Radioimmunotherapy using the radioactive drug yttrium-90 (90Y)
ibritumomab tiuxetan following chemotherapy with fludarabine and
mitoxantrone is feasible, well tolerated, and effective for follicular
non-Hodgkin's lymphoma (NHL) patients. This was published on March 13,
2008 in The Lancet Oncology.



Follicular lymphoma is cancer of the lymphocytes of the follicle center
B-lymphocytes. Approximately 30% of all newly diagnosed NHLs are
follicular lymphomas, making it the most common type of lymphoma in the
United States and Europe. Various trials have previously shown that the
combination of a chemotherapy regiment with rituximab, a targeted
B-cell lymphoma treatment that is not radioactive, will increase the
instance of progression-free survival in comparison with the
chemotherapy regimen alone. Similar to rituximab, 90Y-ibritumomab
tiuxetan is a drug which is able to target B-cell lymphomas by
attaching to specific surface proteins on the cells. However, once
attached, the radioactive yttrium-90 attacks and kills the highly
sensitive lymphoma cells as it emits β-radiation.



To discover the potential benefits of 90Y-ibritumombab
tiuxetan over rituximab, Professor Pier Luigi Zinzani, Institute of
Haematology and Oncology "L & A Seragnoli", University of
Bologna, Italy, and colleagues studied 61 patients in 13 different
institutions in Italy. All patients were administered six cycles of
oral fludarabine and intraveouns mitoxantrone. 57 of these were deemed
eligible for subsequent treatment with 90Y-ibritumomab tiuxetan, 43 of
these with a complete response (CR) to the therapy and 14 with partial
responses (PR).



12 of the 14 PRs reached complete response in the latter part of the
trial after the combined treatment regimen. With a followup of 30
months median, the three year progression free survival was estimated
at 76%, with a three year overall survival of 100%. 36 of the 57 total
patients showed grade 3 or 4 haemotological toxic effects.



The authors indicate that this study shows promise for combination
therapies using 90Y-ibritumomab tiuxetan. They conclude: "This study
has established the feasibility, tolerability, and efficacy of
sequential treatment with six cycles of fludarabine and mitoxantrone
chemotherapy followed by 90Y-ibritumombab tiuxetan as a front-line
treatment for untreated patients with follicular NHL. In particular,
the data represent the first evidence of a role of 90Y-ibritumombab
tiuxetan after a fludarabine-containing regimen in the treatment of
follicular NHL."



Fludarabine and mitoxantrone followed by yttrium-90
ibritumomab tiuxetan in previously untreated patients with follicular
non-Hodgkin lymphoma trial: a phase II non-randomised trial (FLUMIZ)

Pier Luigi Zinzani, Monica Tani, Alessandro Pulsoni, Marco Gobbi,
Alessio Perotti, Stefano De Luca, Alberto Fabbri, Alfonso Zaccaria,
Maria Teresa Voso, Pierpaolo Fattori, Luciano Guardigni, Sonia Ronconi,
Maria Giuseppina Cabras, Luigi Rigacci, Amalia De Renzo, Enrica Marchi,
Vittorio Stefoni, Mariapaola Fina, Cinzia Pellegrini, Gerardo Musuraca,
Enrico Derenzini, Stefano Pileri, Stefano Fanti, Pier Paolo Piccaluga,
Michele Baccarani 

The Lancet Online March 13, 2008  


DOI:10.1016/S1470-2045(08)70039-1

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Written by Anna Sophia McKenney


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