CT within a 2-week interval. Lesion detection, Lugano staging concordance, and maximum standardized uptake value (SUVmax) were assessed and compared using Cohen’s kappa for agreement and paired t-tests for quantitative variables.
Results:
68Ga-Pentixafor PET/CT showed near-perfect agreement with 18F-FDG PET/CT for extranodal lesion detection (κ =0.926, P < 0.001). For nodal lesions, substantial agreement was observed (κ =0.804, P < 0.0001). Lugano staging results were consistent between both modalities in 92.6% of cases (25/27), with only two instances of discordance. Importantly, 68Ga-Pentixafor detected biopsy-confirmed bone marrow involvement in four cases missed by 18F-FDG. Although 18F-FDG showed higher SUVmax values for nodal lesions (15.2 ± 7.6 vs. 8.4 ± 4.2; P < 0.001), there was no significant difference in uptake for extranodal sites. Subgroup analysis indicated a nonsignificant trend toward higher CXCR4 expression in the nongerminal center B-cell (non-GCB) subtype compared to the GCB subtype (P = 0.665). Notably, gastrointestinal artifacts associated with metformin use were absent on 68Ga-Pentixafor scans.
Conclusion:
This first-of-its-kind study in a uniform cohort of newly diagnosed DLBCL patients demonstrates that 68Ga-Pentixafor PET/CT shows high concordance with 18F-FDG PET/CT, with superior detection in the bone marrow and reduced physiological background. Its receptor-specific targeting of CXCR4 facilitates accurate disease assessment and provides a noninvasive approach to evaluate therapeutic targets, supporting its potential role in personalized CXCR4-directed theranostic strategies.
Keywords
18F-fluorodeoxyglucose positron emission tomography/computed tomography
68Ga-Pentixafor
C-X-C chemokine receptor type 4
diffuse large B-cell lymphoma
theranostics
Introduction
Diffuse large B-cell lymphoma (DLBCL) is the most common form of aggressive form of non-Hodgkin lymphoma (NHL), accounting for approximately 30%–40% of all NHL cases worldwide. It affects mature B-cells and exhibits significant biological and molecular diversity.[12] The standard first-line treatment involves immunochemotherapy, typically using the R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). This approach achieves durable remission in 60%–70% of patients. However, up to 40% of patients may experience relapsed or refractory disease, highlighting the need for new diagnostic and therapeutic strategies.[3]
DLBCL is a biologically heterogeneous disease that includes molecular subtypes such as germinal center B-cell-like (GCB) and activated B-cell-like (non-GCB), which show varying treatment responses and prognosis.[45] Currently, 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) remains the clinical standard for staging, restaging, and assessing treatment response in DLBCL based on its ability to detect glycolytic activity in malignant lymphocytes. However, 18F-FDG PET/CT has notable limitations. Its nonspecific uptake in inflammatory or infectious sites, as well as its physiological distribution in the brain, heart, bowel, and urinary tract, can result in false-positive or false-negative findings. Involvement of the bone marrow may be under-recognized due to diffuse uptake patterns lacking specificity. In addition, inter-reader variability in interpreting bone marrow lesions remains a significant concern, with staging discrepancies reported in up to 20% of cases.[678]
Recent advances in understanding DLBCL biology have highlighted the crucial role of the C-X-C chemokine receptor type 4 (CXCR4) in disease pathogenesis and progression. As a G-protein-coupled receptor, CXCR4 mediates tumor homing, invasion, stromal interaction, and resistance to therapy, particularly through the CXCR4/CXCL12 axis. Its over-expression has been linked to advanced stage, extranodal involvement, and poor prognosis, especially in the non-GCB subtype.[91011] Despite this, imaging modalities that assess CXCR4 expression in vivo remain underutilized in clinical practice.
The development of 68Ga-Pentixafor, a CXCR4-targeted PET radiopharmaceutical, offers a promising alternative to metabolic imaging. This cyclic pentapeptide binds with high affinity to the CXCR4 receptor. It enables receptor-specific visualization with high affinity and superior tumor-to-background contrast, particularly in hematopoietic tissues.[1213] Multiple pilot studies in various hematological and solid malignancies, including multiple myeloma and CNS lymphoma, have demonstrated its ability to detect disease sites that may be occult or equivocal on 18F-FDG PET/CT.[141516] In addition, the CXCR4-targeted 68Ga-Pentixafor PET/CT imaging did not require any specific fasting protocols or glycemic control measures.[12] Beyond diagnosis, the theranostic value of the CXCR4 axis is being explored through radiolabeled analogs such as 177Lu-and 90Y-Pentixather, which have shown promising results in early-phase trials for relapsed/refractory hematologic malignancies.[1718]
This prospective study evaluates the effectiveness of 68Ga-Pentixafor PET/CT as a biologically targeted imaging modality in treatment-naïve patients with DLBCL, with the primary objective of assessing its diagnostic performance compared to 18F-FDG PET/CT. As the first study conducted in a homogeneous cohort of newly diagnosed DLBCL patients, it hypothesizes that receptor-targeted imaging with 68Ga-Pentixafor may enhance diagnostic precision, particularly in sites such as the bone marrow, and offer valuable insights into CXCR4-directed theranostic applications.
Methods
This prospective single-center study was approved by the Institutional Ethics Committee (IEC No: JIP/IEC/2020/311). All participants provided written informed consent before enrollment. We enrolled patients referred for baseline PET/CT scans with a diagnosis of DLBCL from January 2021 to December 2022 for both 18F-FDG and 68Ga-Pentixafor PET/CT imaging conducted within a 2-week interval.
Participants were eligible for inclusion if they were 18 years or older, had histopathologically confirmed DLBCL, and had not received prior treatment. Exclusion criteria included pregnancy, uncontrolled diabetes, or any contraindications to undergoing PET/CT imaging.
The 18F-FDG PET/CT scan was performed after at least a 6-h fasting period, ensuring blood glucose levels were less than 180 mg/dL. A tracer dose of 3.7 MBq/kg was administered intravenously, followed by a 60-min uptake period. Images were acquired using a GE Discovery MI DR scanner, with each bed position scanned for 2–3 min and a low-dose CT conducted at 120 kVp and 40 mAs. The 68Ga-Pentixafor was synthesized under GMP conditions, using 30 μg of Pentixafor labeled with 68Ga at 90°C for 12 min and subsequently purified using a C18 column. An intravenous dose of 1.8 MBq/kg was administered, utilizing the same acquisition parameters. For 68Ga-Pentixafor PET/CT imaging, no special fasting or glycemic control preparation was required.
Two experienced nuclear medicine physicians independently reviewed all scans. Lesions were classified as nodal or extranodal based on abnormal tracer uptake that exceeded background levels and could not be attributed to physiological activity. For each lesion, the maximum standardized uptake value (SUVmax) was recorded, and any discrepancies in interpretation were resolved through consensus. The Lugano 2014 criteria were applied to both 18F-FDG and 68Ga-Pentixafor PET/CT for baseline staging.
Inter-modality agreement for lesion detection and staging was evaluated using Cohen’s κ statistic. Paired t-tests were employed to compare the SUVmax values of corresponding lesions between the two imaging modalities. In addition, a subgroup analysis was conducted to assess differences in imaging performance between the GCB and non-GCB subtypes.
Results
We enrolled 27 treatment-naïve DLBCL patients (mean age: 55 ± 11 years; 17 males, 10 females). Patient demographics and baseline clinical data are summarized in Table 1. Among the 19 patients with available immunohistochemistry, molecular subtyping identified 47% as GCB and 53% as non-GCB. Elevated lactate dehydrogenase > 378 IU/L was observed in 45% (9/20) of evaluable cases, and the median Ki-67 proliferation index was 70% (range: 40%–95%).
| Characteristic | Value, n (%) | Notes |
|---|---|---|
| Age (years), mean±SD | 55±11 | Range: 27–73 |
| Gender | ||
| Male | 17 (63) | - |
| Female | 10 (37) | |
| Fasting blood glucose (mg/dL) | 112±40 | Range: 72–178 |
| Histopathological subtype | Available in 19 patients | - |
| GCB | 9 (47) | - |
| Nongerminal center B-cell | 10 (53) | - |
| LDH (IU/L) | Mean: 497 (range: 206–1274) | Available in 20 patients |
| Normal (≤378 IU/L) | 11 (55) | - |
| Elevated (>378 IU/L) | 9 (45) | - |
| Ki-67 index (%) | 70 (IQR: 60–80) | Available in 20 patients |
GCB: Germinal center B-cell, LDH: Lactate dehydrogenase, IQR: Interquartile range, SD: Standard deviation, PET/CT: Positron emission tomography/computed tomography
There was substantial agreement in Lugano staging between 68Ga-Pentixafor and 18F-FDG PET/CT (κ =0.804, P = 0.001), with concordant staging in 25 of 27 cases (92.6%) [Table 2]. Figure 1 presents a representative case demonstrating comparable nodal and extranodal disease involvement on both imaging modalities, underscoring the concordance in lesion detection and overall Lugano staging. Of the two discordant cases, one showed a cervical lymph node positive on 18F-FDG but negative on 68Ga-Pentixafor PET/CT, whereas the other had a bone marrow lesion detected by 68Ga-Pentixafor but not by 18F-FDG. Figure 2 illustrates a representative case where 68Ga-Pentixafor demonstrated focal bone marrow uptake, whereas 18F-FDG PET/CT showed only low-grade diffuse uptake; subsequent bone marrow biopsy confirmed lymphomatous involvement.
| Parameter | 18F-FDG PET/CT | 68Ga-pentixafor PET/CT | Agreement (κ or %) | P |
|---|---|---|---|---|
| Nodal positivity | 26/27 (96.3%) | 26/27 (96.3%) | κ=0.804 | <0.0001 |
| Extranodal positivity | 15/15 (100%) | 14/15 (93.3%) | κ=0.926 | <0.001 |
| SUVmax (mean±SD) | ||||
| Nodal lesions | 15.2±7.6 | 8.4±4.2 | - | <0.001 (paired t-test) |
| Extranodal lesions | 6.8±3.5 | 4.1±2.3 | - | Not significant (P=0.083) |
| Lugano staging concordance | - | - | 92.6% (25/27) | 0.001 |
| Stage I | 4/27 | 4/27 | 100% | - |
| Stage II | 8/27 | 7/27 | 87.5% | - |
| Stage III | 5/27 | 5/27 | 100% | - |
| Stage IV | 10/27 | 9/27 | 90% | - |
SUVmax: Standardized uptake value, SD: Standard deviation, 18F-FDG: 18F-fluorodeoxyglucose, PET/CT: Positron emission tomography/computed tomography
On paired analysis, nodal lesions demonstrated significantly higher SUVmax values on 18F-FDG PET/CT (15.2 ± 7.6) compared to 68Ga-Pentixafor PET/CT (8.4 ± 4.2; P < 0.001) [Figure 3]. For extranodal sites, detection rates were comparable (18F-FDG: 93.3% vs. 68Ga-Pentixafor: 100%). Although 18F-FDG showed numerically higher SUVmax values for extranodal lesions (6.8 ± 3.5 vs. 4.1 ± 2.3), the difference did not reach statistical significance (P = 0.083), as detailed in Table 2.
68Ga-Pentixafor PET/CT offered several advantages and complementary insights over 18F-FDG PET/CT. Notably, it correctly identified 4 out of 5 biopsy-proven focal bone marrow involvements, which appeared only as diffuse uptake on 18F-FDG imaging. In three diabetic patients, metformin-related bowel uptake artifacts on 18F-FDG PET/CT that hindered lesion assessment were absent on 68Ga-Pentixafor scans, improving staging accuracy. Intense diffuse bowel uptake on 18F-FDG in one such patient obscured lesion localization, while the corresponding 68Ga-Pentixafor image clearly delineated disease sites.
In the evaluation of adrenal lesions, 68Ga-Pentixafor demonstrated significantly higher uptake, with a 2.4-fold increase in SUVmax compared to 18F-FDG (12.5 vs. 5.2) [Figure 4]. One such adrenal lesion, 18F-FDG-negative but 68Ga-Pentixafor-avid, was later confirmed as lymphomatous on biopsy. Conversely, a thyroid lesion detected on 18F-FDG (SUVmax 4.87) was not visualized on 68Ga-Pentixafor, indicating occasional complementary limitations.
![Baseline positron emission tomography/computed tomography (PET/CT) images of a 63-year-old male with biopsy-proven diffuse large B-cell lymphoma (germinal center B-cell subtype). (a) 18F-fluorodeoxyglucose (18F-FDG) PET/CT maximum intensity projection (MIP) image shows multiple FDG-avid lesions on both sides of the diaphragm, involving lymph nodes, peritoneal deposits, and focal skeletal (marrow) lesions in the appendicular skeleton. (b) Fused axial 18F-FDG PET/CT image reveals an 18F-FDG-avid, enlarged right adrenal gland lesion (maximum standardized uptake value [SUVmax] 5.2) along with retrocrural and abdominal lymphadenopathy. (c) 68Ga-Pentixafor PET/CT MIP image shows comparable nodal and extranodal disease involvement. (d) Fused axial 68Ga-Pentixafor PET/CT image demonstrates intense tracer uptake in the right adrenal lesion (SUVma × 12.5), which is approximately 2.4 times higher than the 18F-FDG uptake. Despite the difference in tracer avidity, the overall disease stage remained unchanged on both imaging modalities](/content/210/2025/40/4/img/IJNM-40-211-g004.png)
A subgroup analysis comparing the GCB and non-GCB subtypes of DLBCL revealed consistent lesion detection with both 68Ga-Pentixafor and 18F-FDG PET/CT across subtypes. However, 68Ga-Pentixafor PET/CT showed a nonsignificant trend toward higher uptake in the non-GCB group, with a marginally elevated mean SUVmax compared to GCB cases (P = 0.665).
Discussion
This study represents the first prospective, head-to-head comparison of 68Ga-Pentixafor PET/CT and 18F-FDG PET/CT in a homogeneous cohort of newly diagnosed, treatment-naïve patients with DLBCL undergoing baseline staging. While 18F-FDG PET/CT remains the gold standard, our results highlight notable advantages of CXCR4-targeted imaging with 68Ga-Pentixafor PET/CT, including improved lesion characterization, the potential for enhanced staging accuracy, and expanded theranostic applications.[61214]
Overall, 68Ga-Pentixafor PET/CT demonstrated high concordance (92.6%) with 18F-FDG in detecting nodal disease. However, its added diagnostic value became apparent in specific clinical scenarios where 18F-FDG is known to have limitations. In particular, 68Ga-Pentixafor identified bone marrow involvement in four biopsy-proven cases where 18F-FDG showed only diffuse, nonspecific uptake. Additionally, in patients with diabetes on metformin, 18F-FDG-related intestinal hyper-metabolism obscured abdominal lesions, which were clearly visualized with 68Ga-Pentixafor. These findings align with the biodistribution of 68Ga-Pentixafor, characterized by low physiological uptake in areas such as the brain, bowel, and urinary tract, thereby enhancing lesion delineation.[121419]
From a practical standpoint, 68Ga-Pentixafor PET/CT offers logistical advantages: It does not require fasting or glycemic control, and it can be produced using generator-based synthesis, allowing for easier in-house availability.[1214]
Our findings are consistent with previous reports of 68Ga-Pentixafor PET/CT’s utility across various lymphoma subtypes. Pan et al.[20] observed improved lesion detection in lymphoplasmacytic lymphoma and marginal zone lymphoma (MZL), while Mayerhoefer et al.[15] demonstrated 100% sensitivity and better visualization of marrow and spleen in mantle cell lymphoma. Luo et al.[21] reported superior detection of bone marrow, lymph nodes, and central nervous system lesions in Waldenström macroglobulinemia, and Kosmala et al.[22] confirmed a higher detection rate in MZL using 68Ga-Pentixafor versus 18F-FDG PET/CT. These studies, although primarily focused on indolent lymphomas, provide context for interpreting our results in the more aggressive setting of DLBCL. A comparative overview is provided in Table 3.
| Study (author, year, journal) | Lymphoma subtype (s) | n | Detection rate/lesion conspicuity | Sensitivity/specificity/accuracy | SUVmax/TBR (pentixafor vs. FDG) | Advantages/disadvantages | Clinical impact/conclusions |
|---|---|---|---|---|---|---|---|
| Pan et al., 2020, EJNMMI Research[20] | LPL, MZL, FL, MCL, DLBCL, iBCL, NKTCL | 27 | Higher detection in LPL and MZL with 68Ga-Pentixafor; lower in DLBCL and FL | Not consistently reported | MZL: 12.1 versus 5.3; TBR blood: 6.2 versus 2.5 | Superior in indolent subtypes; limited in NKTCL | Useful adjunct in low-FDG-avid lymphomas; less effective in aggressive variants |
| Mayerhoefer et al., 2021, Theranostics[15] | MCL | 22 | 68Ga-Pentixafor detected 114 sites versus 85 with 18F-FDG; no FDG-only positives sites | Sensitivity: 100% (68Ga) versus 75.2% (FDG); PPV: 94.0% versus 96.5% | SUVmax: 8.44 versus 4.08; TBR blood: 4.85 versus 1.95 | Better marrow and spleen visualization; spleen uptake may be confounding | Demonstrated superior lesion detection; supports CXCR4-targeted imaging in MCL |
| Luo et al., 2019, J Nucl Med[21] | Waldenström Macroglobulinemia/LPL | 17 | 100% positive with 68Ga-Pentixafor versus 58.8% with 18F-FDG (P=0.023); better marrow, LN, CNS detection | BM: 94.1% versus 58.8%; LN: 76.5% versus 11.8% (P=0.003); CNS: 5.9% versus 0% | BM SUVmax: 10.7 versus not stated; LN SUVmax: 8.3 versus 2.9 | Superior for marrow, lymph node, CNS; 18F-FDG missed focal/diffuse lesions; excellent treatment response tracking | Promising imaging modality for diagnosis, staging, and response assessment in WM/LPL; supports CXCR4-targeted imaging |
| Kosmala et al., 2024, EJNMMI[22] | MZL | 32 | 68Ga-Pentixafor detected all patients (100%) versus 78.1% for 18F-FDG; 127 68Ga-Pentixafor only lesions | Not explicitly reported; sensitivity implied as high | SUVmax: 10.3 versus 5.72; TBR: 3.85 versus 2.08 | Excellent nodal/extranodal contrast; spleen uptake a minor limitation | Supports 68Ga-Pentixafor as superior in MZL; effective in early and indolent disease detection |
SUVmax: Maximum standardized uptake value; TBR: Tumor-to-background ratio; CXCR4: C-X-C motif chemokine receptor 4; MZL: Marginal zone lymphoma; LPL: lymphoplasmacytic lymphoma; WM: Waldenström macroglobulinemia; MCL: Mantle cell lymphoma; FL: Follicular lymphoma; DLBCL: Diffuse large B-cell lymphoma; iBCL: Indolent B-cell lymphoma; NKTCL: Natural killer/T-cell lymphoma; PPV: Positive predictive value, PET/CT: Positron emission tomography/computed tomography, MZL: Marginal Zone Lymphoma, FDG: Fluorodeoxyglucose
While molecular subtyping was not the primary objective of this study, a nonsignificant trend toward higher 68Ga-Pentixafor uptake was noted in non-GCB DLBCL. Previous literature has linked CXCR4 overexpression to the non-GCB phenotype, associated with more aggressive behavior, treatment resistance, and tumor–microenvironment interactions.[56789101123] Although we did not perform CXCR4 immunohistochemistry, our imaging findings support the need for future studies exploring CXCR4 as a prognostic and predictive biomarker.
Importantly, beyond its diagnostic value, 68Ga-Pentixafor PET/CT holds potential for theranostic use. CXCR4-targeted radioligand therapies, such as 177Lu-or 90Y-Pentixather, have shown encouraging results in early trials for relapsed or refractory hematologic malignancies.[1724] Imaging with 68Ga-Pentixafor could help identify patients suitable for these targeted therapies, especially those with poor prognostic profiles or limited treatment options.[2425]
This study has limitations, including its single-center design and modest sample size, which may restrict generalizability. The lack of correlative CXCR4 immunohistochemistry is another constraint, limiting direct biological validation of imaging findings. However, the dual-tracer approach offers an internally controlled comparison, strengthening the observed diagnostic advantages of receptor-targeted imaging.
Future studies should focus on larger, multicenter cohorts and incorporate molecular profiling and survival data. In particular, correlating 68Ga-Pentixafor uptake with treatment response and long-term outcomes, especially in patients receiving CXCR4-directed therapies, may pave the way for more personalized approaches to managing DLBCL.[2627]
Conclusion
This prospective study underscores the complementary role of 68Ga-Pentixafor PET/CT alongside 18F-FDG PET/CT in the evaluation of newly diagnosed DLBCL patients. While demonstrating comparable efficacy in nodal disease detection, 68Ga-Pentixafor showed distinct advantages in assessing bone marrow involvement and imaging in low-background regions. Its CXCR4-targeted mechanism enhances lesion delineation and holds promise for integration into personalized theranostic strategies. These findings warrant further validation in larger, multicenter studies to define its utility in precision imaging and tailored treatment planning for DLBCL.
Conflicts of interest
There are no conflicts of interest.
Nil.
References
- The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood. 2016;127:2375-90.
- [Google Scholar]
- The international consensus classification of mature lymphoid neoplasms: A report from the clinical advisory committee. Blood. 2022;140:1229-53.
- [Google Scholar]
- Long-term outcome of patients in the LNH-98.5 trial, the first randomized study comparing rituximab-CHOP to standard CHOP chemotherapy in DLBCL patients: A study by the Groupe d’etudes des lymphomes de l’Adulte. Blood. 2010;116:2040-5.
- [Google Scholar]
- Distinct types of diffuse large B-cell lymphoma identified by gene expression profiling. Nature. 2000;403:503-11.
- [Google Scholar]
- CXCR4 over-expression and survival in cancer: a system review and meta-analysis. Oncotarget. 2015;6:5022-40.
- [Google Scholar]
- Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: The Lugano classification. J Clin Oncol. 2014;32:3059-68.
- [Google Scholar]
- Role of imaging in the staging and response assessment of lymphoma: consensus of the International Conference on Malignant Lymphomas Imaging Working Group. J Clin Oncol. 2014;32:3048-3058.
- [Google Scholar]
- FDG PET/CT to detect bone marrow involvement in the initial staging of patients with aggressive non-Hodgkin lymphoma: Results from the prospective, multicenter PETAL and OPTIMAL>60 trials. Eur J Nucl Med Mol Imaging. 2021;48:3550-9.
- [Google Scholar]
- CXCR4: A key receptor in the crosstalk between tumor cells and their microenvironment. Blood. 2006;107:1761-7.
- [Google Scholar]
- The extracellular matrix: A key player in the pathogenesis of hematologic malignancies. Blood Rev. 2021;48:100787.
- [Google Scholar]
- [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.
- [Google Scholar]
- Assessment of central nervous system lymphoma based on CXCR4 expression in vivo using 68Ga-pentixafor PET/MRI. Clin Nucl Med. 2021;46:16-20.
- [Google Scholar]
- Chemokine receptor-4 targeted PET/CT with (68) Ga-Pentixafor in assessment of newly diagnosed multiple myeloma: Comparison to (18) F-FDG PET/CT. Eur J Nucl Med Mol Imaging. 2020;47:537-46.
- [Google Scholar]
- CXCR4 PET imaging of mantle cell lymphoma using [(68) Ga] pentixafor: Comparison with [(18) F] FDG-PET. Theranostics. 2021;11:567-78.
- [Google Scholar]
- 68Ga-pentixafor PET/MRI for treatment response assessment in mantle cell lymphoma: Comparison between changes in lesion CXCR4 expression on PET and lesion size and diffusivity on MRI. Clin Nucl Med. 2023;48:557-62.
- [Google Scholar]
- First-in-Human Experience of CXCR4-Directed Endoradiotherapy with 177Lu- and 90Y-Labeled Pentixather in Advanced-Stage Multiple Myeloma with Extensive Intra- and Extramedullary Disease. J Nucl Med. 2016;57:248-51.
- [Google Scholar]
- Imaging of C-X-C Motif Chemokine Receptor 4 Expression in 690 Patients with Solid or Hematologic Neoplasms Using 68Ga-Pentixafor PET. J Nucl Med. 2022;63:1687-92.
- [Google Scholar]
- CXCR4-directed PET/CT with [(68) Ga] Ga-pentixafor in solid tumors-a comprehensive analysis of imaging findings and comparison with histopathology. Eur J Nucl Med Mol Imaging. 2024;51:1383-94.
- [Google Scholar]
- Preliminary evidence of imaging of chemokine receptor-4-targeted PET/CT with [(68) Ga] pentixafor in non-Hodgkin lymphoma: Comparison to [(18) F] FDG. EJNMMI Res. 2020;10:89.
- [Google Scholar]
- (68) Ga-Pentixafor PET/CT for imaging of chemokine receptor 4 expression in waldenström macroglobulinemia/lymphoplasmacytic lymphoma: Comparison to (18) F-FDG PET/CT. J Nucl Med. 2019;60:1724-9.
- [Google Scholar]
- Chemokine receptor-targeted PET/CT provides superior diagnostic performance in newly diagnosed marginal zone lymphoma patients: a head-to-head comparison with [18F]FDG. Eur J Nucl Med Mol Imaging. 2024;51:749-55.
- [Google Scholar]
- Identification of CXCR4 Upregulation in Diffuse Large B-Cell Lymphoma Associated with Prognostic Significance and Clinicopathological Characteristics. Dis Markers. 2022;2022:3276925.
- [Google Scholar]
- Feasibility of CXCR4-Directed Radioligand Therapy in Advanced Diffuse Large B-Cell Lymphoma. J Nucl Med. 2019;60:60-4.
- [Google Scholar]
- CXCR4-targeted theranostics in oncology. Eur J Nucl Med Mol Imaging. 2022;49:4133-44.
- [Google Scholar]
- C-X-C Motif Chemokine Receptor 4-Targeted Radioligand Therapy in Patients with Advanced T-Cell Lymphoma. J Nucl Med. 2023;64:34-9.
- [Google Scholar]
- Advances in PET Imaging of the CXCR4 Receptor: [68Ga]Ga-PentixaFor. Semin Nucl Med. 2024;54(1):163-70.
- [Google Scholar]