Department of Hematology Regina Elena National Cancer Institute, Via Elio Chianesi, 53 00128 Rome, Italy.
J Exp Clin Cancer Res. 2011 Feb 8;30(1):16. doi: 10.1186/1756-9966-30-16.
This retrospective analysis is focused on the efficacy and safety of radioimmunotherapy (RIT) with Zevalin® in nine patients with recurrent follicular lymphoma (FL) who were treated in a consolidation setting after having achieved complete remission or partial remission with FCR.
The median age was 63 yrs (range 46-77), all patients were relapsed with histologically confirmed CD20-positive (grade 1 or 2) FL, at relapse they received FCR every 28 days: F (25 mg/m2x 3 days), C (1 gr/m2 day 1) and R (375 mg/m2 day 4) for 4 cycles. Who achieved at least a partial remission, with < 25% bone marrow involvement, was treated with 90Yttrium Ibritumomab Tiuxetan 11.1 or 14.8 MBq/Kg up to a maximum dose 1184 MBq, at 3 months after the completion of FCR. The patients underwent a further restaging at 12 weeks after 90Y-RIT with total body CT scan, FDG-PET/CT and bilateral bone marrow biopsy.
Nine patients have completed the treatment: FCR followed by 90Y-RIT (6 patients at 14.8 MBq/Kg, 3 patients at 11.1 MBq/Kg). After FCR 7 patients obtained CR and 2 PR; after 90Y-RIT two patients in PR converted to CR 12 weeks later. With median follow up of 34 months (range 13-50) the current analysis has shown that overall survival (OS) is 89% at 2 years, 76% at 3 years and 61% at 4 years. The most common grade 3 or 4 adverse events were hematologic, one patient developed herpes zoster infection after 8 months following valacyclovir discontinuation; another patient developed fungal infection.
Our experience indicate feasibility, tolerability and efficacy of FCR regimen followed by 90Y-RIT in patients relapsed with grades 1 and 2 FL with no unexpected toxicities. A longer follow up and a larger number of patients with relapsed grades 1 and 2 FL are required to determine the impact of this regimen on long-term duration of response and PFS.
本回顾性分析专注于放射性免疫疗法（RIT）在九例复发性滤泡性淋巴瘤（FL）患者中的疗效和安全性，这些患者在完成 FCR 后达到完全缓解或部分缓解，处于巩固治疗阶段。
中位年龄为 63 岁（范围 46-77 岁），所有患者均为组织学证实的 CD20 阳性（1 或 2 级）FL 复发，在复发时接受每 28 天一次的 FCR 治疗：F（25mg/m2x3 天）、C（1g/m2 第 1 天）和 R（375mg/m2 第 4 天）共 4 个周期。至少获得部分缓解且骨髓受累<25%的患者在完成 FCR 后 3 个月接受 90Y 碘替比肽替曲昔单抗 11.1 或 14.8MBq/Kg，最大剂量为 1184MBq。在 90Y-RIT 后 12 周，患者在全身 CT 扫描、FDG-PET/CT 和双侧骨髓活检后进行进一步分期。
九名患者完成了治疗：FCR 后接受 90Y-RIT（6 名患者使用 14.8MBq/Kg，3 名患者使用 11.1MBq/Kg）。FCR 后 7 名患者获得完全缓解，2 名患者获得部分缓解；90Y-RIT 后 2 名部分缓解患者在 12 周后转化为完全缓解。中位随访 34 个月（范围 13-50），目前分析显示，2 年时总生存率（OS）为 89%，3 年时为 76%，4 年时为 61%。最常见的 3 级或 4 级不良事件为血液学毒性，1 名患者在停用伐昔洛韦 8 个月后患带状疱疹感染；另一名患者发生真菌感染。
我们的经验表明，FCR 方案后接受 90Y-RIT 治疗 1 级和 2 级 FL 复发患者具有可行性、耐受性和疗效，无意外毒性。需要更长时间的随访和更多 1 级和 2 级 FL 复发患者，以确定该方案对长期缓解持续时间和无进展生存期的影响。
