Rituximab immunotherapy
combined with dexamethasone followed by 90Y-ibritumomab tiuxetan radioimmunotherapy in pretreated patients
with relapsed follicular lymphoma
Papajík T1., Szotkowski T.1, Procházka V.1, Kubová Z.1, Heinzová V.2, Brejcha M.3, Drymlová J.4, Buriánková E.4, Koranda P.4, Mysliveček M.4, Kučerová L.5, Indrák K.1
1Hemato-onkologická klinika FNO a LF UP v Olomouci, 2Hematologické a transfúzní oddělení nemocnice Opava, 3Onkologické centrum J. G. Mendela Nový Jičín, 4Klinika nukleární medicíny FNO a LF UP v Olomouci, 5Oddělení patologie FNO a LF UP v Olomouci |
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Summary:
The introduction of monoclonal antibody therapy has provided hope for the patients with follicular lymphoma (FL)
that their prognosis may be improved. Rituximab (anti-CD20 chimeric monoclonal antibody, MabThera®) has proven
to be highly effective and non-toxic targeted treatment of FL. The response rate and therapeutic benefit of
monoclonal antibodies seems to be enhanced by the use of radioisotope-labelled antibody therapy. 90Y-ibritumomab
tiuxetan (Zevalin®) was the first radioimmunotherapy (RIT) approved for the treatment in relapsed or refractory
FL and many clinical trials demonstrated its efficacy and safety even in patients with advanced stage disease. According
to new studies, RIT should be preferably used as consolidation treatment after tumor debulking. We report 3
patients with relapsed FL treated with four weekly doses of rituximab (375 mg/m2) and dexamethasone (20 mg/m2)
with respect to their age, previous therapy, concomitant diseases or some concerns about chemotherapy complications.
All patients responded to rituximab, but residual disease was demonstrated in each of them. Therefore, it was
decided to treat them with 90Y-ibritumomab tiuxetan RIT in a dose of 14,8 MBq/kg in two patients and 11,1 MBq/kg
in one patient (with platelet counts 125x109/l). Hematological nadirs were reached 4–6 weeks later, with one grade
3 neutropenia, one grade 4 and one grade 3 thrombocytopenia, respectively. Two patients had minor infection complications
(acute bronchitis and enteritis). From 2 to 3 months after radioimmunotherapy, the 18F-fluoro-deoxy-glucose
positron emission tomography (18F-FDG PET) analysis proved no accumulation of 18F-FDG in any lymph node
(LN) and computed tomography (CT) scans documented LN with the maximum size of 2x1 cm in two patients (one
CR, two CRu). Eleven, nine and seven months after RIT, the patients were subjectively well, clinically in durable
disease remission without any late complications
Key words:
folicullar lymphoma, 90Y-ibritumomab tiuxetan, rituximab, positron emission tomography, remission
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