title: Outcomes of patients with non-Hodgkin's lymphoma treated with Bexxar with or without external-beam radiotherapy.
abstract: OBJECTIVE
  To compare the efficacy and toxicity of external-beam radiotherapy (EBRT) to sites of bulky lymphadenopathy in patients with chemotherapy-refractory low-grade non-Hodgkin's lymphoma (NHL) immediately before receiving Bexxar (tositumomab and (131)I) vs. in patients receiving Bexxar alone for nonbulky disease.
  
  
  METHODS
  Nineteen patients with chemotherapy-refractory NHL were treated with Bexxar at our institution (University of Florida, Gainesville, FL) from 2005 to 2008. Seventeen patients had Grade 1-2 follicular lymphoma. Ten patients received a median of 20 Gy in 10 fractions to the areas of clinical involvement, immediately followed by Bexxar (EBRT + Bexxar); 9 patients received Bexxar alone. The median tumor sizes before EBRT + Bexxar and Bexxar alone were 4.8 cm and 3.3 cm, respectively. All 5 patients with a tumor diameter >5 cm were treated with EBRT + Bexxar. A univariate analysis of prognostic factors for progression-free survival (PFS) was performed.
  
  
  RESULTS
  The median follow-up was 2.3 years for all patients and 3.1 years for 12 patients alive at last follow-up. Of all patients, 79% had a partial or complete response; 4 of the 8 responders in the EBRT + Bexxar group achieved a durable response of over 2 years, including 3 of the 5 with tumors >5 cm. Three of 9 patients treated with Bexxar alone achieved a durable response over 2 years. Actuarial estimates of 3-year overall survival and PFS for EBRT + Bexxar and Bexxar alone were 69% and 38% and 62% and 33%, respectively. The median time to recurrence after EBRT + Bexxar and Bexxar alone was 9 months. Having fewer than 4 involved lymph-node regions was associated with superior PFS at 3 years (63% vs. 18%). There was no Grade 4 or 5 complications.
  
  
  CONCLUSIONS
  Adding EBRT immediately before Bexxar produced PFS equivalent to that with Bexxar alone, despite bulkier disease. Hematologic toxicity was not worsened. EBRT combined with Bexxar adds a safe and effective therapeutic treatment for managing recurrent low-grade follicular NHL.
authors.affiliation: Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610-0385, USA.
authors.forename: Kristy
authors.initials: K
authors.lastname: Smith
authors.forename: Gracie
authors.initials: G
authors.lastname: Byer
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Morris
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Kirwan
authors.forename: Judith
authors.initials: J
authors.lastname: Lightsey
authors.forename: Nancy P
authors.initials: NP
authors.lastname: Mendenhall
authors.forename: Bradford S
authors.initials: BS
authors.lastname: Hoppe
authors.forename: James
authors.initials: J
authors.lastname: Lynch
authors.forename: Kenneth
authors.initials: K
authors.lastname: Olivier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*; D016393:Lymphoma, B-Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D008224:Lymphoma, Follicular / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008875:Middle Aged; D016499:Radioimmunotherapy / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden / Q000528:radiation effects
chemical_list: D000911:Antibodies, Monoclonal; D007457:Iodine Radioisotopes; C119496:tositumomab I-131