title: Subsequent therapy can be administered after tositumomab and iodine I-131 tositumomab for non-Hodgkin lymphoma.
abstract: BACKGROUND
  Iodine I-131 tositumomab is a well tolerated and effective therapy for recurrent low-grade and transformed low-grade non-Hodgkin lymphoma (NHL). Hematologic reserve after radioimmunotherapy (RIT) is an important consideration when subsequent therapy is required.
  
  
  METHODS
  One hundred fifty-five patients who received treatment with I-131 tositumomab were assessed, and 68 patients had progressive disease after RIT. The median age (n=68 patients) was 59 years (range,18-82 yrs), and patients received a median of 2 pre-RIT regimens (range,1-8 regimens), including 66% who received anthracycline, 19% who received platinum, and 50% who received fludarabine.
  
  
  RESULTS
  The median time to disease progression (among progressors) was 168 days (range, 19-771 days). At the time they developed recurrent disease, patients had median white blood cell count (WBC) of 4.9 K cells/microL (range, 1.1-21.4 K cells/microL), a median absolute neutrophil count (ANC) of 3.25 K cells/microL (range, 0.59-8.20 K cells/microL), a median platelet count of 130 K cells/microL (range, 9-440 K cells/microL), and there was no significant difference between pre-RIT and recurrence values except for the platelet count (P<0.05). No patient demonstrated a WBC<1.0 K cells/microL or an ANC<0.5 K cells/microL, although 1 patient had a platelet count<10 K cells/microL. Twenty-four patients subsequently received no further chemotherapy; and, in 21 patients (88%), hematologic parameters appeared to allow subsequent chemotherapy if necessary (blood counts: National Cancer Institute Grade 0-2). Among 44 patients (65%) who received further chemotherapy (median, 2 regimens; range, 1-4 regimens), 19 patients (43%) were treated with anthracyclines, 17 patients (39%) were treated with platinum, 10 patients (23%) were treated with fludarabine, and 13 patients (30%) underwent stem cell transplantation. Disease improvement occurred in most patients, although 18 patients died (40%) after further chemotherapy, predominantly from refractory lymphoma.
  
  
  CONCLUSIONS
  Most patients with progressive disease after treatment with iodine I-131 tositumomab were able to receive subsequent therapy, including cytotoxic chemotherapy and stem cell transplantation.
authors.affiliation: Center for Lymphoma and Myeloma, Division of Hematology/Oncology, Weill Medical College of Cornell University and New York Presbyterian Hospital, New York, New York 10021, USA.
authors.forename: Alan D
authors.initials: AD
authors.lastname: Dosik
authors.forename: Morton
authors.initials: M
authors.lastname: Coleman
authors.forename: Lale
authors.initials: L
authors.lastname: Kostakoglu
authors.forename: Richard R
authors.initials: RR
authors.lastname: Furman
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Fiore
authors.forename: Daniel
authors.initials: D
authors.lastname: Muss
authors.forename: Ruben
authors.initials: R
authors.lastname: Niesvizky
authors.forename: Tsiporah
authors.initials: T
authors.lastname: Shore
authors.forename: Michael W
authors.initials: MW
authors.lastname: Schuster
authors.forename: Patricia
authors.initials: P
authors.lastname: Stewart
authors.forename: Shankar
authors.initials: S
authors.lastname: Vallabhajosula
authors.forename: Stanley J
authors.initials: SJ
authors.lastname: Goldsmith
authors.forename: John P
authors.initials: JP
authors.lastname: Leonard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000532:radiotherapy* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000209:etiology; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D013921:Thrombocytopenia / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; C119496:tositumomab I-131