title: ⁹⁰Y-Ibritumomab tiuxetan, fludarabine, and TBI-based nonmyeloablative allogeneic transplantation conditioning for patients with persistent high-risk B-cell lymphoma.
abstract: Nonmyeloablative allogeneic transplantation (NMAT) infrequently cures active chemoresistant, bulky, or aggressive B-cell lymphoma (B-cell non-Hodgkin lymphoma [B-NHL]). We hypothesized that ⁹⁰Y-ibritumomab tiuxetan-based NMAT would facilitate early cytoreduction in such patients promoting improved long-term disease control by the allogeneic graft. Forty high-risk B-NHL patients with persistent disease received 0.4 mCi/kg (maximum, 32 mCi/kg) ⁹⁰Y-ibritumomab tiuxetan, fludarabine, and 2 Gy total body irradiation and matched-related (15) or unrelated (25) transplantation. Baseline features included: median age, 58 years (range, 29-69 years); median prior regimens, 6 (range, 3-12); chemosensitive disease, 6 (15%); bulk > 5 cm, 17 (range, 5.2-18.6 cm, 43%); diffuse large B-cell lymphoma, 14 (35%); and comorbidity score > zero, 34 (85%). Early responses were observed in 24 (60%, 14 complete remission/complete remission unconfirmed, 10 partial response) patients, including 17 of 29 (59%) with chemotherapy-resistant disease and 10 (59%) with bulk > 5 cm. The estimated 30-month survival, progression-free survival, and nonrelapse mortality were 54.1%, 31.1%, and 15.9%, respectively. Early response, baseline platelet counts over 25 000/μL, indolent histology, and related donors were associated with improved survival. The addition of ⁹⁰Y-ibritumomab tiuxetan to NMAT is safe and yields early responses and prolonged disease control in some of the highest-risk B-NHL patients. This trial was registered at www.clinicaltrials.gov as #NCT00119392.
authors.affiliation: Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA. agopal@u.washington.edu
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Gopal
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Guthrie
authors.forename: Joseph
authors.initials: J
authors.lastname: Rajendran
authors.forename: John M
authors.initials: JM
authors.lastname: Pagel
authors.forename: George
authors.initials: G
authors.lastname: Oliveira
authors.forename: David G
authors.initials: DG
authors.lastname: Maloney
authors.forename: Manuela C
authors.initials: MC
authors.lastname: Matesan
authors.forename: Rainer F
authors.initials: RF
authors.lastname: Storb
authors.forename: Oliver W
authors.initials: OW
authors.lastname: Press
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation / Q000379:methods; D006801:Humans; D016393:Lymphoma, B-Cell / Q000628:therapy*; D008875:Middle Aged; D016499:Radioimmunotherapy / Q000379:methods; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D000911:Antibodies, Monoclonal; C422802:ibritumomab tiuxetan; D014740:Vidarabine; C024352:fludarabine