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⁶⁷Ga Citrate versus ^99mTc-labeled LL2-Fab' (Anti-CD22) Fragments in the Staging of B-Cell Non-Hodgkin's Lymphoma¹

Departments of Nuclear Medicine [W. S. B., T. M. B., F.C., F. G. W.] and Internal Medicine III [W.R., J. W., P.M.K., M. G., J. R. K.], University of Erlangen-Nuremberg, D-91054 Erlange, Germany, and Center for Molecular Medicine and Immunology, Newark, New Jersey 07103 [D. M. G.]

The value of ⁶⁷Ga citrate scanning as a transferrin receptor agent was compared in this study with a ^99mTc-labeled anti-CD22 (B-cell) Fab' fragment (LL2) in patients with low- and high-grade B-cell non-Hodgkin's lymphoma (NHL). Thirteen patients with histologically confirmed NHL were examined prospectively with both radiopharmaceuticals within 8 days. The results of immunoscintigraphy were compared with those of ⁶⁷Ga scanning and the clinical and radiological workup (computed tomography, ultrasound, and magnetic resonance imaging) of the patients.

The overall sensitivity of ⁶⁷Ga citrate and ^99mTc-labeled LL2 fragment was each 80% in a total of 43 lesions. Low-grade lymphoma patients had a higher sensitivity in LL2 imaging (82% versus 71%), and high-grade lymphoma patients in ⁶⁷Ga citrate scanning (100% versus 75%). The target:background ratio in low-grade NHL for LL2 was 1.43 ± 0.3:1 versus 1.8 ± 0.5:1 in ⁶⁷Ga scans; in high-grade NHL, 1.49 ± 0.35:1 versus 2.2 ± 0.8:1, respectively. Single-photon emission computed tomography imaging was necessary in 21.7% of the patients 4 h after injection to localize the lesions.

In conclusion, the overall sensitivity of ^99mTc-labeled LL2 is comparable to ⁶⁷Ga citrate scanning in patients with B-cell NHL. ^99mTc-labeled LL2 antibodies are rapid to use, are safe, and need a shorter imaging time (24 h versus 72 h). Because of these advantages, ^99mTc-labeled LL2 may be superior to ⁶⁷Ga scanning for the staging of lymphoma patients.