Leukemia & lymphoma
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Leukemia & lymphoma · Jan 2003
Review Comparative StudyGraft-vs.-lymphoma effect in various histologies of non-Hodgkin's lymphoma.
Generally, there is a significantly lower risk of lymphoma relapse following allogeneic than after autologous stem cell transplant. Factors contributing to this lower risk of relapse include an absence of the use of ablative conditioning, with a tumor-free graft, and the generation of a graft-vs.-tumor (GVT) immune response. Allogeneic transplantation, however, has the possibility of graft-vs.-host disease (GVHD). ⋯ Results for non-myeloablative allogeneic HSCT are particularly promising in low-grade NHL and the GVT effect may augment response and delay or prevent relapse. However, for aggressive disease, non-myeloablative regimens are only indicated for patients with minimal disease, as the non-myeloablative regimens are unable to control the tumor before the generation of a GVT effect, and/or lack the ability to control rapidly proliferating disease. Patients with relapsed disease may require a higher-dose regimen or tandem transplant approach.
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Leukemia & lymphoma · Jan 2003
ReviewRadioimmunotherapy for NHL: experience of 90Y-ibritumomab tiuxetan in clinical practice.
Radioimmunotherapy (RIT) is a novel treatment modality that combines the benefits of radiotherapy and immunotherapy, enabling multiple sites of disseminated disease to be treated simultaneously and effectively, while minimizing toxicity to normal tissues. 90Y-ibritumomab tiuxetan consists of the anti-CD20 monoclonal antibody (MAb) ibritumomab covalently linked to tiuxetan for chelation of 90Y for therapy. Early work established that a dose of 14.8 MBq/kg (0.4 mCi/kg) is safe and effective in patients with < 25% bone marrow involvement and adequate marrow reserves, as is a dose of 11.1 MBq/kg (0.3 mCi/kg) in patients with mild thrombocytopenia (platelet counts 100 x 10(9)-150 x 10(9)/l). To date, 5 clinical trials using 90Y-ibritumomab tiuxetan have been reported, one of which assessed the efficacy in rituximab-refractory patients with follicular non-Hodgkin's lymphoma (NHL) histology. ⋯ In an integrated analysis of safety data from 5 90Y-ibritumomab tiuxetan studies, only 7% of patients were hospitalized due to infection during the treatment period. In addition, 90Y-ibritumomab tiuxetan therapy was not shown to increase the risk of developing secondary malignancies (myelodysplastic syndrome/acute myeloid leukemia), or preclude subsequent therapy upon relapse. Current investigations are focussing on the potential role of 90Y-ibritumomab tiuxetan earlier in the treatment algorithm, including as single-agent therapy for relapsed diffuse large B-cell lymphoma patients not eligible for transplantation, and consolidation treatment for low-grade NHL patients after first-line, alkylating agent-based therapy.