link
Bookmarks
Lymphoma Therapy
Virginia Barnes Planz, MD; Hollins Clark, MD; Paige Bennett, MD
To access 4,300 diagnoses written by the world's leading experts in radiology, please log in or subscribe.Log inSubscribe

KEY FACTS

  • Terminology

    • Procedure

      • Outcomes

        TERMINOLOGY

        • Definitions

          • Y-90 ibritumomab tiuxetan (Zevalin) radioimmunotherapy (RIT)
            • Targeted therapy delivering localized radiation to tumor via monoclonal antibody (anti-CD20)
              • Epitope CD20 often expressed on B cells of non-Hodgkin lymphoma (NHL), pre-B cells, and mature B cells, but not plasma cells
              • Labeling anti-CD20 with radionuclide allows for 2 therapeutic mechanisms
                • Anti-CD20 promotes cellular apoptosis and delivers radionuclide to tumor
                • Emission of β particle from radionuclide provides local radiation to tumor cells
            • Physical t1/2 of 2.7 days; β decay, particle energy 2.3 MeV; particle path length 5.3 mm
            • Ibritumomab: Murine monoclonal antibody (anti-CD20), which binds to CD20(+) cells
            • Tiuxetan: Metallic stabilizing agent used to link Y-90 and ibritumomab
            • Tumor-absorbed radiation dose ~ 15 Gy (1,500 rad)
              • Tumor:Normal tissue = 7:1
          • Another RIT drug, I-131 tositumomab (Bexxar), was discontinued in 2014 for commercial reasons, partly due to projected decline in sales

        PREPROCEDURE

        • Indications

          • Getting Started

            • Precautions

              PROCEDURE

              • Equipment Preparation

                • Procedure Steps

                  POST PROCEDURE

                  • Expected Outcome

                    • Things To Do

                      • Things To Avoid

                        • Problems 

                          Selected References

                          1. Kitajima K et al: Early evaluation of tumor response to 90Y-ibritumomab radioimmunotherapy in relapsed/refractory B cell non-Hodgkin lymphoma: What is the optimal timing for FDG-PET/CT? Eur Radiol. 29(7):3935-44, 2019
                          2. Rizzieri D: Zevalin(®) (ibritumomab tiuxetan): After more than a decade of treatment experience, what have we learned? Crit Rev Oncol Hematol. 105:5-17, 2016
                          3. Prasad V: The withdrawal of drugs for commercial reasons: the incomplete story of tositumomab. JAMA Intern Med. 174(12):1887-8, 2014
                          4. Chamarthy MR et al: Radioimmunotherapy of non-Hodgkin's lymphoma: from the 'magic bullets' to 'radioactive magic bullets'. Yale J Biol Med. 84(4):391-407, 2011
                          5. Goldsmith SJ: Radioimmunotherapy of lymphoma: Bexxar and Zevalin. Semin Nucl Med. 40(2):122-35, 2010
                          Related Anatomy
                          Loading...
                          Related Differential Diagnoses
                          Loading...
                          References
                          Tables

                          Tables

                          KEY FACTS

                          • Terminology

                            • Procedure

                              • Outcomes

                                TERMINOLOGY

                                • Definitions

                                  • Y-90 ibritumomab tiuxetan (Zevalin) radioimmunotherapy (RIT)
                                    • Targeted therapy delivering localized radiation to tumor via monoclonal antibody (anti-CD20)
                                      • Epitope CD20 often expressed on B cells of non-Hodgkin lymphoma (NHL), pre-B cells, and mature B cells, but not plasma cells
                                      • Labeling anti-CD20 with radionuclide allows for 2 therapeutic mechanisms
                                        • Anti-CD20 promotes cellular apoptosis and delivers radionuclide to tumor
                                        • Emission of β particle from radionuclide provides local radiation to tumor cells
                                    • Physical t1/2 of 2.7 days; β decay, particle energy 2.3 MeV; particle path length 5.3 mm
                                    • Ibritumomab: Murine monoclonal antibody (anti-CD20), which binds to CD20(+) cells
                                    • Tiuxetan: Metallic stabilizing agent used to link Y-90 and ibritumomab
                                    • Tumor-absorbed radiation dose ~ 15 Gy (1,500 rad)
                                      • Tumor:Normal tissue = 7:1
                                  • Another RIT drug, I-131 tositumomab (Bexxar), was discontinued in 2014 for commercial reasons, partly due to projected decline in sales

                                PREPROCEDURE

                                • Indications

                                  • Getting Started

                                    • Precautions

                                      PROCEDURE

                                      • Equipment Preparation

                                        • Procedure Steps

                                          POST PROCEDURE

                                          • Expected Outcome

                                            • Things To Do

                                              • Things To Avoid

                                                • Problems 

                                                  Selected References

                                                  1. Kitajima K et al: Early evaluation of tumor response to 90Y-ibritumomab radioimmunotherapy in relapsed/refractory B cell non-Hodgkin lymphoma: What is the optimal timing for FDG-PET/CT? Eur Radiol. 29(7):3935-44, 2019
                                                  2. Rizzieri D: Zevalin(®) (ibritumomab tiuxetan): After more than a decade of treatment experience, what have we learned? Crit Rev Oncol Hematol. 105:5-17, 2016
                                                  3. Prasad V: The withdrawal of drugs for commercial reasons: the incomplete story of tositumomab. JAMA Intern Med. 174(12):1887-8, 2014
                                                  4. Chamarthy MR et al: Radioimmunotherapy of non-Hodgkin's lymphoma: from the 'magic bullets' to 'radioactive magic bullets'. Yale J Biol Med. 84(4):391-407, 2011
                                                  5. Goldsmith SJ: Radioimmunotherapy of lymphoma: Bexxar and Zevalin. Semin Nucl Med. 40(2):122-35, 2010