Yttrium-90 Ibritumomab Tiuxetan Followed By Rituximab Maintenance As Treatment For Patients With Diffuse Large B-Cell Lymphoma Are Not Candidates For Autologous Stem Cell Transplant

Background: Not all patients with diffuse large B-cell lymphoma (DLBCL) are candidates for aggressive regimens. Y-90 ibritumomab tiuxetan (Y-90-IT), an anti-CD20 radionuclide-conjugated antibody, has demonstrated clinical efficacy in DLBCL with a favorable toxicity profile. Methods: This phase II trial investigated the overall response rate (ORR), event-free survival (EFS), overall survival (OS) and toxicity of treatment with Y-90-IT (0.4 or 0.3 mCi Y-90/kg based on platelets) followed by rituximab maintenance therapy in patients with DLBCL not candidates for transplant. Results: 25 patients were enrolled. At best response 8 patients obtained a complete response (CR) and 1 a partial response (ORR 36%). Median EFS was 2.5 months and OS 8.1 months. No patient who obtained CR later relapsed systemically. Two patients were free of disease at the 61-and 100-month follow-ups; 65% had grade 3/4 thrombocytopenia, but no significant bleeding was observed. Grade 3 nonhematologic toxicity occurred in 36%. Patients who had progressed through a rituximab-containing regimen responded poorly. Conclusion: The ORR of 36% with Y-90-IT as salvage therapy for DLBCL while inferior to more aggressive regimens is significant with acceptable toxicity. For a subset of patients not candidates for salvage with autologous transplant, this treatment strategy can produce a durable, long-lasting remission. (C) 2015 S. Karger AG, Basel