Retreatment with yttrium-90 ibritumomab tiuxetan in patients with B-cell non-Hodgkin's lymphoma

Abstract

There is no data on safety and efficacy of a second course of ibritumomab tiuxetan. In this work, data on patients with B-cell NHL who were treated with two courses of ibritumomab tiuxetan were analyzed. Eighteen such patients were analyzed (age: 58 years, 48 - 91), with a median of four prior regimens (1 - 7), stem cell transplantation (n = 5), and radiation therapy (n = 6). After the first course, G3/4 neutropenia and thrombocytopenia was 35% and 41%; overall response rate (ORR) was 89%; time between courses was 16.6 months (6.0 - 42.7). After the second course, the incidence of G3/4 neutropenia and thrombocytopenia was 28% and 44%; and ORR 77%. There were no infectious or bleeding complications, secondary myelodysplastic syndromes, or leukemias. Retreatment with the ibritumomab tiuxetan regimen was well tolerated, with a safety profile similar to that of the first course. To conclude, patients who benefited from the first course of ibritumomab tiuxetan can benefit from retreatment.

Radioimmunotherapy of relapsed indolent non-Hodgkin lymphoma with 131I-rituximab in routine clinical practice: 10-year single-institution experience of 142 consecutive patients

“…The incidence of grade 3/4 toxicity was not increased by retreatment. [34][35][36] Whole-body gamma imaging of tracer 200-MBq activities of 131 I-rituximab performed in all our patients confirmed the expected biodistribution of those radiolabeled mAbs, including those patients in whom previous RIT may theoretically have given rise to human antichimeric antibody. Such evidence of humanmouse immunoreaction was not seen in any of our patients, which contrasts with a significant risk of HAMA formation after RIT with murine-based mAbs, which, however, does not preclude effective retreatment of those patients who did not have HAMA.…”

“…Such evidence of humanmouse immunoreaction was not seen in any of our patients, which contrasts with a significant risk of HAMA formation after RIT with murine-based mAbs, which, however, does not preclude effective retreatment of those patients who did not have HAMA. 35,36 Our use of 131 I-rituximab chimeric mAb allowed retreatment of indolent lymphoma without potential problems of HAMA and achieved ORR 63%, with 7 of 10 responding patients achieving a CR/CRu having the same or longer duration of response. The median event-free survival, and the severity of myelosuppression, was not significantly different between the initial and repeat treatments.…”

A re-examination of radioimmunotherapy in the treatment of non-Hodgkin lymphoma: prospects for dual-targeted antibody/radioantibody therapy

“…2 Today, 2 radiolabeled anti-CD20 IgG antibodies, 90 Y-ibritumomab tiuxetan (Zevalin; Cell Therapeutics, Seattle, WA; Bayer Schering Healthcare, Berlin, Germany) and 131 Itositumomab (Bexxar; GlaxoSmithKline, Philadelphia, PA), are approved for treatment of patients with follicular and transformed non-Hodgkin lymphoma (NHL) who failed or relapsed from prior therapies, including rituximab and standard chemotherapy. 3,4 Although results from ongoing clinical studies support the use of such radioimmunoconjugates in various front-line and salvage treatment settings, [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] important issues remain regarding how these agents are administered, yet also suggest some potential new treatment paradigms. 20 …”

Update on the rational use of (90)Y-ibritumomab tiuxetan in the treatment of follicular lymphoma

“…Notably, also retreatment with 90 Y-IT (ie, 2 courses of RIT) seemed feasible and effective in a retrospective analysis of a small cohort of patients with B-cell NHL. 53 In the relapsed setting, 90 Y-IT proved capable of achieving long-term remissions. However, in a randomized phase III trial RIT did not yield a significant improvement of TTP or duration of response as compared to a short course of rituximab treatment, despite better efficacy in terms of response rates.…”