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The coefficient of variation (CV) for the individual mean absorbed bone marrow doses was 0.08.
No statistically significant correlation was obtained between mean absorbed bone marrow dose and Hb (p = 0.16) or WBC (p = 0.42) counts.
The sensitivity of the threshold value was tested for by changing its value between 0.05 and 0.25 and the mean absorbed bone marrow doses varied up to 10%% in this interval.
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Despite the uncertainties in the presented method, it showed a dose-response relationship between absorbed bone marrow dose and haematological toxicity according to Hb, WBC and PLT counts for both mean and total absorbed dose.
It is especially difficult to use pharmacokinetic data for calculation of the absorbed bone marrow dose, since bone marrow involvement is a strong confounder.
Fig. 5 Mean absorbed doses and total absorbed doses to the bone marrow correlated with the decrease in Hb (a, b), WBC (c, d) and platelet (e, f) counts respectively during 177Lu-DOTATATE treatment.
Bone normally undergoes continual remodelling and two types of cells are involved: osteoblasts (these make and regulate the bone matrix) and osteoclasts (these absorb bone matrix).
Specialized cells are engaged in the bone remodeling and turnover processes, such as osteoblasts initiating bone formation, osteocytes monitoring bone mechanical stresses, and osteoclasts absorbing bone [ 1].
Radium-223 is an alpha-emitting, bone-seeking radionuclide and is absorbed by bone tissue depending on bone remodelling [1 4].
This low bone turnover means that calcium and phosphate are not absorbed into bone and accumulate in the blood.
These medications are chemically absorbed into bone, decreasing osteoclast number and activity and thereby decreasing bone resorption.
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