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Previous Volume 352:441-449 February 3, 2005 Number 5 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Connors, J. M. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Advanced-stage follicular B-cell lymphoma is considered incurable. Anti-CD20 radioimmunotherapy is effective in patients who have had a relapse after chemotherapy or who have refractory follicular lymphoma, but it has not been tested in previously untreated patients.

Methods Seventy-six patients with stage III or IV follicular lymphoma received as initial therapy a single course of treatment with ¹³¹I-tositumomab therapy (registered as Tositumomab and Iodine I 131 Tositumomab [the Bexxar therapeutic regimen]). This consisted of a dosimetric dose of tositumomab and ¹³¹I-labeled tositumomab followed one week later by a therapeutic dose, delivering 75 cGy of radiation to the total body.

Results Ninety-five percent of the patients had any response, and 75 percent had a complete response. The use of polymerase chain reaction (PCR) to detect rearrangement of the BCL2 gene showed molecular responses in 80 percent of assessable patients who had a clinical complete response. After a median follow-up of 5.1 years, the actuarial 5-year progression-free survival for all patients was 59 percent, with a median progression-free survival of 6.1 years. The annualized rate of relapse progressively decreased over time: 25 percent, 13 percent, and 12 percent during the first, second, and third years, respectively, and 4.4 percent per year after three years. Of 57 patients who had a complete response, 40 remained in remission for 4.3 to 7.7 years. Hematologic toxicity was moderate, with no patient requiring transfusions or hematopoietic growth factors. No cases of myelodysplastic syndrome have been observed.

Conclusions A single one-week course of ¹³¹I-tositumomab therapy as initial treatment can induce prolonged clinical and molecular remissions in patients with advanced follicular lymphoma.

Source Information

From the Department of Internal Medicine, Division of Hematology and Oncology (M.S.K., M.T., J.E.), the Department of Pathology (C.W.R.), and the Department of Radiology, Division of Nuclear Medicine (K.Z., D.R., P.K., S.F.), University of Michigan Medical Center, Ann Arbor; the Department of Oncology, Norwegian Radium Hospital, Oslo (A.K.); Corixa, Seattle (S.K.); and the Department of Radiology and Radiological Sciences, Division of Nuclear Medicine, Johns Hopkins University School of Medicine, Baltimore (R.L.W.).

Address reprint requests to Dr. Kaminski at the Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan Cancer Center and Geriatrics Center, Rm. 4316, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-0936, or at mkaminsk{at}umich.edu.

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