Cheung Matthew C, Haynes Adam E, Stevens Adrienne, Meyer Ralph M, Imrie Kevin
Cancer Care Ontario, Program in Evidence-Based Care, McMaster University, Hamilton, Ontario, Canada.
Leuk Lymphoma. 2006 Jun;47(6):967-77. doi: 10.1080/10428190600572582.
Radioimmunoconjugates are radioisotope-bound monoclonal antibodies that target radiation specifically to sites of lymphoma involvement. Initial studies of 90Y-ibritumomab tiuxetan in non-Hodgkin's lymphoma (NHL) have suggested benefit in patients with relapsed or refractory indolent disease. However, the routine adoption of this agent is tempered by concerns of associated toxicities and unclear long-term benefit. A comprehensive search for studies on 90Y-ibritumomab tiuxetan use in lymphoma was completed. The aims of this systematic review were to summarize and evaluate the evidence on: (1) the benefits and risks of this novel therapy; (2) predictors for response and toxicity; and (3) the role of dosimetry and imaging studies prior to treatment. A total of twenty trials investigating the use of 90Y-ibritumomab tiuxetan for the treatment of adult patients with NHL were identified. In trials of patients with relapsed or refractory indolent NHL, overall response rates ranged from 67 - 83%. In patients with follicular NHL refractory to the monoclonal antibody, rituximab, response rates remained high (74%). However, in rituximab-naïve patients with relapsed or refractory indolent or transformed NHL, the higher response rate seen with 90Y-ibritumomab tiuxetan therapy compared to rituximab monotherapy has not translated into clear improvements in time-to-progression or survival. 90Y-ibritumomab tiuxetan is an active agent in relapsed and refractory non-Hodgkin's lymphoma that should be considered in select patients.
放射免疫缀合物是与放射性同位素结合的单克隆抗体，可将辐射特异性靶向淋巴瘤累及部位。钇-90 替伊莫单抗治疗非霍奇金淋巴瘤（NHL）的初步研究表明，对复发或难治性惰性疾病患者有益。然而，由于担心相关毒性和长期益处不明确，该药物的常规应用受到限制。我们全面检索了关于钇-90 替伊莫单抗用于淋巴瘤治疗的研究。本系统评价的目的是总结和评估以下方面的证据：（1）这种新疗法的益处和风险；（2）反应和毒性的预测因素；（3）治疗前剂量测定和影像学研究的作用。共确定了 20 项研究钇-90 替伊莫单抗用于治疗成年 NHL 患者的试验。在复发或难治性惰性 NHL 患者的试验中，总体缓解率为 67% - 83%。在对单克隆抗体利妥昔单抗耐药的滤泡性 NHL 患者中，缓解率仍然很高（74%）。然而，在未使用过利妥昔单抗的复发或难治性惰性或转化型 NHL 患者中，与利妥昔单抗单药治疗相比，钇-90 替伊莫单抗治疗的较高缓解率并未转化为无进展生存期或总生存期的明显改善。钇-90 替伊莫单抗是复发和难治性非霍奇金淋巴瘤的一种有效药物，应在特定患者中考虑使用。
