Clinical utility of Y-90 Zevalin

Full text: Y-90 Zevalin (tiuxetan ibritumomab) therapy was recently approved for routine treatment of non-Hodgkin's lymphoma. We therefore reviewed the results of our first non-research use of the drug administered between December 2003 and March 2006. 18 patients, 11(61%) males and 7(39%) females with an age range 39-75 years (mean 58.5) years were treated. 13(72%) patients had Follicular Lymphoma, 3(16%) had DLBCL, 1(6%) had T-cell rich B-cell lymphoma and 1(6%) had Mantle cell lymphoma. Previous treatments included chemotherapy, Rituximab, stem cell transplant and external beam radiation. 1 patient received therapy as a first line treatment while one patient as a second line treatment, the rest had undergone multiple treatments. Patients were given therapy IV with activity range 500-1200MBq mean activity of 1054.3MBq. There were 15 (82%) patients who had no immediate side effects. 1 (6%) patient had severe bronchospasm during the Y-90 Zevalin infusion, while 1 (6%) patient reported nausea and vomiting on the third day post therapy. 1 (6%) patient complained of fatigue. There were 13 patients who had delayed side 5(28%) patients developed thrombocytopenia, one of which required treatment. 4(22%) developed pancytopenia, of which three required treatment. 1(6%) patient experienced a transient rash and 1(6%) patient developed anaemia. At the current time 13(72%) patients are alive; 5(28%) are deceased. At present a total of 7 (41%) patients are in complete remission (CR), 1 (6%) patient has had a partial response (PR), 2 (12%) patients have stable disease (SD) and 7(41%) patients have progressive disease (PD). 5 out of 7 patients with PD have died. 2 patients initially had CR and PR post therapy but subsequently progressed. All but one CR was in follicular lymphoma the other being in the Mantle cell lymphoma. Conclusion: The overall response rate was 47%. Of the Follicular Lymphoma patients 6(50%) had CR, 1 (8%) had PR, 2 (17%) had SD and 3 (25%) had PD. It was too soon to assess 1 patient. The overall response rate in the Follicular Lymphoma patients was 58%. (author)