RIT Conditioning with Zevalin Prior to Autologous Transplantation Improves Overall Survival in Patients with DLCL

Radioimmunotherapy conditioning with Zevalin® (ibritumomab tiuxetan) prior to autologous stem cell transplantation in patients with diffuse large cell lymphoma offers a similar relapse incidence to total body irradiation, but has lower toxicity and improved overall survival, according to the results of a study published in Biol Blood Marrow Transplant.

Non-Hodgkin’s lymphoma (NHL) refers to a group of cancers that originate in different cells of the immune system. Diffuse large cell NHL (DLCL) is considered an aggressive type of NHL.

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 matched cohort analysis of autologous transplant conditioning regimens for DLCL in 92 patients. Patients were treated either with Zevalin plus BEAM (BCNU, etoposide, cytarabine, melphalan) (Z-BEAM) or with total body irradiation (TBI) plus etoposide and cyclophosphamide.

At four years, the results indicated that overall survival in the Z-BEAM group was 81 percent compared with 52.7 percent in the TBI group. The four-year cumulative incidence of relapse/progression was 40.4 percent in the Z-BEAM group and 42.1 percent in the TBI group. Nonrelapse mortality was superior in the Z-BEAM group—0 percent compared with 15.8 percent in the TBI group. Patients in the TBI group had higher rates of cardiac toxicity, whereas patients in the Z-BEAM group had higher rates of pulmonary toxicity.

The researchers concluded that the radioimmunotherapy-based conditioning regimen with Zevalin had a similar relapse incidence to TBI and resulted in improved overall survival, particularly in patients with more than two prior regimens.

Reference:

Krishnan A, Palmer JM, Tsai NC, et al. Matched-cohort analysis of autologous hematopoietic cell transplantation with radioimmunotherapy versus total body irradiation-based conditioning for poor-risk diffuse large cell lymphoma. Biol Blood Marrow Transplant. 2012; 18: 441-450.

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