# Tolerability of PSMA radioligand therapy in metastatic prostate cancer patients with baseline mild to moderate leukopenia

## TL;DR

This study shows that PSMA radioligand therapy is safe for prostate cancer patients with mild to moderate leukopenia, with no significant worsening of blood cell counts.

## Contribution

The study demonstrates that PSMA-RLT can be safely administered to mCRPC patients with preexisting mild to moderate leukopenia.

## Key findings

- Leukocyte counts remained stable after each PSMA-RLT cycle without significant deterioration.
- Patients with leukopenia showed no significant change in CTCAE scores after treatment.
- PSMA-RLT was feasible in patients with leukopenia, challenging its exclusion as a contraindication.

## Abstract

Aim of this study was to analyze the safety of prostate-specific membrane antigen radioligand therapy (PSMA-RLT) in patients with metastatic castration-resistant prostate cancer (mCRPC) with preexisting mild to moderate leukopenia (CTCAE ≥ 1).

Thirty-seven mCRPC patients with preexisting leukopenia (leukocyte count < 3.8 × 109/L) were included in this study. Patients received a median of 3 cycles of [177Lu]Lu-PSMA-617 (range 1–9). No significant difference in leukocyte counts was observed between baseline and follow-up after each PSMA-RLT cycle: first cycle (3.0 ± 0.5 at baseline vs. 3.4 ± 1.4 at follow up [in × 109/L], p = 0.0921), second cycle (3.1 ± 0.4 vs. 3.8 ± 1.7, p = 0. 0.0509), and third cycle (3.1 ± 0.4 vs. 3.2 ± 2.0, p = 0.2929), respectively. Similarly, baseline and end of treatment values, irrespective of the number of administered cycles, did not reveal a significant difference (3.0 ± 0.5 vs. 3.5 ± 1.4, p = 0.0684). After the end of therapy, irrespective of the number of administered cycles, 27% patients remained stable in terms of CTCAE scoring, 46% changed to a higher score and 27% improved to a lower score.

Although marked preexisting leukopenia is often considered a relative contraindication for PSMA-RLT, our findings indicate that PSMA-RLT is feasible in patients with leukopenia of CTCAE grade ≥ 1. In our cohort, leukocyte counts remained stable without significant RLT-induced deterioration. Therefore, patients with leukopenia should not be categorically excluded from receiving PSMA-RLT.

Trial registration: Clinicaltrials.gov identifier: NCT04833517, registered 01.01.2016.

The online version contains supplementary material available at 10.1186/s13550-025-01280-0.