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First published online October 17, 2007, 10.2967/jnumed.107.043489
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Journal of Nuclear Medicine Vol. 48 No. 11 1767-1776
© 2007 by Society of Nuclear Medicine
doi: 10.2967/jnumed.107.043489

Clinical Investigation

Comparison of 90Y-Ibritumomab Tiuxetan and 131I-Tositumomab in Clinical Practice

Heather A. Jacene*, Ross Filice*, Wayne Kasecamp and Richard L. Wahl

Russell H. Morgan Department of Radiology and Radiological Science, Division of Nuclear Medicine, Johns Hopkins University, Baltimore, Maryland

Correspondence: For correspondence or reprints contact: Richard L. Wahl, MD, 601 N. Caroline St., JHOC 3223, Baltimore, MD 21287. E-mail: rwahl{at}jhmi.edu

We retrospectively evaluated our single-center clinical experience with 90Y-ibritumomab tiuxetan and 131I-tositumomab for therapy of refractory non-Hodgkin's lymphoma (NHL). We evaluated the hypothesis that the patient-specific dosing regimen used with 131I-tositumomab results in less bone marrow toxicity than does the weight-based dosing regimen used with 90Y-ibritumomab tiuxetan. Methods: Thirty-eight patients (25 male and 13 female; median age, 64 y) received radioimmunotherapy for NHL (20 received 90Y-ibritumomab tiuxetan; 18 received 131I-tositumomab). Patient and disease characteristics were evaluated to determine whether any were prognostic indicators of short- or long-term clinical response. The 12-wk response rate and clinical and hematologic toxicities attributable to each therapy were assessed. The response rate at 12 wk was correlated with long-term overall survival. Results: Twenty-six patients received full-radiation-dose radioimmunotherapy and 12 received attenuated doses because of hematologic concerns. The 12-wk overall response rate for all patients was 47%, and the complete response rate was 13%. The 12-wk overall response rate did not significantly differ between the 90Y-ibritumomab tiuxetan and 131I-tositumomab groups. Responses at 12 wk were more frequent in patients with normal levels of serum lactate dehydrogenase, no bone marrow involvement, and International Prognostic Index scores of no more than 2 (P ≤ 0.04). Grade 3 or 4 thrombocytopenia occurred in 57% and 56% of patients treated with 90Y-ibritumomab tiuxetan and 131I-tositumomab, respectively. Grade 3 or 4 neutropenia was observed in 57% and 50%, respectively. The time to the absolute neutrophil count nadir was shorter for the 90Y-ibritumomab tiuxetan group than for the 131I-tositumomab group (36 ± 9 vs. 46 ± 14 d, P = 0.01). The mean percentage decline in platelet count after radioimmunotherapy was greater in the 90Y-ibritumomab tiuxetan group than in the 131I-tositumomab group (79% ± 17% vs. 63% ± 28%, P = 0.04). Overall survival was longer in responders than in nonresponders 12 wk after therapy (P ≤ 0.05). Conclusion: Both 90Y-ibritumomab tiuxetan and 131I-tositumomab were well tolerated. We observed response rates at the lower range of those reported in the literature, possibly because of referral bias, dose attenuation, and reasonably liberal acceptance criteria for a patient to receive therapy. Initial response assessments 12 wk after radioimmunotherapy predict longer-term response. 131I-tositumomab caused significantly less severe declines in platelet counts than did 90Y-ibritumomab tiuxetan and may be a more appropriate choice for patients with limited bone marrow reserve, but large, randomized, prospective trials are needed to better compare the performance of these 2 treatments.

Key Words: radioimmunotherapy • 90Y-ibritumomab tiuxetan • 131I-tositumomab • Zevalin • Bexxar • dosimetry

* Contributed equally to this work.

COPYRIGHT © 2007 by the Society of Nuclear Medicine, Inc.


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