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Annals of Oncology Advance Access originally published online on June 2, 2008
Annals of Oncology 2008 19(9):1629-1633; doi:10.1093/annonc/mdn172
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© The Author 2008. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

hematologic malignancies

Repeat treatment with iodine-131-rituximab is safe and effective in patients with relapsed indolent B-cell non-Hodgkin's lymphoma who had previously responded to iodine-131-rituximab

M. J. Bishton1, M. F. Leahy2, R. J. Hicks1, J. H. Turner2, A. D. McQuillan2 and J. F. Seymour1,3,*

1 Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria
2 Department of Haematology, University of Western Australia, Fremantle Hospital, Fremantle
3 Department of Haematology and Medical Oncology, University of Melbourne, Victoria, Australia

* Correspondence to: Prof. J. F. Seymour, Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, East Melbourne 3002, Victoria, Australia. Tel: +61-3-9656-1076; Fax: +61-3-9656-1408; E-mail: john.seymour{at}petermac.org

Background: Small series suggest retreatment of indolent lymphomas with murine anti-CD20 radioimmunotherapy is effective. The longer half-life of iodine-131 (131I)-rituximab may result in increased bone marrow exposure, with greater toxicity on repeat administration. We examined the effects of a second 131I-rituximab in patients with indolent lymphoma following relapse.

Patients and methods: We analyzed two institutional databases from January 2000 to July 2007 for retreatment with 131I-rituximab. The severity of cytopenia, development of myelodysplasia (MDS), acute myeloid leukemia (AML) and hypothyroidism was noted. We compared response duration and toxicity of the treatments.

Results: Fourteen of 16 patients responded with nine complete responses (CRs), with a median duration of 10.5 months in responders. Six of 13 reresponders had the same or a longer response and six more remain in complete response. The median event-free survival was not significantly different for the two treatments. There was no significant difference in the severity of myelosuppression. Four patients developed hypothyroidism with three requiring thyroxine. One patient developed AML, with no other cases of MDS. The actuarial progression-free survival rate at 12 months was 36%.

Conclusions: Repeat 131I-rituximab induces high response rates, some of which result in durable remissions in patients who had previously responded.

Key words: lymphoma, radioimmunotherapy, repeat

Received for publication December 15, 2007. Revision received March 18, 2008. Accepted for publication March 21, 2008.


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