Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2013 Jun;4(6):899-910.
doi: 10.18632/oncotarget.1037.

Myeloablative anti-CD20 radioimmunotherapy +/- high-dose chemotherapy followed by autologous stem cell support for relapsed/refractory B-cell lymphoma results in excellent long-term survival

Julia Y Wagner  1 , Kathleen Schwarz, Susanne Schreiber, Burkhard Schmidt, Hans-Jürgen Wester, Markus Schwaiger, Christian Peschel, Christoph von Schilling, Klemens Scheidhauer, Ulrich Keller
Affiliations
Clinical Trial

Myeloablative anti-CD20 radioimmunotherapy +/- high-dose chemotherapy followed by autologous stem cell support for relapsed/refractory B-cell lymphoma results in excellent long-term survival

Julia Y Wagner et al. Oncotarget. 2013 Jun.

Abstract

Background: Radioimmunotherapy (RIT) has been used to treat relapsed/refractory CD20+ Non-Hodgkin lymphoma (NHL). Myeloablative anti-CD20 RIT followed by autologous stem cell infusion (ASCT) enables high radiation doses to lymphoma sites. We performed a phase I/II trial to assess feasibility and survival.

Methods: Twenty-three patients with relapsed/refractory NHL without complete remission (CR) to salvage chemotherapy were enrolled to evaluate RIT with Iodine-131 labelled rituximab (131I-rituximab) in a myeloablative setting. Biodistribution and dosimetric studies were performed to determine 131I activity required to induce a total body dose of 21-27Gy to critical organs. In 6/23 patients RIT was combined with high-dose chemotherapy. 8/23 patients received a sequential high-dose chemotherapy with a second ASCT. The median follow-up is 9.5 years.

Results: 6.956-19.425GBq of 131I was delivered to achieve the limiting organ dose to lungs or kidneys. No grade III/IV non-hematologic toxicity was seen with RIT alone. Significant grade III/IV toxicity (mucositis, fever, infection, one therapy related death) was observed in patients treated with RIT combined with high-dose chemotherapy. The overall response rate was 87% (64% CR). The median progression-free (PFS) and overall survival (OS) is 47.5 and 101.5 months. An international prognostic index score >1 was predictive for OS.

Conclusion: Myeloablative RIT with 131I-rituximab followed by ASCT is feasible, well-tolerated and effective in high risk CD20+ NHL. Combination of RIT and high-dose chemotherapy increased toxicity significantly. Long-term results for PFS and OS are encouraging.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Treatment schedule
Figure 2
Figure 2. Overall survival (OS) and Progression-free survival (PFS) in all participating patients
Figure 3
Figure 3. (A) Overall survival and (B) Progression-free survival according to treatment modality. (C) Overall survival and (D) Progression-free survival of patients who received RIT alone versus patients who received combined RIT/HD-CTX or RIT/BEAM sequentially
See this image and copyright information in PMC

Comment in

References

    1. Swerdlow SHC E, Harris N.L, Jaffe E.S, Pileri S.A, Stein H, Thiele J, Vardiman J.W. (Lyon: International Agency for Research on Cancer); 2008. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues.
    1. DeNardo SJ, DeNardo GL, O'Grady LF, Macey DJ, Mills SL, Epstein AL, Peng JS, McGahan JP. Treatment of a patient with B cell lymphoma by I-131 LYM-1 monoclonal antibodies. Int J Biol Markers. 1987;2(1):49–53. - PubMed
    1. Parker BA, Vassos AB, Halpern SE, Miller RA, Hupf H, Amox DG, Simoni JL, Starr RJ, Green MR, Royston I. Radioimmunotherapy of human B-cell lymphoma with 90Y-conjugated antiidiotype monoclonal antibody. Cancer Res. 1990;50(3 Suppl):1022s–1028s. - PubMed
    1. Kaminski MS, Zasadny KR, Francis IR, Milik AW, Ross CW, Moon SD, Crawford SM, Burgess JM, Petry NA, Butchko GM, et al. Radioimmunotherapy of B-cell lymphoma with [131I]anti-B1 (anti-CD20) antibody. N Engl J Med. 1993;329(7):459–465. - PubMed
    1. Kaminski MS, Zasadny KR, Francis IR, Fenner MC, Ross CW, Milik AW, Estes J, Tuck M, Regan D, Fisher S, Glenn SD, Wahl RL. Iodine-131-anti-B1 radioimmunotherapy for B-cell lymphoma. J Clin Oncol. 1996;14(7):1974–1981. - PubMed

Publication types

MeSH terms

LinkOut - more resources