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Blood. 2015 Jun 25;125(26):4095-102. doi: 10.1182/blood-2015-01-618215. Epub 2015 May 8.

Allogeneic cell transplant expands bone marrow distribution by colonizing previously abandoned areas: an FDG PET/CT analysis.

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Chair of Nuclear Medicine, Genoa University, Istituti di Ricovero e Cura e Carattere Scientifico San Martino Istituto Scientifico Tumori, Genoa, Italy;
Consiglio Nazionale delle Ricerche Institute of Molecular Bioimaging and Physiology, Milan, Section of Genoa, Genoa, Italy;
Consiglio Nazionale delle Ricerche SPIN (Superconductors, oxides and other innovative materials and devices), Genoa, Italy;
Department of Pediatric Hemato-Oncology, Stem Cell and Cell Therapy Laboratory, Istituto G. Gaslini, Genoa, Italy;
Hematology and Bone Marrow Transplantation Department, Istituti di Ricovero e Cura e Carattere Scientifico San Martino Istituto Scientifico Tumori, Genoa, Italy; and.
Department of Mathematics, University of Genoa, Italy.


Mechanisms of hematopoietic reconstitution after bone marrow (BM) transplantation remain largely unknown. We applied a computational quantification software application to hybrid 18F-fluorodeoxyglucose positron emission tomography (PET)/computed tomography (CT) images to assess activity and distribution of the hematopoietic system throughout the whole skeleton of recently transplanted patients. Thirty-four patients underwent PET/CT 30 days after either adult stem cell transplantation (allogeneic cell transplantation [ACT]; n = 18) or cord blood transplantation (CBT; n = 16). Our software automatically recognized compact bone volume and trabecular bone volume (IBV) in CT slices. Within IBV, coregistered PET data were extracted to identify the active BM (ABM) from the inactive tissue. Patients were compared with 34 matched controls chosen among a published normalcy database. Whole body ABM increased in ACT and CBT when compared with controls (12.4 ± 3 and 12.8 ± 6.8 vs 8.1 ± 2.6 mL/kg of ideal body weight [IBW], P < .001). In long bones, ABM increased three- and sixfold in CBT and ACT, respectively, compared with controls (0.9 ± 0.9 and 1.7 ± 2.5 vs 0.3 ± 0.3 mL/kg IBW, P < .01). These data document an unexpected distribution of transplanted BM into previously abandoned BM sites.

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