Radioimmunotherapy

Radioimmunotherapy of CD-20 positive follicular non-Hodgkin's lymphoma with 90-Y-Ibritumomab-Tiuxetan

Radioimmunotherapy (RIT) is a relatively new procedure in the treatment of B-cell lymphomas. An antibody against the so-called "CD20" feature, which is present at high density on the surface of almost all B-lymphoma cells, is coupled with a radioactive substance. The radioactive substance emits high-energy beta radiation, which produces a very high radiation dose in the lymphoma cells. Since this radiation has a small range of <1 cm in the tissue, the B-cell lymphoma is treated in a targeted fashion without significant side effects for other organs.

In Germany, Ibritumomab-Tiuxetane (Zevalin®) labeled with the radionuclide Yttrium-90 (Y-90) is currently used for the treatment of patients with CD20-positive follicular non-Hodgkin's lymphoma of the B-cell type in relapse or as a so-called consolidation therapy (following the regression of the disease achieved by chemotherapy).

What preparation is necessary for Radioimmunotherapy with Zevalin?

All important aspects of the medical feasibility and the actual procedure of Radioimmunotherapy will be discussed with you in a detailed preliminary discussion.

To be able to check the indication for RIT as quickly as possible, you should bring the following documents with you to the first interview:

• A current blood count, including blood clotting parameters and INR,
• Your current medication (important: medication that affects coagulation),
• Your current findings on bone marrow puncture
• Documents on your entire therapy course, including all radiological images, all documentation on previous chemo- (immune-) therapies or percutaneous radiation therapies

How does the therapy work?

Radioimmunotherapy is relatively simple and can be performed on an outpatient basis, it is carried out in cooperation and close consultation between the treating hematologist / oncologist, the patient and the nuclear physician.

Radioimmunotherapy involves the application of cold and hot (i.e. radioactively labeled) antibodies at certain times. At the first and eighth day of the therapy, you will receive a rituximab infusion (antibody against the so-called "CD20" feature) in the hematology department. On the eighth or ninth day, the radioactive medication Y-90-Zevalin is administered to you in nuclear medicine as a slow infusion over 10 minutes.

The treatment can be carried out on an outpatient basis, as the beta radiation emitted here has a small range in the tissue and does not escape from the patient's body.

Are there contraindications to Radioimmunotherapy with Zevalin?

Absolute contraindications

• Pregnancy or lactation
• Hypersensitivity to the antibody or ligament

Relative contraindication

• Children and adolescents under the age of 18
• Poor blood cell values (a thrombocyte count of less than 100,000/mm3 or a leukocyte count of less than 1500/mm3)
• Infestation of > 25% of the entire bone marrow by lymphoma cells.
• Following external irradiation covering > 25% of the active bone marrow
• Following bone marrow or stem cell transplantation
• Detectable human anti-mouse antibodies after pretreatment with murine monoclonal antibodies (due to the high likelihood of allergic reactions or hypersensitivity reactions under therapy)

In the case of a "relative contraindication", the decision for treatment is at the discretion of the treating physician. Radioimmunotherapy is often possible despite the presence of a relative contraindication, e.g. with a reduced dose.