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Lymphoma Therapy
Virginia Barnes Planz, MD; Hollins Clark, MD
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KEY FACTS

  • Terminology

    • Preprocedure

      • Procedure

        • Outcomes

          TERMINOLOGY

          • Definitions

            • 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
            • Yttrium-90 ibritumomab tiuxetan (Zevalin)
              • 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 cells with CD20(+)
              • Tiuxetan: Metallic stabilizing agent used to link Y-90 and ibritumomab
            • Other RIT drug, I-131 tositumomab (Bexxar), discontinued in 2014 for commercial reasons, partly due to projected decline in sales
            • Rituximab (Rituxan)
              • Chimeric anti-CD20 monoclonal antibody (non-radiolabeled) primarily used as single agent or in combination with chemotherapy for lymphoma
              • Serves as "predose" agent for RIT: Administered as "cold" antibody before radiolabeled antibody
                • Saturates CD20 binding sites of B-cells in circulation and in spleen and promotes better binding of therapeutic dose to tumor

          PREPROCEDURE

          • Indications

            • Getting Started

              • Precautions

                PROCEDURE

                • Equipment Preparation

                  • Procedure Steps

                    POST PROCEDURE

                    • Expected Outcome

                      • Things To Do

                        • Things To Avoid

                          OUTCOMES

                          • Problems

                            Selected References

                            1. Prasad V: The withdrawal of drugs for commercial reasons: the incomplete story of tositumomab. JAMA Intern Med. 174(12):1887-8, 2014
                            2. 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
                            3. Goldsmith SJ: Radioimmunotherapy of lymphoma: Bexxar and Zevalin. Semin Nucl Med. 40(2):122-35, 2010
                            4. Wahl RL: Tositumomab and (131)I therapy in non-Hodgkin's lymphoma. J Nucl Med. 46 Suppl 1:128S-40S, 2005
                            5. Zevalin Dosing and Administration. Spectrum Pharmaceuticals, 2014
                            Related Anatomy
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                            Related Differential Diagnoses
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                            References
                            Tables

                            Tables

                            KEY FACTS

                            • Terminology

                              • Preprocedure

                                • Procedure

                                  • Outcomes

                                    TERMINOLOGY

                                    • Definitions

                                      • 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
                                      • Yttrium-90 ibritumomab tiuxetan (Zevalin)
                                        • 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 cells with CD20(+)
                                        • Tiuxetan: Metallic stabilizing agent used to link Y-90 and ibritumomab
                                      • Other RIT drug, I-131 tositumomab (Bexxar), discontinued in 2014 for commercial reasons, partly due to projected decline in sales
                                      • Rituximab (Rituxan)
                                        • Chimeric anti-CD20 monoclonal antibody (non-radiolabeled) primarily used as single agent or in combination with chemotherapy for lymphoma
                                        • Serves as "predose" agent for RIT: Administered as "cold" antibody before radiolabeled antibody
                                          • Saturates CD20 binding sites of B-cells in circulation and in spleen and promotes better binding of therapeutic dose to tumor

                                    PREPROCEDURE

                                    • Indications

                                      • Getting Started

                                        • Precautions

                                          PROCEDURE

                                          • Equipment Preparation

                                            • Procedure Steps

                                              POST PROCEDURE

                                              • Expected Outcome

                                                • Things To Do

                                                  • Things To Avoid

                                                    OUTCOMES

                                                    • Problems

                                                      Selected References

                                                      1. Prasad V: The withdrawal of drugs for commercial reasons: the incomplete story of tositumomab. JAMA Intern Med. 174(12):1887-8, 2014
                                                      2. 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
                                                      3. Goldsmith SJ: Radioimmunotherapy of lymphoma: Bexxar and Zevalin. Semin Nucl Med. 40(2):122-35, 2010
                                                      4. Wahl RL: Tositumomab and (131)I therapy in non-Hodgkin's lymphoma. J Nucl Med. 46 Suppl 1:128S-40S, 2005
                                                      5. Zevalin Dosing and Administration. Spectrum Pharmaceuticals, 2014