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Originally published as JCO Early Release 10.1200/JCO.2002.11.076 on April 22 2002

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Journal of Clinical Oncology, Vol 20, Issue 10 (May), 2002: 2453-2463
© 2002 American Society for Clinical Oncology

Randomized Controlled Trial of Yttrium-90–Labeled Ibritumomab Tiuxetan Radioimmunotherapy Versus Rituximab Immunotherapy for Patients With Relapsed or Refractory Low-Grade, Follicular, or Transformed B-Cell Non-Hodgkin’s Lymphoma

By Thomas E. Witzig, Leo I. Gordon, Fernando Cabanillas, Myron S. Czuczman, Christos Emmanouilides, Robin Joyce, Brad L. Pohlman, Nancy L. Bartlett, Gregory A. Wiseman, Norman Padre, Antonio J. Grillo-López, Pratik Multani, Christine A. White

From the Division of Internal Medicine and Hematology and Department of Radiology, Nuclear Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN; Division of Hematology/Oncology and The Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; M.D. Anderson Cancer Center, Houston, TX; Roswell Park Cancer Center, Buffalo, NY; University of California Los Angeles Medical Center, Los Angeles, IDEC Pharmaceuticals Corporation, San Diego, and Clinical Research and Regulatory Strategy, Rancho Santa Fe, CA; Beth Israel Deaconess Medical Center, Boston, MA; The Cleveland Clinic Foundation, Cleveland, OH; and Washington University School of Medicine, St Louis, MO.

Address reprint requests to Thomas E. Witzig, MD, Mayo Clinic, 620 Stabile Building, Rochester, MN 55905; email: witzig{at}mayo.eduThis article was published online ahead of print at www.jco.org.

PURPOSE: Radioimmunotherapy combines biologic and radiolytic mechanisms to target and destroy tumor cells, thus offering a needed therapeutic alternative for refractory non-Hodgkin’s lymphoma (NHL) patients. This phase III randomized study compares the novel radioimmunotherapy yttrium-90 (90Y) ibritumomab tiuxetan with a control immunotherapy, rituximab, in 143 patients with relapsed or refractory low-grade, follicular, or transformed CD20+ transformed NHL.

PATIENTS AND METHODS: Patients received either a single intravenous (IV) dose of 90Y ibritumomab tiuxetan 0.4 mCi/kg (n = 73) or rituximab 375 mg/m2 IV weekly for four doses (n = 70). The radioimmunotherapy group was pretreated with two rituximab doses (250 mg/m2) to improve biodistribution and one dose of indium-111 ibritumomab tiuxetan for imaging and dosimetry. The primary end point, overall response rate (ORR), was assessed by an independent, blinded, lymphoma expert panel.

RESULTS: ORR was 80% for the 90Y ibritumomab tiuxetan group versus 56% for the rituximab group (P = .002). Complete response (CR) rates were 30% and 16% in the 90Y ibritumomab tiuxetan and rituximab groups, respectively (P = .04). An additional 4% achieved an unconfirmed CR in each group. Kaplan-Meier estimated median duration of response was 14.2 months in the 90Y ibritumomab tiuxetan group versus 12.1 months in the control group (P = .6), and time to progression was 11.2 versus 10.1 months (P = .173) in all patients. Durable responses of >= 6 months were 64% versus 47% (P = .030). Reversible myelosuppression was the primary toxicity noted with 90Y ibritumomab tiuxetan.

CONCLUSION: Radioimmunotherapy with 90Y ibritumomab tiuxetan is well tolerated and produces statistically and clinically significant higher ORR and CR compared with rituximab alone.


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Re-Treatment With I-131 Tositumomab in Patients With Non-Hodgkin's Lymphoma Who Had Previously Responded to I-131 Tositumomab
J. Clin. Oncol., November 1, 2005; 23(31): 7985 - 7993.
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R. I. Fisher, M. S. Kaminski, R. L. Wahl, S. J. Knox, A. D. Zelenetz, J. M. Vose, J. P. Leonard, S. Kroll, S. J. Goldsmith, and M. Coleman
Tositumomab and Iodine-131 Tositumomab Produces Durable Complete Remissions in a Subset of Heavily Pretreated Patients With Low-Grade and Transformed Non-Hodgkin's Lymphomas
J. Clin. Oncol., October 20, 2005; 23(30): 7565 - 7573.
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A. Nademanee, S. Forman, A. Molina, H. Fung, D. Smith, A. Dagis, C. Kwok, D. Yamauchi, A.-L. Anderson, P. Falk, et al.
A phase 1/2 trial of high-dose yttrium-90-ibritumomab tiuxetan in combination with high-dose etoposide and cyclophosphamide followed by autologous stem cell transplantation in patients with poor-risk or relapsed non-Hodgkin lymphoma
Blood, October 15, 2005; 106(8): 2896 - 2902.
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Ann OncolHome page
P. F. Ferrucci, A. Vanazzi, G. Tesoriere, M. Ferrari, M. Bartolomei, P. Rocca, M. Cremonesi, G. Paganelli, and G. Martinelli
Cerebrospinal fluid diffusion of Zevalin(R) after high-activity treatment and stem cell support in a patient affected by diffuse large B-cell non-Hodgkin's lymphoma with central nervous system involvement
Ann. Onc., October 1, 2005; 16(10): 1710 - 1711.
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D. M. Goldenberg
Introduction to the Tenth Conference on Cancer Therapy with Antibodies and Immunoconjugates
Clin. Cancer Res., October 1, 2005; 11(19): 7045s - 7046s.
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G. L. DeNardo, E. Tobin, K. Chan, B. M. Bradt, and S. J. DeNardo
Direct Antilymphoma Effects on Human Lymphoma Cells of Monotherapy and Combination Therapy with CD20 and HLA-DR Antibodies and 90Y-Labeled HLA-DR Antibodies
Clin. Cancer Res., October 1, 2005; 11(19): 7075s - 7079s.
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S. A. Jacobs, N. Vidnovic, J. Joyce, B. McCook, F. Torok, and N. Avril
Full-Dose 90Y Ibritumomab Tiuxetan Therapy Is Safe in Patients with Prior Myeloablative Chemotherapy
Clin. Cancer Res., October 1, 2005; 11(19): 7146s - 7150s.
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W. Hiddemann, C. Buske, M. Dreyling, O. Weigert, G. Lenz, R. Forstpointner, C. Nickenig, and M. Unterhalt
Treatment Strategies in Follicular Lymphomas: Current Status and Future Perspectives
J. Clin. Oncol., September 10, 2005; 23(26): 6394 - 6399.
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J. P. Leonard, M. Coleman, L. Kostakoglu, A. Chadburn, E. Cesarman, R. R. Furman, M. W. Schuster, R. Niesvizky, D. Muss, J. Fiore, et al.
Abbreviated Chemotherapy With Fludarabine Followed by Tositumomab and Iodine I 131 Tositumomab for Untreated Follicular Lymphoma
J. Clin. Oncol., August 20, 2005; 23(24): 5696 - 5704.
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J. P. Leonard, M. Coleman, J. Ketas, M. Ashe, J. M. Fiore, R. R. Furman, R. Niesvizky, T. Shore, A. Chadburn, H. Horne, et al.
Combination Antibody Therapy With Epratuzumab and Rituximab in Relapsed or Refractory Non-Hodgkin's Lymphoma
J. Clin. Oncol., August 1, 2005; 23(22): 5044 - 5051.
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A. V. Rao, G. Akabani, and D. A. Rizzieri
Radioimmunotherapy for Non-Hodgkin's Lymphoma
Clin. Med. Res., August 1, 2005; 3(3): 157 - 165.
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O. Linden, C. Hindorf, E. Cavallin-Stahl, W. A. Wegener, D. M. Goldenberg, H. Horne, T. Ohlsson, L. Stenberg, S.-E. Strand, and J. Tennvall
Dose-Fractionated Radioimmunotherapy in Non-Hodgkin's Lymphoma Using DOTA-Conjugated, 90Y-Radiolabeled, Humanized Anti-CD22 Monoclonal Antibody, Epratuzumab
Clin. Cancer Res., July 15, 2005; 11(14): 5215 - 5222.
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J. M. Bennett, M. S. Kaminski, J. P. Leonard, J. M. Vose, A. D. Zelenetz, S. J. Knox, S. Horning, O. W. Press, J. A. Radford, S. M. Kroll, et al.
Assessment of treatment-related myelodysplastic syndromes and acute myeloid leukemia in patients with non-Hodgkin lymphoma treated with tositumomab and iodine I131 tositumomab
Blood, June 15, 2005; 105(12): 4576 - 4582.
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Ann OncolHome page
A. Hagenbeek and V. Lewington
Report of a European consensus workshop to develop recommendations for the optimal use of 90Y-ibritumomab tiuxetan (Zevalin(R)) in lymphoma
Ann. Onc., May 1, 2005; 16(5): 786 - 792.
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A. P Levene, G. Singh, and C. Palmieri
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J R Soc Med, April 1, 2005; 98(4): 146 - 152.
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J. D. Hainsworth, S. Litchy, D. W. Shaffer, V. L. Lackey, M. Grimaldi, and F. A. Greco
Maximizing Therapeutic Benefit of Rituximab: Maintenance Therapy Versus Re-Treatment at Progression in Patients With Indolent Non-Hodgkin's Lymphoma--A Randomized Phase II Trial of the Minnie Pearl Cancer Research Network
J. Clin. Oncol., February 20, 2005; 23(6): 1088 - 1095.
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J. M. Connors
Radioimmunotherapy -- Hot New Treatment for Lymphoma
N. Engl. J. Med., February 3, 2005; 352(5): 496 - 498.
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D. M. Goldenberg and R. M. Sharkey
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J. Nucl. Med., February 1, 2005; 46(2): 383 - 384.
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S. J. Horning, A. Younes, V. Jain, S. Kroll, J. Lucas, D. Podoloff, and M. Goris
Efficacy and Safety of Tositumomab and Iodine-131 Tositumomab (Bexxar) in B-Cell Lymphoma, Progressive After Rituximab
J. Clin. Oncol., February 1, 2005; 23(4): 712 - 719.
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M. Ginj, J. Chen, M. A. Walter, V. Eltschinger, J. C. Reubi, and H. R. Maecke
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E. R. Nemecek, D. K. Hamlin, D. R. Fisher, K. A. Krohn, J. M. Pagel, F. R. Appelbaum, O. W. Press, and D. C. Matthews
Biodistribution of Yttrium-90-Labeled Anti-CD45 Antibody in a Nonhuman Primate Model
Clin. Cancer Res., January 15, 2005; 11(2): 787 - 794.
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M. Z. Lin, M. A. Teitell, and G. J. Schiller
The Evolution of Antibodies into Versatile Tumor-Targeting Agents
Clin. Cancer Res., January 1, 2005; 11(1): 129 - 138.
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A. S. Freedman
Biology and Management of Histologic Transformation of Indolent Lymphoma
Hematology, January 1, 2005; 2005(1): 314 - 320.
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L. S. Shahied, Y. Tang, R. K. Alpaugh, R. Somer, D. Greenspon, and L. M. Weiner
Bispecific Minibodies Targeting HER2/neu and CD16 Exhibit Improved Tumor Lysis When Placed in a Divalent Tumor Antigen Binding Format
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J. W. Friedberg
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Clin. Cancer Res., December 1, 2004; 10(23): 7789 - 7791.
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T. A. Davis, M. S. Kaminski, J. P. Leonard, F. J. Hsu, M. Wilkinson, A. Zelenetz, R. L. Wahl, S. Kroll, M. Coleman, M. Goris, et al.
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C.-L. Law, C. G. Cerveny, K. A. Gordon, K. Klussman, B. J. Mixan, D. F. Chace, D. L. Meyer, S. O. Doronina, C. B. Siegall, J. A. Francisco, et al.
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S. S. Dave, G. Wright, B. Tan, A. Rosenwald, R. D. Gascoyne, W. C. Chan, R. I. Fisher, R. M. Braziel, L. M. Rimsza, T. M. Grogan, et al.
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J. Christiansen and A. K. Rajasekaran
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S. Hallmeyer and D. Peace
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CA Cancer J Clin, September 1, 2004; 54(5): 260 - 272.
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J. P. Leonard, M. Coleman, J. C. Ketas, A. Chadburn, R. Furman, M. W. Schuster, E. J. Feldman, M. Ashe, S. J. Schuster, W. A. Wegener, et al.
Epratuzumab, a Humanized Anti-CD22 Antibody, in Aggressive Non-Hodgkin's Lymphoma: Phase I/II Clinical Trial Results
Clin. Cancer Res., August 15, 2004; 10(16): 5327 - 5334.
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A. Forero, P. L. Weiden, J. M. Vose, S. J. Knox, A. F. LoBuglio, J. Hankins, M. L. Goris, V. J. Picozzi, D. B. Axworthy, H. B. Breitz, et al.
Phase 1 trial of a novel anti-CD20 fusion protein in pretargeted radioimmunotherapy for B-cell non-Hodgkin lymphoma
Blood, July 1, 2004; 104(1): 227 - 236.
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L. I. Gordon, A. Molina, T. Witzig, C. Emmanouilides, A. Raubtischek, M. Darif, R. J. Schilder, G. Wiseman, and C. A. White
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M. Bendandi, S. A. Pileri, and P. L. Zinzani
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A.J. Davies, A.Z.S. Rohatiner, S. Howell, K.E. Britton, S.E. Owens, I.N. Micallef, D.P. Deakin, B.M. Carrington, J.A. Lawrance, S. Vinnicombe, et al.
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Blood, February 15, 2004; 103(4): 1485 - 1494.
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J. N. Winter, R. D. Gascoyne, and K. Van Besien
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Radioimmunotherapy of Non-Hodgkin's Lymphoma with 90Y-DOTA Humanized Anti-CD22 IgG (90Y-Epratuzumab): Do Tumor Targeting and Dosimetry Predict Therapeutic Response?
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A Phase I Trial of 90Y-Anti-Carcinoembryonic Antigen Chimeric T84.66 Radioimmunotherapy with 5-Fluorouracil in Patients with Metastatic Colorectal Cancer
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T. A. Lister
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J. Clin. Oncol., November 1, 2003; 21(21): 3894 - 3896.
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E-Selectin Up-Regulation Allows for Targeted Drug Delivery in Prostate Cancer
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High-dose radioimmunotherapy versus conventional high-dose therapy and autologous hematopoietic stem cell transplantation for relapsed follicular non-Hodgkin lymphoma: a multivariable cohort analysis
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Phase I Therapy Study with 186Re-labeled Humanized Monoclonal Antibody BIWA 4 (Bivatuzumab) in Patients with Head and Neck Squamous Cell Carcinoma
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