Cicone Francesco, Sarnelli Anna, Guidi Claretta, Belli Maria Luisa, Ferrari Mahila Esmeralda, Wahl Richard, Cremonesi Marta, Paganelli Giovanni
Department of Experimental and Clinical Medicine, and Neuroscience Research Centre, PET/RM Unit, "Magna Graecia" University of Catanzaro, Catanzaro, Italy; Nuclear Medicine Unit, University Hospital "Mater Domini", Catanzaro, Italy.
Medical Physics Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy.
Semin Nucl Med. 2022 Mar;52(2):191-214. doi: 10.1053/j.semnuclmed.2021.11.001. Epub 2022 Jan 5.
Radioimmunotherapy (RIT) is a safe and active treatment available for non-Hodgkin lymphomas (NHLs). In particular, two monoclonal antibodies raised against CD20, that is Zevalin (Y-ibritumomab-tiuxetan) and Bexxar (I-tositumomab) received FDA approval for the treatment of relapsing/refractory indolent or transformed NHLs. RIT is likely the most effective and least toxic anticancer agent in NHLs. However, its use in the clinical setting is still debated and, in case of relapse after optimized rituximab-containing regimens, the efficacy of RIT at standard dosage is suboptimal. Thus, clinical trials were based on the hypothesis that the inclusion of RIT in myeloablative conditioning would allow to obtain improved efficacy and toxicity profiles when compared to myeloablative total-body irradiation and/or high-dose chemotherapy regimens. Standard-activity RIT has a safe toxicity profile, and the utility of pretherapeutic dosimetry in this setting can be disputed. In contrast, dose-escalation clinical protocols require the assessment of radiopharmaceutical biodistribution and dosimetry before the therapeutic injection, as dose constrains for critical organs may be exceeded when RIT is administered at high activities. The aim of the present study was to review and discuss the internal dosimetry protocols that were adopted for non-standard RIT administration in the myeloablative setting before hematopoietic stem cell transplantation in patients with NHLs.
放射免疫疗法（RIT）是一种可用于治疗非霍奇金淋巴瘤（NHL）的安全且有效的治疗方法。特别是，两种针对CD20的单克隆抗体，即泽瓦林（钇-伊布替莫单抗-替曲膦）和贝沙罗（碘-托西莫单抗）已获得美国食品药品监督管理局（FDA）批准，用于治疗复发性/难治性惰性或转化型NHL。RIT可能是NHL中最有效且毒性最小的抗癌药物。然而，其在临床环境中的应用仍存在争议，并且在含利妥昔单抗的优化方案治疗后复发的情况下，标准剂量的RIT疗效并不理想。因此，临床试验基于这样的假设，即与清髓性全身照射和/或高剂量化疗方案相比，在清髓性预处理中加入RIT将能获得更好的疗效和毒性特征。标准活性的RIT具有安全的毒性特征，在此情况下治疗前剂量测定的实用性可能存在争议。相比之下，剂量递增的临床方案要求在治疗性注射前评估放射性药物的生物分布和剂量测定，因为当以高活性给予RIT时，可能会超过关键器官的剂量限制。本研究的目的是回顾和讨论在非霍奇金淋巴瘤患者造血干细胞移植前的清髓性治疗中，用于非标准RIT给药的体内剂量测定方案。
