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Nouvelles modalités (consolidation, fractionnement) de radioimmunothérapie par 90Y-ibritumomab tiuxetan ("Zevalin") en traitement de première ligne des lymphomes malin non hodgkinien de type folliculaire: efficacité, toxicité et approche dosimétrique personnalisée

Abstract : Rationale : radioimmunotherapy (RIT) with 90Y-ibritumomab tiuxetan ([90Y] Zevalin ) is a new treatment option for patients with relapsed/refractory non hodgkin follicular lymphoma (FL). Efficacy increases when Zevalin is used earlier in the disease course. Currently, Zevalin dosage is based on weight and not dosimetry. This most likely results in a wide range of absorbed dose to critical organs and tumor, which in turn translates in unpredictable efficacy and toxicity. Optimizing RIT with [90Y] Zevalin will require its use as part of first-line therapy and implementation of patient-specific dosimetry methods in clinical trials.
Objectives and methods : we have consecutively studied 2 new modalities of using Zevalin in first line therapy of FL. First, we conducted an international, randomized, phase 3 trial to evaluate the efficacy and safety of consolidation with Zevalin(15MBq/Kg) in patients with advanced-stage FL achieving at least a partial response after induction immuno-chemotherapy. A second approach consisted of evaluating a fractionated schedule with 2 doses of Zevalin (11.1 MBq/kg each), 9 to 13 weeks apart, as frontline therapy in FL patients with high tumor burden. As part of this second approach, we designed a refined imaging-based (planar and 3-dimensional) dosimetry protocol to improve prediction of dose-efficacy and toxicity after each dose of zevalin. Data acquisition was performed in 3 centers (lille, Nantes and Manchester) while data treatment and specific dose calculations for major organ, tumor masses and bone marrow were centralized.

Conclusion : Consolidation of first remission with 90Y-ibritumomab tiuxetan in advanced-stage follicular lymphoma is highly effective with no unexpected toxicities, prolonging PFS by 2 years and resulting in high PR-to-CR conversion rates regardless of type of first-line induction treatment. Preliminary data show the feasibility of frontline fractionated RIT with Zevalin in patient with high tumor burden and of implementing a standardized refined data acquisition/treatment protocol for imaging-based dosimetry in the multicenter setting. Dosimetry results obtained for 6 patients who underwent patient-specific quantitative planar imaging after both Zevalin fractions will be presented.
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Contributor : Franck Morschhauser <>
Submitted on : Thursday, January 22, 2009 - 3:50:01 PM
Last modification on : Friday, October 23, 2020 - 4:33:22 PM
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  • HAL Id : tel-00355344, version 1

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Franck Morschhauser. Nouvelles modalités (consolidation, fractionnement) de radioimmunothérapie par 90Y-ibritumomab tiuxetan ("Zevalin") en traitement de première ligne des lymphomes malin non hodgkinien de type folliculaire: efficacité, toxicité et approche dosimétrique personnalisée. Sciences du Vivant [q-bio]. Université du Droit et de la Santé - Lille II, 2008. Français. ⟨tel-00355344⟩

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