Zevalin Plus Nonmyeloablative Allogeneic Transplantation Effective in High-Risk B-Cell NHL
The addition of Zevalin® (ibritumomab tiuxetan) to nonmyeloablative allogeneic transplantation (NMAT) is safe and produces early responses and prolonged disease control in high-risk patients with B-cell non-Hodgkin’s lymphoma, according to the results of a study published in Blood.
Non-Hodgkin’s lymphoma (NHL) is a form of cancer that begins in the cells of the lymph system. The lymph system includes the spleen, thymus, tonsils, bone marrow, lymph nodes, and circulating immune cells. The main cells in the lymph system are lymphocytes, of which there are two types: B and T-cells. Patients with heavily pretreated B-cell NHL along with comorbidities such as advancing age have few effective treatment options and little chance for cure. NMAT has the potential to eradicate disease in these patients.
Zevalin is a type of radioimmunotherapy treatment (RIT) that combines the monoclonal antibody Rituxan® (rituximab) with Zevalin, which is comprised of an anti-CD20 monoclonal antibody and Yttrium-90, a radioisotope that delivers the radiation. When injected into the body, Zevalin attaches to a protein (CD20) found only on the surface of B-lymphcytes, such as cancerous B-cells found in many forms of non-Hodgkin’s lymphoma. The radioactivity that is spontaneously emitted targets the B-cell and destroys it. This approach protects healthy tissue.
Zevalin has been shown to be a highly effective treatment-and has the added benefit of being administered over a single short period of time. Zevalin is administered on an outpatient basis and the total duration of therapy is less than 10 days. Zevalin offers active patients the opportunity to spend less time undergoing treatment than more conventional chemotherapy.
Researchers conducted a study that included 40 patients with persistent, high-risk B-cell NHL. The goal was to evaluate whether the addition of Zevalin to NMAT would deliver safe and effective cytoreduction and provide additional time for the allogeneic graft to take effect. Patients receive Zevalin, fludarabine, and 2 Gy of total body irradiation as conditioning prior to the allogeneic transplant.
The results indicated that 60 percent of patients achieved early responses—14 patients with complete remission or complete remission unconfirmed and 10 with partial response, including 17 of 29 patients (59%) with chemotherapy-resistant disease and 10 patients (59%) with bulk greater than 5 cm. The estimated 30-month survival was 54.1 percent, progression-free survival was 31.1 percent, and nonrelapse mortality was 15.9 percent.
The researchers concluded that the addition of Zevalin to NMAT is safe and yields early responses and prolonged disease control in persistent high-risk B-Cell NHL.
Gopal AK, Guthrie KA, Rajendran J, et al. Y-ibritumomab tiuxetan, fludarabine, and TBI-based nonmyeloablative allogeneic transplantation conditioning for patients with persistent high-risk B-cell lymphoma. Blood. 2011; 118(4): 1132-1139.
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