Papajik Tomas, Prochazka Vit, Raida Ludek, Kubova Zuzana, Myslivecek Miroslav, Drymlova Jaroslava, Buriankova Eva, Kucerova Ladislava, Indrak Karel
Department of Hemato-oncology, University Hospital, Olomouc, Czech Republic.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2007 Jun;151(1):109-12. doi: 10.5507/bp.2007.020.
Monoclonal antibodies have dramatically changed the treatment possibilities for follicular lymphoma. (90)Y-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.
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/m(2)). (18)F-fluoro-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 (90)Y-ibritumomab tiuxetan radioimmunotherapy. No acute complications were noted afterwards. Hematological nadirs were reached 4 weeks later, with a platelet count of 24 x 10(9)/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 2 x 1 cm. The PET scan analysis proved no accumulation of (18)F-fluoro-deoxy-glucose in any lymph nodes or other organs and tissues.
Sequential treatment with rituximab and (90)Y-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.
单克隆抗体显著改变了滤泡性淋巴瘤的治疗选择。钇[90Y] 替伊莫单抗（泽瓦林）是首个被批准用于治疗复发及难治性滤泡性淋巴瘤患者的放射免疫治疗药物。尤其在放射免疫治疗后达到完全缓解的患者中观察到了长期获益。
一名65岁女性患者，患有CD20阳性滤泡性淋巴瘤第二次复发且伴有多种合并症，接受了4周每周一次的利妥昔单抗治疗（375 mg/m²）。氟[18F]脱氧葡萄糖正电子发射断层扫描联合计算机断层扫描（PET-CT）显示治疗仅部分缓解，腹部肿大淋巴结的PET扫描持续呈阳性。因此，决定对她采用1200 MBq（32 mCi）剂量的钇[90Y]替伊莫单抗进行放射免疫治疗。此后未观察到急性并发症。4周后达到血液学最低点，血小板计数为24×10⁹/L，在接下来的2周内恢复正常。患者既没有感染也没有出血并发症。放射免疫治疗8周后，PET-CT扫描显示腹主动脉周围仅有3个淋巴结，最大尺寸为2×1 cm。PET扫描分析证明在任何淋巴结或其他器官及组织中均无氟[18F]脱氧葡萄糖聚集。
对于复发的滤泡性淋巴瘤或其他惰性淋巴瘤，在经预处理的或患有其他合并症的老年患者中，利妥昔单抗和钇[90Y]替伊莫单抗序贯治疗可能是一种有吸引力的选择。
