多次小剂量^(188)Re-CL58放射免疫治疗的临床研究

Study on the Radioimmunotherapy Efficiency of Patients Treated With Multiple Low Dose ^(188)Re-CL58

采用FDG-PET显像方法及动态观察血清中肿瘤标志物的变化监测^(188)Re-CL58(或^(131)I-HAb18)对临床病例进行多次小剂量治疗的疗效,及其对造血系统和肝、肾等器官的毒副作用。结果显示;治疗后PET显像显示病灶部位的^(18)F标记的脱氧葡萄糖(FDG)标准化摄取值(SUV)均有不同程度下降,对于小转移灶SUV下降明显甚至降至正常,且治疗后血清中肿瘤标志物CEA、AFP水平均有不同程度下降或下降至正常水平。多次小剂量^(188)Re-CL58治疗后CD_4^+细胞升高、CD_8^+细胞减少以及CD_4^+/CD_8^+比例升高。对白细胞、血小板、血色素的影响不明显,对肝、肾功能均无明显损害。随访至半年,循环系统中均未检测到HAMA。因此,多次小剂量^(188)Re-CL58(或^(131)I-HAb18)治疗对于实体瘤的小转移灶有明显的治疗作用;能解除机体的免疫抑制,放射免疫治疗仅引起造血系统的轻度抑制;多次小剂量RIT能避免产生HAMA。

The change of tumor marker in serum is observed with FDG PET and dynamica observation, which is to monitor the curative effect of patients treated with MLD(Multiple Low Dose) of 188Re-CL58(or 131I-HAbl8). The results show that after treated with MLD-RIT, 18F-FDG concentrated in lesions, evaluated with naked eyes and semi-quantitation method (SUV) is decreased significantly. Compared with larger focusts, micro-metastatic lesions show greater decrease of SUV. In some cases, SUV of the metastases are even brough down to the normal line. MLD 188Re-CL58 affect the immune system positively for it brought down CD3+ cell and brough up the ratio of CD4+/ CD8+ , while MLD RIT induced no visible blood toxication. Both of them have no toxic effect on liver and kidney. What's exciting, the MLD did not induce any HAMA during the follow-up period(2 weeks to 6 months). So MLD RIT is efficiency for the treatment of micro-metastasis. MLD RIT partially relief the immune system from suppression, the toxication of RIT is manifested mainly as blood cell inhibition. MLD RIT induced no HAMA (Human Anti-mouse Antibody) generally.