Treatment with ibritumomab tiuxetan radioimmunotherapy in patients with rituximab-refractory follicular non-Hodgkin's lymphoma

Thomas E. Witzig, Ian W. Flinn, Leo I. Gordon, Christos Emmanouilides, Myron S. Czuczman, Mansoor N. Saleh, Larry Cripe, Gregory Wiseman, Teresa Olejnik, Pratik S. Multani, Christine A. White

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567 Scopus citations

Abstract

Purpose: Rituximab is commonly used as a single agent or in combination therapy for non-Hodgkin's lymphoma (NHL). Ibritumomab tiuxetan radioimmunotherapy targets the same antigen as rituximab and has demonstrated efficacy in rituximab-naïve NHL. This study evaluated ibritumomab tiuxetan in the treatment of rituximab-refractory follicular NHL. Patients and Methods: Eligible patients were refractory to rituximab; this was defined as no objective response to rituximab (375 mg/m2 weekly for 4 weeks) or time to progression (TTP) of ≤ 6 months. The ibritumomab tiuxetan treatment regimen consisted of pretreatment with rituximab (250 mg/m2 intravenously on days 1 and 8) to deplete peripheral blood B cells, then yttrium-90 ibritumomab tiuxetan (0.4 mCi/ kg; maximum, 32 mCi) intravenously on day 8, administered on an outpatient basis. An imaging/dosimetry dose of indium-111 ibritumomab tiuxetan (5 mCi) was injected after rituximab (day 1) in 28 patients. Results: Fifty-seven patients were treated. The median age was 54 years, 74% had tumors ≥ 5 cm, and all were extensively pretreated (median, four prior therapies; range, one to nine). The estimated radiation-absorbed doses to healthy organs were below the study-defined limit in all patients studied with dosimetry. The overall response rate for the 54 patients with follicular NHL was 74% (15% complete responses and 59% partial responses). The Kaplan-Meier-estimated TTP was 6.8 months (range, 1.1 to ≥ 25.9 months) for all patients and 8.7 months for responders. Adverse events were primarily hematologic; the incidence of grade 4 neutropenia, thrombocytopenia, and anemia was 35%, 9%, and 4%, respectively. Conclusion: Ibritumomab tiuxetan radioimmunotherapy is effective in rituximab-refractory patients. The only significant toxicity is hematologic.

Original languageEnglish (US)
Pages (from-to)3262-3269
Number of pages8
JournalJournal of Clinical Oncology
Volume20
Issue number15
DOIs
StatePublished - Aug 1 2002

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Witzig, T. E., Flinn, I. W., Gordon, L. I., Emmanouilides, C., Czuczman, M. S., Saleh, M. N., Cripe, L., Wiseman, G., Olejnik, T., Multani, P. S., & White, C. A. (2002). Treatment with ibritumomab tiuxetan radioimmunotherapy in patients with rituximab-refractory follicular non-Hodgkin's lymphoma. Journal of Clinical Oncology, 20(15), 3262-3269. https://doi.org/10.1200/JCO.2002.11.017