Adding radioimmunotherapy to chemo produces non-Hodgkin's lymphoma remission

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The addition of radioimmunotherapy (RIT) to chemotherapy for previously untreated patients with non-follicular indolent non-Hodgkin's lymphoma (NHL) proved to be well tolerated and effective, producing a 100 percent complete remission at the end of treatment. An estimated 89 percent of patients remained in remission at three years, according to results from a phase II clinical study, published in January issue of Cancer.

The study, conducted at the Institute of Hematology and Medical Oncology at University of Bologna, Italy, investigated the use of a single dose of Zevalin (Ibritumomab Tiuxetan) as consolidation therapy following treatment with a regimen of fludarabine and mitoxantrone (FM chemotherapy) among 26 patients with newly diagnosed non-follicular indolent NHL.

Results showed that in 50 percent of patients receiving FM chemotherapy achieved a complete remission (CR) and 30 percent achieve a partial remission (PR). Of the 20 patients (13 with CR and seven with PR) who were evaluable for Zevalin consolidation, 100 percent obtained a CR at the end of treatment. With a median follow up of 20 months, the estimated three-year progression free survival (PFS) was 89.5 percent. The most common greater than or equal to grade 3 toxicities included neutropenia (11 patients) and thrombocytopenia (16 patients).

The FM treatment was well-tolerated; there were no treatment-related deaths. According to the authors, “reversible hematologic toxicities included neutropenia grade 4 in five patients and grade 3 in 13 patients. Only one patient developed febrile neutropenia. Following Zevalin administration grade 3-4 thrombocytopenia occurred in 16 of 20 patients with grade 3-4 neutropenia reported in 11 of 20 patients. Four patients received GCSF and three patients received platelet transfusions. Only one patient experienced febrile neutropenia.”

The authors said that through this study, they established “the feasibility, tolerability and efficacy of sequential treatement with 6 cycles of FM chemotherapy followed by 90Y ibritumomab tiuxetan as front line therapy for patients with untreated, indolent, nonfollicular NHL.” To their knowledge, the authors said the data represent the first demonstration in the literature of the real role of 90Y ibritumomab tiuxetan in the treatment of indolent nonfollicular NHL.

“Because this novel sequential treatment appears to be promising compared with results reported for CHOP and CVP- containing regimens plus rituximab, we believe the current phase II trial represents an important first step and positive new angle in therapy to combat indolent, nonfollicular NHL,” the authors concluded.