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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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
Externally publishedYes

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Radioimmunotherapy
Follicular Lymphoma
Non-Hodgkin's Lymphoma
Therapeutics
Rituximab
ibritumomab tiuxetan
Indium
Neutropenia
Anemia
Blood Cells
B-Lymphocytes
Outpatients
Radiation
Antigens

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Witzig, T. E., Flinn, I. W., Gordon, L. I., Emmanouilides, C., Czuczman, M. S., Saleh, M. N., ... 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

Treatment with ibritumomab tiuxetan radioimmunotherapy in patients with rituximab-refractory follicular non-Hodgkin's lymphoma. / Witzig, Thomas E.; Flinn, Ian W.; Gordon, Leo I.; Emmanouilides, Christos; Czuczman, Myron S.; Saleh, Mansoor N.; Cripe, Larry; Wiseman, Gregory; Olejnik, Teresa; Multani, Pratik S.; White, Christine A.

In: Journal of Clinical Oncology, Vol. 20, No. 15, 01.08.2002, p. 3262-3269.

Research output: Contribution to journalArticle

Witzig, TE, Flinn, IW, Gordon, LI, Emmanouilides, C, Czuczman, MS, Saleh, MN, Cripe, L, Wiseman, G, Olejnik, T, Multani, PS & White, CA 2002, 'Treatment with ibritumomab tiuxetan radioimmunotherapy in patients with rituximab-refractory follicular non-Hodgkin's lymphoma', Journal of Clinical Oncology, vol. 20, no. 15, pp. 3262-3269. https://doi.org/10.1200/JCO.2002.11.017
Witzig, Thomas E. ; Flinn, Ian W. ; Gordon, Leo I. ; Emmanouilides, Christos ; Czuczman, Myron S. ; Saleh, Mansoor N. ; Cripe, Larry ; Wiseman, Gregory ; Olejnik, Teresa ; Multani, Pratik S. ; White, Christine A. / Treatment with ibritumomab tiuxetan radioimmunotherapy in patients with rituximab-refractory follicular non-Hodgkin's lymphoma. In: Journal of Clinical Oncology. 2002 ; Vol. 20, No. 15. pp. 3262-3269.
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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-na{\"i}ve 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.",
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AU - Emmanouilides, Christos

AU - Czuczman, Myron S.

AU - Saleh, Mansoor N.

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