Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2007, 151(1):109-112 | DOI: 10.5507/bp.2007.020

Relapsed follicular lymphoma sequentially treated with rituximab and ⁹⁰Y-ibritumomab tiuxetan. Case report

Tomas Papajik^a, Vit Prochazka^a, Ludek Raida^a, Zuzana Kubova^a, Miroslav Myslivecek^b, Jaroslava Drymlova^b, Eva Buriankova^b, Ladislava Kucerova^c, Karel Indrak^a

^a Department of Hemato-oncology, University Hospital, Olomouc, Czech Republic

^b Department of Nuclear Medicine, University Hospital, Olomouc, Czech Republic

^c Department of Pathology, University Hospital, Olomouc, Czech Republic

Background: Monoclonal antibodies have dramatically changed the treatment possibilities for follicular lymphoma. ⁹⁰Y-ibritumomab tiuxetan (Zevalin®) is the first radioimmunotherapy agent approved for the treatment of relapsed and resistant follicular lymphoma patients. Long-term benefit was observed especially for patients achieving CR after radioimmunotherapy.

Methods and Results: A 65-year-old female patient with the second relapse of CD20 positive follicular lymphoma and multiple concomitant diseases was treated with four weekly doses of rituximab (375 mg/m²). ¹⁸F-fl uoro-deoxyglucose positron emission tomography combined with computed tomography (PET-CT) demonstrated only partial response to therapy with persistent PET scan positivity in enlarged abdominal lymph nodes. Therefore, it was decided to treat her with a 1200-MBq (32-mCi) dose of ⁹⁰Y-ibritumomab tiuxetan radioimmunotherapy. No acute complications were noted afterwards. Hematological nadirs were reached 4 weeks later, with a platelet count of 24x10⁹/l that normalized within the next 2 weeks. The patient had neither infection nor bleeding complications. Eight weeks after radioimmunotherapy, the PET-CT scans documented only 3 lymph nodes around the abdominal aorta, maximum size 2x1 cm. The PET scan analysis proved no accumulation of ¹⁸F-fluoro-deoxy-glucose in any lymph nodes or other organs and tissues.

Conclusions: Sequential treatment with rituximab and ⁹⁰Y-ibritumomab tiuxetan may be an interesting alternative in cases of relapsed follicular or other indolent lymphomas in pretreated or older patients with other concomitant diseases.

Keywords: Follicular lymphoma, Ibritumomab tiuxetan, Rituximab, CD20 antigen, Therapy, Positron emission tomography

Received: February 24, 2007; Accepted: April 24, 2007; Published: June 1, 2007  Show citation