Zevalin for large cell lymphoma

Zevalin, also called 90Y-ibritumomab tiuxetan is a novel radioimmunotherapeutic agent recently approved for the treatment of relapsed or refractory low-grade, follicular, or CD20+ transformed non-Hodgkin’s lymphoma (NHL). 90Y-ibritumomab tiuxetan consists of a mouse monoclonal antibody attached to a metal chelator, which stably connects these two components. ONe is essential for imaginga dn teh otehr is therapeutic. It is often used for other than first line of treatment for lymphoma. Ibritumomab tiuxetan (Zevalin®) was granted accelerated approval by the U.S. Food and Drug Administration (FDA) in February 2002 for the treatment of patients with relapsed or refractory lowgrade, follicular or transformed B-cell non-Hodgkin lymphoma, including patients with rituximab refractory follicular non-Hodgkin lymphoma. In September 2009, the FDA approved ibritumomab (Zevalin®) for consolidation therapy in previously untreated follicular lymphoma in patients who achieve  partial or complete response to first-line chemotherapy.

A recent guideline states experts’ consensus: “It is the opinion of the Hematology Disease Site Group that the benefit of 90Y-ibritumomab tiuxetan radioimmunotherapy may be generalizable to other relapsed or refractory indolent non-Hodgkin’s lymphomas previously treated with rituximab… but not CLL.”

What about large cell lymphoma? Adding Zevalin to Rituxan for large cell lymphoma with or without  radiation to bulky areas, is being investigated for large cell lymphoma. It is an NCCN recommended option for follicular lymphoma in relapse but not large cell lymphoma( BCEL-6). It is also in trials for conditioning for stem cell transplants  with BEAM chemotherapy. For consolidation, Yang et al found that 90)Y-ibritumomab tiuxetan consolidation following six cycles of R-CHOP resulted in an acceptable response with tolerable toxicity in patients with limited-stage and bulky DLBCL. The place of Zevalin in large cell lymphoma therapy continues to be researched and defined.

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