Fractionated radioimmunotherapy treatment with Zevalin® (ibritumomab tiuxetan) is an effective first-line treatment for advanced stage follicular lymphoma and delivers high response rates in patients with high tumor burden, according to the results of a phase II study presented at the 53rd annual meeting of the American Society of Hematology (ASH) in San Diego, California.

Zevalin is a type of radioimmunotherapy treatment (RIT) that combines the monoclonal antibody Rituxan with Zevalin, which is comprised of an anti-CD20 monoclonal antibody and Yttrium-90, a radioisotope that delivers the radiation. When injected into the body, Zevalin attaches to a protein (CD20) found only on the surface of B-lymphcytes, such as cancerous B-cells found in many forms of non-Hodgkin’s lymphoma. The radioactivity that is spontaneously emitted targets the B-cell and destroys it. This approach protects healthy tissue.

Zevalin has been shown to be a highly effective treatment-and has the added benefit of being administered over a single short period of time. Zevalin is administered on an outpatient basis and the total duration of therapy is less than 10 days.  Zevalin offers active patients the opportunity to spend less time undergoing treatment than more conventional chemotherapy.

NHL is a form of cancer that begins in the cells of the lymph system. The lymph system includes the spleen, thymus, tonsils, bone marrow, lymph nodes, and circulating immune cells. Follicular lymphoma is a type of NHL that is considered to be a low-grade or indolent lymphoma, meaning it is a slow-growing subset of NHL. It involves a type of white blood cell known as a B cell.

Some research has indicated that in patients with higher tumor burden, using more than one fraction of RIT increases the overall radiation dose over that of a single fraction of treatment—thereby potentially improving response rates and survival. Researchers conducted an international, mutlitcenter phase II study to evaluate the safety and efficacy of fractionated Zevalin as first-line therapy for follicular lymphoma.

The study included 72 patients (median age 61) with untreated follicular lymphoma and at least one criterion of high tumor burden. Patients were treated with two doses of Zevalin given 8-12 weeks apart. Thirteen patients required pretreatment with Rituxan, 72 received the first Zevalin infusion, and 55 received the second infusion.

The end of treatment response (EOR) was 95.7 percent with CR/CRu of 57.1 percent. Six patients subsequently improved response, resulting in an overall response rate (ORR) of 97.1 percent and CR/Cru of 64.3 percent. After a median follow-up of 1.52 years, the progression-free survival (PFS) was 67 percent and 20 patients had progressed, 12 of whom required further treatment.

Treatment was well tolerated, with a few infectious episodes and adverse events and manageable hematologic toxicity.

The researchers concluded that fractionated Zevalin is an effective first-line treatment for advanced stage follicular lymphoma in patients with a high tumor burden requiring treatment. The treatment delivers high response rates.


Illidge TM, Pettengell R, Bayne M, et al. Fractionated 90Yttrium Ibritumomab Tiuxetan (Zevalin) radioimmunotherapy as an initial therapy of follicular lymphoma: First results from a phase II study in patients requiring treatment according to GELF/BNLI criteria. Blood. 2011; 118(21): Abstract 102.

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