Follow-up of relapsed B-cell lymphoma patients treated with iodine-131-labeled anti-CD20 antibody and autologous stem-cell rescue.

Abstract

PURPOSE:

Radioimmunotherapy (RIT) is a promising treatment approach for B-cell lymphomas. This is our first opportunity to report long-term follow-up data and late toxicities in 29 patients treated with myeloablative doses of iodine-131-anti-CD20 antibody (anti-B1) and autologous stem-cell rescue.

PATIENTS AND METHODS:

Trace-labeled biodistribution studies first determined the ability to deliver higher absorbed radiation doses to tumor sites than to lung, liver, or kidney at varying amounts of anti-B1 protein (0.35, 1.7, or 7 mg/kg). Twenty-nine patients received therapeutic infusions of single-agent (131)I-anti-B1, given at the protein dose found optimal in the biodistribution study, labeled with amounts of (131)I (280 to 785 mCi [10.4 to 29.0 GBq]) calculated to deliver specific absorbed radiation doses to the normal organs, followed by autologous stem-cell support.

RESULTS:

Major responses occurred in 25 patients (86%), with 23 complete responses (CRs; 79%). The nonhematopoietic dose-limiting toxicity was reversible cardiopulmonary insufficiency, which occurred in two patients at RIT doses that delivered > or = 27 Gy to the lungs. With a median follow-up time of 42 months, the estimated overall and progression-free survival rates are 68% and 42%, respectively. Currently, 14 of 29 patients remain in unmaintained remissions that range from 27+ to 87+ months after RIT. Late toxicities have been uncommon except for elevated thyroid-stimulating hormone (TSH) levels found in approximately 60% of the subjects. Two patients developed second malignancies, but none have developed myelodysplasia (MDS).

CONCLUSION:

Myeloablative (131)I-anti-B1 RIT is relatively well tolerated when given with autologous stem-cell support and often results in prolonged remission durations with few late toxicities.

• Authors: S Y Liu, J F Eary, S H Petersdorf, P J Martin, D G Maloney, F R Appelbaum, D C Matthews, S A Bush, L D Durack, D R Fisher, T A Gooley, I D Bernstein, O W Press
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 16 Issue 10 Pg. 3270-8 (Oct 1998) ISSN: 0732-183X [Print] United States
• PMID: 9779701 (Publication Type: Clinical Trial, Clinical Trial, Phase I, Clinical Trial, Phase II, Journal Article, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Antibodies, Monoclonal
• Antigens, CD20
• Iodine Radioisotopes
• tositumomab I-131

Topics

• Adult
• Antibodies, Monoclonal (adverse effects, therapeutic use)
• Antigens, CD20 (immunology)
• Disease-Free Survival
• Female
• Follow-Up Studies
• Hematopoietic Stem Cell Transplantation
• Humans
• Iodine Radioisotopes (adverse effects, therapeutic use)
• Lymphoma, B-Cell (immunology, therapy)
• Male
• Middle Aged
• Radioimmunotherapy (adverse effects)
• Radiotherapy Dosage
• Recurrence
• Remission Induction