Dose-attenuated radioimmunotherapy with tositumomab and iodine 131 tositumomab in patients with recurrent non-Hodgkin's lymphoma (NHL) and extensive bone marrow involvement

Jodi Mones, Morton Coleman, Lale Kostakoglu, Richard R. Furman, Amy Chadburn, Tsiporah B. Shore, Daniel Muss, Patricia Stewart, Stewart Kroll, Shankar Vallabhajosula, Stanley J. Goldsmith, John P. Leonard

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Abstract

Radioimmunotherapy (RIT) with tositumomab and iodine 131 tositumomab can produce durable and complete responses in relapsed/refractory low-grade Non-Hodgkin's lymphoma. Patients with bone marrow involvement (BMI) with tumor > 25% of the intertrabecular space are generally excluded from RIT because of risk of excessive hematologic toxicity. The authors conducted a dose-escalation study of tositumomab and iodine 131 tositumomab to determine whether RIT is feasible in this population. Patients had baseline BMI of >25% and platelet count of ≥150 000/ mm3. In contrast to the usual 75cGy total body dose of radiation, dose escalation of Iodine I 131 tositumomab began at a total body dose of 45 cGy, and increased to 55 cGy in a second cohort. Dose-limiting toxicity (DLT) was defined as absolute neutrophil count <500 cells/mm3 or platelets <25 000/mm3 for >17 days, or absolute neutrophil count <750/mm3 or platelets <50 000/mm3 for >24 days. Eleven subjects were enrolled (8 at 45 cGy and 3 at 55 cGy). Estimated BMI ranged from 30 to 65% (median approximately 40%). Patients had received a median of three prior chemotherapies (range 1-6). One of the six evaluable patients treated at 45 cGy experienced DLT. Three patients received 55 cGy, one had hematologic DLT concurrent with lymphoma progression and extensive BMI at relapse. Three of 11 (27%) patients received hematologic supportive care. Two patients had objective responses of 1 and 42.4+ months, respectively. RIT with attenuated dose iodine 131 tositumomab for patients with >25% BMI has acceptable toxicity and can result in lymphoma responses.

Original languageEnglish (US)
Pages (from-to)342-348
Number of pages7
JournalLeukemia and Lymphoma
Volume48
Issue number2
DOIs
StatePublished - Feb 2007
Externally publishedYes

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Radioimmunotherapy
Non-Hodgkin's Lymphoma
Bone Marrow
Lymphoma
Neutrophils
iodine-131 anti-B1 antibody
Platelet Count
Radiation
Recurrence
Drug Therapy

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

Cite this

Dose-attenuated radioimmunotherapy with tositumomab and iodine 131 tositumomab in patients with recurrent non-Hodgkin's lymphoma (NHL) and extensive bone marrow involvement. / Mones, Jodi; Coleman, Morton; Kostakoglu, Lale; Furman, Richard R.; Chadburn, Amy; Shore, Tsiporah B.; Muss, Daniel; Stewart, Patricia; Kroll, Stewart; Vallabhajosula, Shankar; Goldsmith, Stanley J.; Leonard, John P.

In: Leukemia and Lymphoma, Vol. 48, No. 2, 02.2007, p. 342-348.

Research output: Contribution to journalArticle

Mones, J, Coleman, M, Kostakoglu, L, Furman, RR, Chadburn, A, Shore, TB, Muss, D, Stewart, P, Kroll, S, Vallabhajosula, S, Goldsmith, SJ & Leonard, JP 2007, 'Dose-attenuated radioimmunotherapy with tositumomab and iodine 131 tositumomab in patients with recurrent non-Hodgkin's lymphoma (NHL) and extensive bone marrow involvement', Leukemia and Lymphoma, vol. 48, no. 2, pp. 342-348. https://doi.org/10.1080/10428190601059720
Mones, Jodi ; Coleman, Morton ; Kostakoglu, Lale ; Furman, Richard R. ; Chadburn, Amy ; Shore, Tsiporah B. ; Muss, Daniel ; Stewart, Patricia ; Kroll, Stewart ; Vallabhajosula, Shankar ; Goldsmith, Stanley J. ; Leonard, John P. / Dose-attenuated radioimmunotherapy with tositumomab and iodine 131 tositumomab in patients with recurrent non-Hodgkin's lymphoma (NHL) and extensive bone marrow involvement. In: Leukemia and Lymphoma. 2007 ; Vol. 48, No. 2. pp. 342-348.
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abstract = "Radioimmunotherapy (RIT) with tositumomab and iodine 131 tositumomab can produce durable and complete responses in relapsed/refractory low-grade Non-Hodgkin's lymphoma. Patients with bone marrow involvement (BMI) with tumor > 25{\%} of the intertrabecular space are generally excluded from RIT because of risk of excessive hematologic toxicity. The authors conducted a dose-escalation study of tositumomab and iodine 131 tositumomab to determine whether RIT is feasible in this population. Patients had baseline BMI of >25{\%} and platelet count of ≥150 000/ mm3. In contrast to the usual 75cGy total body dose of radiation, dose escalation of Iodine I 131 tositumomab began at a total body dose of 45 cGy, and increased to 55 cGy in a second cohort. Dose-limiting toxicity (DLT) was defined as absolute neutrophil count <500 cells/mm3 or platelets <25 000/mm3 for >17 days, or absolute neutrophil count <750/mm3 or platelets <50 000/mm3 for >24 days. Eleven subjects were enrolled (8 at 45 cGy and 3 at 55 cGy). Estimated BMI ranged from 30 to 65{\%} (median approximately 40{\%}). Patients had received a median of three prior chemotherapies (range 1-6). One of the six evaluable patients treated at 45 cGy experienced DLT. Three patients received 55 cGy, one had hematologic DLT concurrent with lymphoma progression and extensive BMI at relapse. Three of 11 (27{\%}) patients received hematologic supportive care. Two patients had objective responses of 1 and 42.4+ months, respectively. RIT with attenuated dose iodine 131 tositumomab for patients with >25{\%} BMI has acceptable toxicity and can result in lymphoma responses.",
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