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Radioimmunotherapy/Chemotherapy Combination Could Extend Survival in Some Patients with Advanced Lymphoma

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Key Points

  • A randomized study in patients with relapsed and aggressive lymphoma compared standard high-dose chemotherapy (BEAM) alone with BEAM plus radioimmunotherapy with Y-90 ibritumomab tiuxetan (Z-BEAM) prior to autologous bone marrow transplant.
  • Patients who underwent BEAM chemotherapy alone had a 43% chance of survival without cancer recurrence, whereas those who received Z-BEAM were shown to have a 64% chance of survival.
  • Patients who received Z-BEAM and who did not have limiting factors were shown to have a 100% chance of survival at 2-year follow-up.

A new patient protocol for aggressive and recurrent lymphoma that combines intensive chemotherapy and radioimmunotherapy showed encouraging overall survival rates in some patients preparing for autologous bone marrow transplant, reported researchers at the 2013 Annual Meeting of the Society of Nuclear Medicine and Molecular Imaging. In a study presented at the meeting, survival rates without recurrence improved with the addition of radioimmunotherapy, with some patients having a 100% chance of survival over 2 years.

“This is a unique randomized study aimed at evaluating a novel treatment approach in patients who have relapsed and aggressive lymphoma with a grave prognosis,” said S. Tzila Zwas, MD, Professor of Nuclear Medicine at Sackler School of Medicine, Tel-Aviv University, and Sheba Medical Center in Ramat Gan, Israel. “Currently the best choice for these patients is bone marrow transplantation preceded by high-dose chemotherapy with a preparation called BEAM to enhance their response to this engraftment treatment. Here we are studying the effectiveness of a new treatment adding targeted radioimmunotherapy to this standard in order to improve patients’ survival.”

BEAM (carmustine, etoposide, cytarabine, and melphalan) is a high-dose chemotherapy developed to treat invasive bone marrow cancer. This research compares standard BEAM with BEAM and the addition of radioimmunotherapy with Y-90 ibritumomab tiuxetan (Zevalin), a radionuclide that emits a cancer-killing dose of radiation. This allows doctors to monitor how patients respond to therapy. The new treatment combination is known as Z-BEAM.

BEAM vs Z-BEAM

In this two-part multicenter prospective study, a total of 43 patients with remaining or relapsed lymphoma were randomized and received one of the two possible treatments prior to bone marrow transplant. Patients who underwent BEAM chemotherapy alone had a 43% chance of survival without cancer recurrence, whereas those who received Z-BEAM were shown to have a 64% chance of survival, a significant improvement for lymphoma patients.

Prognosis varied widely depending on the circumstances of disease and patient age, but those who did not have limiting factors and received Z-BEAM were shown to have a 100% chance of survival at 2-year follow-up.

“The major significance of this study is in its encouraging overall survival rate—results improved to survival of more than 2 years in increasing numbers of patients, giving them a better chance overall with very low side effects with Z-BEAM compared to BEAM alone, which appeared to be rather inferior in its results during this study,” said Dr. Zwas, who also mentioned that further studies are required to expand this regimen into general clinical practice.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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