Prospective trial of targeted radioimmunotherapy with Y-90 ibritumomab tiuxetan (Zevalin) for front-line treatment of early-stage extranodal indolent ocular adnexal lymphoma
Prospective trial of targeted radioimmunotherapy with Y-90 ibritumomab tiuxetan (Zevalin) for front-line treatment of early-stage extranodal indolent ocular adnexal lymphoma
复制标题
DOI：
10.1093/annonc/mdn692
复制
发表时间：
2009-04-01
影响因子：
50.5
通讯作者：
Kwak, L. W.
中科院分区：
文献类型：
--
作者：
Esmaeli, B.;McLaughlin, P.;Kwak, L. W.
工作背景：确定Y-90替伊莫单抗（Zevalin）作为眼附属器早期淋巴结惰性淋巴瘤患者的一线治疗的疗效和副作用（眼眶、结膜或眼睑）。患者和方法：2004年8月至2007年11月，12例眼附属器I-E期淋巴结惰性淋巴瘤患者参加了一项利妥昔单抗随后给予Y-利妥昔单抗的前瞻性试验。90替伊莫单抗（Zevalin治疗方案）。对于每例患者，使用国际工作组反应标准，通过临床检查和影像学研究记录对治疗的反应。所有患者在-111 ibritumomab tixuetan成像确认Y-90-Zevalin治疗前预期的生物分布;此外，3例患者有一个可选的单光子发射计算机断层扫描，计算机断层扫描，以估计吸收的辐射剂量的眼眶和眼tissues.Results：该研究包括7名女性和5名男性。中位年龄为60岁（范围22-79岁）。9例患者为结膜或眼眶粘膜相关淋巴组织淋巴瘤; 3例患者为眼眶1-2级滤泡性淋巴瘤。一名最初被认为是I-E期的患者在入组后2周在正电子发射断层扫描中发现三角肌中有另一处病变。她继续接受试验，尽管由于这一单一额外（活检证实）部位，她的疾病被重新分类为IV期。10例患者在治疗3个月内有完全缓解和2例部分缓解（PR）。1例患者在初次PR后6个月出现上眼睑复发，然后接受了30戈伊的外照射放疗（EBRT）。他的病情后来在轨道上再次进展，目前正在考虑其他治疗。第二名达到PR的患者在治疗后12个月保持稳定，没有进展。中位随访时间为20个月（范围6-44个月），无远处（眶外）复发病例。所有12例患者在入组试验后的前3个月内均发生I级或II级一过性全血细胞减少症。未发生III级或IV级骨髓抑制。估计眼眶软组织的吸收辐射剂量< 3戈伊，比EBRT低10倍。结论：利妥昔单抗联合替伊莫单抗治疗早期眼附属器淋巴结惰性B细胞淋巴瘤是一种安全有效的一线治疗方法。
Background: To determine the efficacy and side-effects of Y-90 ibritumomab tiuxetan (Zevalin) as front-line treatment in patients with early-stage extranodal indolent lymphoma of the ocular adnexa (orbit, conjunctiva, or eyelid).Patients and methods: From August 2004 to November 2007, 12 patients with stages I-E extranodal indolent lymphoma of the ocular adnexa were enrolled in a prospective trial of rituximab followed by Y-90 ibritumomab tiuxetan (Zevalin therapeutic regimen). For each patient, clinical examinations and imaging studies were used to document response to therapy using the The International Working Group response criteria. All patients had In-111 ibritumomab tixuetan imaging to confirm expected biodistribution before Y-90-Zevalin therapy; in addition, three patients had an optional single photon emission computed tomography-computed tomography scan to estimate the absorbed radiation dose to the orbital and ocular tissues.Results: The study included seven women and five men. The median age was 60 years (range 22-79). Nine patients had mucosa-associated lymphoid tissue lymphoma of conjunctiva or orbit; three patients had grades 1-2 follicular lymphoma of orbit. One patient who had been deemed stage I-E initially was found to have another lesion in her deltoid muscle on positron emission tomography 2 weeks after enrollment. She was kept on trial although her disease was reclassified as stage IV due to this single additional (biopsy-proven) site. Ten patients had a complete response and two partial response (PR) within 3 months of treatment. One patient had a recurrence in the upper eyelid 6 months after an initial PR; he then received 30 Gy of external-beam radiotherapy (EBRT). His disease later progressed again in the orbit and he is currently being considered for other treatments. A second patient who attained a PR has remained stable with no progression 12 months after treatment. With a median follow-up time of 20 months (range 6-44 months), there were no cases of distant (extraorbital) relapse. All 12 patients experienced grade I or II transient pancytopenia during the first 3 months after enrollment in the trial. There were no episodes of grade III or IV myelosuppression. The estimated absorbed radiation dose to the orbital soft tissues was < 3 Gy, 10 times lower than that with EBRT.Conclusions: Rituximab followed by Y-90 ibritumomab tiuxetan is an effective and safe front-line treatment for early-stage extranodal indolent B-cell lymphoma of the ocular adnexa.