Radiation dosimetry results and safety correlations from 90Y-ibritumomab tiuxetan radioimmunotherapy for relapsed or refractory non-Hodgkin's lymphoma: Combined data from 4 clinical trials

Gregory A. Wiseman, Ellen Kornmehl, Bryan Leigh, William D. Erwin, Donald A. Podoloff, Stewart Spies, Richard B. Sparks, Michael G. Stabin, Thomas Elmer Witzig, Christine A. White

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Abstract

Ibritumomab tiuxetan is an anti-CD20 murine IgG1 κ monoclonal antibody (ibritumomab) conjugated to the linker-chelator tiuxetan, which securely chelates 111In for imaging or dosimetry and 90Y for radioimmunotherapy (RIT). Dosimetry and pharmacokinetic data from 4 clinical trials of 90Y-ibritumomab tiuxetan RIT for relapsed or refractory B-cell non-Hodgkin's lymphoma (NHL) were combined and assessed for correlations with toxicity data. Methods: Data from 179 patients were available for analysis. Common eligibility criteria included <25% bone marrow involvement by NHL, no prior myeloablative therapy, and no prior RIT. The baseline platelet count was required to be ≥100,000 cells/mm3 for the reduced 90Y-ibritumomab tiuxetan administered dose (7.4-11 MBq/kg [0.2-0.3 mCi/kg]) or ≥150,000 cells/mm3 for the standard 90Y-ibritumomab tiuxetan administered dose (15 MBq/kg [0.4 mCi/kg]). Patients were given a tracer administered dose of 185 MBq (5 mCi) 111In-ibritumomab tiuxetan on day 0, evaluated with dosimetry, and then a therapeutic administered dose of 7.4-15 MBq/kg (0.2-0.4 mCi/kg) 90Y-ibritumomab tiuxetan on day 7. Both ibritumomab tiuxetan administered doses were preceded by an infusion of 250 mg/m2 rituximab to clear peripheral B-cells and improve ibritumomab tiuxetan biodistribution. Residence times for 90Y in blood and major organs were estimated from 111In biodistribution, and the MIRDOSE3 computer software program was used, with modifications to account for patient-specific organ masses, to calculate radiation absorbed doses to organs and red marrow. Results: Median radiation absorbed doses for 90Y were 7.42 Gy to spleen, 4 50 Gy to liver, 2.11 Gy to lung, 0.23 Gy to kidney, 0.62 Gy (blood-derived method) and 0.97 Gy (sacral image-derived method) to red marrow, and 0.57 Gy to total body. The median effective blood half-life was 27 h, and the area under the curve (AUC) was 25 h. No patient failed to meet protocol-defined dosimetry safety criteria and all patients were eligible for treatment. Observed toxicity was primarily hematologic, transient, and reversible. Hematologic toxicity did not correlate with estimates of red marrow radiation absorbed dose, total-body radiation absorbed dose, blood effective half-life, or blood AUG. Conclusion: Relapsed or refractory NHL in patients with adequate bone marrow reserve and <25% bone marrow involvement by NHL can be treated safely with 90Y-ibritumomab tiuxetan RIT on the basis of a fixed, weight-adjusted dosing schedule. Dosimetry and pharmacokinetic results do not correlate with toxicity.

Original languageEnglish (US)
Pages (from-to)465-474
Number of pages10
JournalJournal of Nuclear Medicine
Volume44
Issue number3
StatePublished - Mar 2003

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Keywords

  • Y-ibritumomab tiuxetan
  • Dosimetry
  • Radioimmunotherapy
  • Rituximab

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology

Cite this

Wiseman, G. A., Kornmehl, E., Leigh, B., Erwin, W. D., Podoloff, D. A., Spies, S., Sparks, R. B., Stabin, M. G., Witzig, T. E., & White, C. A. (2003). Radiation dosimetry results and safety correlations from 90Y-ibritumomab tiuxetan radioimmunotherapy for relapsed or refractory non-Hodgkin's lymphoma: Combined data from 4 clinical trials. Journal of Nuclear Medicine, 44(3), 465-474.