High activity 90Y-ibritumomab tiuxetan (Zevalin) with peripheral blood progenitor cells support in patients with refractory/resistant B-cell non-Hodgkin lymphomas.
Radioimmunotherapy (RIT) is an alternative approach in the treatment of resistant/refractory B-cell non-Hodgkin lymphoma (NHL). We performed a feasibility and toxicity pilot study of escalating activity of 90Y-ibritumomab tiuxetan followed by autologous stem cell transplantation (ASCT). Three activity levels were fixed--30 MBq/kg (0.8 mCi/kg), 45 MBq/kg (1.2 mCi/kg) and 56 MBq/kg (1.5 mCi/kg)--and 13 patients enrolled. One week before treatment all patients underwent dosimetry. ASCT was performed 13 d after Zevalin administration. Treatment was well tolerated and all patients engrafted promptly. No differences in terms of haematological toxicities were observed among the three levels, apart from a delayed platelet recovery in heavily pretreated patients receiving 56 MBq/kg. Non-haematologic toxicity was mainly related to infections and liver toxicity. One patient died 4 months after treatment because of hepatitis C virus reactivation. One patient developed a myelodysplastic syndrome 2 years after treatment. In conclusion, high-activity Zevalin with ASCT is feasible and could be safely delivered in elderly and heavily pretreated NHL patients, including those who previously received high-dose chemotherapy and ASCT. Maximum tolerated dose was not clearly defined according to dosimetry and clinical toxicities, and further studies are needed to confirm the toxicity profile and evaluate efficacy.
Ferrucci
Pier F
PF
Melanoma and Sarcoma Division, European Institute of Oncology, Milan, Italy. pier.ferrucci@ieo.it
Vanazzi
Anna
A
Grana
Chiara M
CM
Cremonesi
Marta
M
Bartolomei
Mirco
M
Chinol
Marco
M
Ferrari
Mahila
M
Radice
Davide
D
Papi
Stefano
S
Martinelli
Giovanni
G
Paganelli
Giovanni
G
D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D019008:Drug Resistance, Neoplasm; D005240:Feasibility Studies; D005260:Female; D006085:Graft Survival; D006801:Humans; D016393:Lymphoma, B-Cell / Q000532:radiotherapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods*; D010865:Pilot Projects; D016499:Radioimmunotherapy / Q000009:adverse effects / Q000379:methods*; D011879:Radiotherapy Dosage; D012008:Recurrence; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; C422802:ibritumomab tiuxetan