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Journal of Nuclear Medicine Vol. 43 No. 2 267-272
© 2002 by Society of Nuclear Medicine

Special Contributions

Administration Guidelines for Radioimmunotherapy of Non-Hodgkin’s Lymphoma with 90Y-Labeled Anti-CD20 Monoclonal Antibody

Henry N. Wagner, Jr., MD1, Gregory A. Wiseman, MD2, Carol S. Marcus, MD, PhD3, Hani A. Nabi, MD, PhD4, Conrad E. Nagle, MD5, Darlene M. Fink-Bennett, MD5, Dominick M. Lamonica, MD6 and Peter S. Conti, MD, PhD7

1 School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Maryland
2 Mayo Clinic and Mayo Foundation, Rochester, Minnesota
3 University of California, Los Angeles, California
4 State University of New York, Buffalo, New York
5 William Beaumont Hospital, Troy, Michigan
6 Roswell Park Cancer Institute, Buffalo, New York
7 University of Southern California, Los Angeles, California

90Y-ibritumomab tiuxetan is a novel radioimmunotherapeutic agent recently approved for the treatment of relapsed or refractory low-grade, follicular, or CD20+ transformed non-Hodgkin’s lymphoma (NHL). 90Y-ibritumomab tiuxetan consists of a murine monoclonal antibody covalently attached to a metal chelator, which stably chelates 111In for imaging and 90Y for therapy. Both health care workers and patients receiving this therapy need to become familiar with how it differs from conventional chemotherapy and what, if any, safety precautions are necessary. Because 90Y is a pure ß-emitter, the requisite safety precautions are not overly burdensome for health care workers or for patients and their families. 90Y-ibritumomab tiuxetan is dosed on the basis of the patient’s body weight and baseline platelet count; dosimetry is not required for determining the therapeutic dose in patients meeting eligibility criteria similar to those used in clinical trials, such as <25% lymphomatous involvement of the bone marrow. 111In- and 90Y-ibritumomab tiuxetan are labeled at commercial radiopharmacies and delivered for on-site dose preparation and administration. Plastic and acrylic materials are appropriate for shielding during dose preparation and administration; primary lead shielding should be avoided because of the potential exposure risk from bremsstrahlung. Because there are no penetrating {gamma}-emissions associated with the therapy, 90Y-ibritumomab tiuxetan is routinely administered on an outpatient basis. Furthermore, the risk of radiation exposure to patients’ family members has been shown to be in the range of background radiation, even without restrictions on contact. There is therefore no need to determine activity limits or dose rate limits before patients who have been treated with 90Y radioimmunotherapy are released, as is necessary with patients who have been treated with radiopharmaceuticals that contain 131I. Standard universal precautions for handling body fluids are recommended for health care workers and patients and their family members after 90Y-ibritumomab tiuxetan administration. In summary, 90Y-ibritumomab tiuxetan introduces 90Y into clinical practice and expands the role nuclear medicine plays in the care of patients with cancer. Understanding the unique properties of this novel radioimmunoconjugate will facilitate its safe and effective use.

Key Words: radioimmunotherapy • non-Hodgkin’s lymphoma • 90Y-ibritumomab tiuxetan • anti-CD20 monoclonal antibodies • guidelines




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