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131I-Tositumomab (Bexxar®) vs.90Y-Ibritumomab (Zevalin®) Therapy of Low-Grade Refractory/Relapsed Non-Hodgkin Lymphoma

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Abstract

Introduction

The American Cancer Society estimated 66,120 new cases of non-Hodgkin lymphoma (NHL) in the USA in 2008. Radioimmunotherapy has been shown in clinical trials to be an effective treatment for refractory/relapsed NHL. The available agents are Bexxar®, a 131I radiolabeled murine monoclonal antibody and Zevalin®, a 90Y radiolabeled murine antibody. Both target CD20 receptors present on the surface of lymphocytes. We present our clinical experience with Bexxar® and Zevalin® in the management of low-grade refractory or relapsed NHL.

Methods

This is a retrospective study (Jan 2000–Jul 2006) of 67 patients with NHL, who were treated with Bexxar® (31 patients, group A) or Zevalin® (36 patients, group B) for refractory/relapsed disease. Group A included 16 men and 15 women, 35–81 years old (average, 59.3 ± 13.4). Group B included 27 men and nine women, 36–85 years old (average, 55.4 ± 13.8). Therapeutic doses ranged 40–138 mCi (average, 78.1 ± 28.2) for Bexxar® and 17–34 mCi (average, 28.8 ± 4.37) for Zevalin®.

Results

Objective responses were induced in 22 of the 31 patients (70.9%) in group A and 28 of the 36 patients (77.8%) in group B. Complete response was noted in 11 patients (35.5%), partial response in seven patients (22.6%), and mixed response in four patients (12.9%) in group A. There were five patients (16.1%) with stable disease and four patients (12.9%) with disease progression in the same group. Complete response was noted in 15 patients (41.7%), partial response in nine patients (25%), and mixed response in four patients (11.1%) in group B. There were four patients (11.1%) with stable disease and another four patients (11.1%) with disease progression in the same group. The average decreases at posttherapy nadir were 36.9% ± 0.33 (group A) and 52.6% ± 0.32 (group B) for platelets, 27.8% ± 0.27 (group A) and 34.2% ± 0.38 (group B) for leukocytes, and 4.9% ± 0.15 (group A) and 7.6% ± 0.11 (group B) for hemoglobin. Grades 3 and 4 hematological toxicity occurred in 14 patients (45.2%) treated with Bexxar® and 22 patients (61.1%) treated with Zevalin®, but was reversible.

Conclusion

Our study suggests that clinical practice of Bexxar® and Zevalin® radioimmunotherapy is an effective and safe adjunctive treatment for patients with NHL refractory/relapsed to conventional treatment. However, due to the small number of subjects, it was not possible to determine whether differences in the outcomes or toxicities from the two agents were statistically significant.

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Authors and Affiliations

  1. Division of Nuclear Medicine, Stanford University Medical Center, 300 Pasteur Dr, Room H-0101, Stanford, CA, 94305, USA

    Andrei Iagaru, Erik S. Mittra & Michael L. Goris

  2. Division of Medical Oncology, Stanford University Medical Center, Stanford, CA, USA

    Kristen Ganjoo

  3. Division of Radiation Oncology, Stanford University Medical Center, Stanford, CA, USA

    Susan J. Knox

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  1. Andrei Iagaru
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  2. Erik S. Mittra
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  3. Kristen Ganjoo
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  4. Susan J. Knox
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  5. Michael L. Goris
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Correspondence to Andrei Iagaru.

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Iagaru, A., Mittra, E.S., Ganjoo, K. et al. 131I-Tositumomab (Bexxar®) vs.90Y-Ibritumomab (Zevalin®) Therapy of Low-Grade Refractory/Relapsed Non-Hodgkin Lymphoma. Mol Imaging Biol 12, 198–203 (2010). https://doi.org/10.1007/s11307-009-0245-9

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  • DOI: https://doi.org/10.1007/s11307-009-0245-9

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