High-dose chemo-radioimmunotherapy with autologous stem cell support for relapsed mantle cell lymphoma.

Abstract

Relapsed mantle cell lymphoma is a radiation-sensitive malignancy that is unlikely to be cured by treatment with conventional high-dose therapy and autologous stem cell transplantation. We tested the safety and efficacy of using a CD20-specific monoclonal antibody conjugated with (131)I to deliver high-dose radiation selectively to all lymphoma sites. Patients with relapsed or refractory mantle cell lymphoma received infusions of (131)I-labeled CD20-specific monoclonal antibody (Tositumomab). The antibody dose was 1.7 mg/kg body weight, and the amount of (131)I was calibrated to deliver 20 to 25 Gy to vital normal organs. This treatment was followed 10 days later by administration of high-dose etoposide (30-60 mg/kg), cyclophosphamide (60-100 mg/kg), and infusion of cryopreserved autologous stem cells. The 16 patients in this study had received a median of 3 prior treatments, and 7 had chemotherapy-resistant disease. The median dose of (131)I was 510 mCi (18.87 GBq). There were no therapy-related deaths. Among the 11 patients with conventionally measurable disease at the time of treatment, the respective complete and overall response rates were 91% and 100%. Fifteen patients remain alive, and 12 have had no progression of lymphoma at 6 to 57 months from transplantation and 16 to 97 months from diagnosis. Overall survival at 3 years from transplantation is estimated at 93%, and progression-free survival is estimated at 61%. High-dose treatment with (131)I-Tositumomab, etoposide, and cyclophosphamide results in a high remission rate and may provide long-term disease-free survival for patients with relapsed or refractory mantle cell lymphoma.

• Authors: Ajay K Gopal, Joseph G Rajendran, Stephen H Petersdorf, David G Maloney, Janet F Eary, Brent L Wood, Theodore A Gooley, Sharon A Bush, Lawrence D Durack, Paul J Martin, Dana C Matthews, Frederick R Appelbaum, Irwin D Bernstein, Oliver W Press
• Journal: Blood (Blood) Vol. 99 Issue 9 Pg. 3158-62 (May 01 2002) ISSN: 0006-4971 [Print] United States
• PMID: 11964278 (Publication Type: Clinical Trial, Clinical Trial, Phase I, Clinical Trial, Phase II, Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Antibodies, Monoclonal
• Iodine Radioisotopes
• tositumomab I-131

Topics

• Adult
• Antibodies, Monoclonal (administration & dosage, therapeutic use, toxicity)
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, toxicity)
• Combined Modality Therapy (methods)
• Disease-Free Survival
• Hematopoietic Stem Cell Transplantation (mortality)
• Humans
• Iodine Radioisotopes (therapeutic use)
• Lymphoma, Mantle-Cell (mortality, radiotherapy, therapy)
• Middle Aged
• Radioimmunotherapy (methods)
• Remission Induction
• Salvage Therapy
• Survival Rate
• Transplantation, Autologous