Radioimmunotherapy of Lymphomas
Radioimmunotherapy (RIT) using radionuclide labeled anti-CD20 monoclonal antibodies allows for the delivery of the radionuclides directly to the surface of targeted B-cell non-Hodgkin’s lymphoma (NHL) achieving additional cytotoxic effect.
Actually the only RIT agent is 90Y-ibritumomab tiuxetan registered and commercialized as Zevalin® in the USA since February 2002 and in European Union since 2004.
In the first part, the main characteristics of the radiopharmaceutical are described including the different steps of RIT, i.e., radiolabeling and quality control procedure, the preparation of the patients for the treatment, the preparation and administration of the individual dose, and the main contraindications, risks, and collateral effects. The entire procedure reported in this chapter follows the Annex I summary of product characteristics.
In the second part dedicated to radiation protection issue, the current modalities of the treatment are reported in order to obtain the best clinical results and at the same time to respect the radiation protection recommendations, considering the patients, their relatives, and the nuclear medicine staff.
In the third part on clinical experience with Zevalin®, the most important clinical results are discussed. These studies highlight the safety and efficacy of the treatment especially in relapsed/refractory low-grade follicular lymphoma but also in other CD20-positive lymphomas. Despite these evidences, 90Y-ibritumomab tiuxetan during the time missed its high initial interest for hematologists, and at present its use became limited for various reasons. These treatments in different countries require protected dedicated rooms not always available in all hospitals; the use of this radioisotope therapy includes several complex multidisciplinary steps, and some alternative nonradioactive options to 90Y-ibritumomab tiuxetan have demonstrated several comparable advantages in terms of feasibility and efficacy. However this targeted therapy still remains an important example of the successful therapeutic use of radiolabeled antibodies in the clinical routine of hematology.
Keywords90Y-Zevalin Radioimmunotherapy Radiolabeling Radiation protection
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