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Initial Treatment With ^Sup 131^I-Tositumomab

Posted on: Saturday, 16 April 2005, 03:00 CDT

Evidence of the effectiveness of ^sup 131^I-tositumomab therapy continues to accrue, as the results of clinical trials are assessed and as elapsed time provides perspective on survival and quality of life. Results of a multiinstutional study were published in 2 journals in February. In the February 3 edition of the New England Journal of Medicine (2005;352:441-449), an article by Kaminski from the University of Michigan Medical Center (Ann Arbor) and other authors detailed a trial in which a single course of ^sup 131^I- tositumomab therapy was used as initial treatment for patients with stage III or IV follicular B-cell lymphoma. The study included 76 patients who received a dosimetric administration of tositumomab and ^sup 131^I-labeled tositumomab and 1 week later received the therapeutic dose. Of these patients, 75% (57) showed a complete response, with 40 of these responders remaining in remission for 4.3- 7.7 years. Some response was noted in all but 5% of patients treated, and the 5-year progressionfree survival for all patients was 59%, with a median progression-free survival of 6.1 years. Hematologie toxicity was moderate, but no transfusions or hematopoietic growth factors were required, and no cases of myelodysplastic syndrome were reported. The authors concluded that "a single 1-week course of ^sup 131^Itositumomab therapy as initial treatment can induce prolonged clinical and molecular remissions in patients with advanced follicular lymphoma." The editors of The New England Journal of Medicine hailed the treatment in a separate commentary as a "hot new treatment for lymphoma."

In an article e-published ahead of print on February 24 in Blood, many of the same authors reported on the occurrence of treatment- related myelodysplastic syndromes and acute myeloid leukemia after initial therapy with ^sup 131^-tositumomab in patients with non- Hodgkin's lymphoma (NHL) and compared these results with those from patients with NHL who had previously undergone treatment(s) with other regimens. Bennett from the University of Rochester School of Medicine (NY) and others outlined the aggregated results from 7 studies including 1,071 patients (995 with relapsed/refractory low- grade NHL with a median of 3 prior treatment regimens) and 76 patients with previously untreated low-grade follicular NHL. A single dose of tositumomab, followed 1 week later by the radiolabeled tositumomab, was administered. Median follow-up was 6 years after diagnosis and 2 years after radioimmunotherapy (RIT) in previously treated patients and 4.6 years after RIT for previously untreated patients. Treatment-related myelodysplastic syndromes and/ or acute myeloid leukemia were reported in 35 of the 995 previously treated patients, but only 13 of these were confirmed to have developed these conditions after RIT, an incidence consistent with the prior chemotherapy regimens of these patients. During a median follow-up period of almost 5 years, no cases of treatmentrelated myelodysplastic syndromes or acute myeloid leukemia were reported in the group of 76 patients receiving the ^sup 131^I-tositumomab as initial therapy for NHL.

The New England Journal of Medicine Blood

Copyright Society of Nuclear Medicine Apr 2005

Source: Journal of Nuclear Medicine, The

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