SINGLE CENTER EXPERIENCE OF 90Y-IBRITUMOMAB TIUXETAN IN THE OLDER POPULATION WITH NON-HODGKIN LYMPHOMA
(Abstract release date: 05/19/16)
EHA Library. Agrawal V. 06/09/16; 132712; E1163
Dr. Vaibhav Agrawal
Contributions
Contributions
Abstract
Abstract: E1163
Type: Eposter Presentation
Background
90Y-Ibritumomab tiuxetan (90Y-IT) as radioimmunotherapy in the treatment of B-cell non-Hodgkin lymphoma (NHL) has been approved for consolidation and salvage treatment of follicular and indolent lymphoma. It has also been studied in the treatment of diffuse large B-cell and mantle cell lymphoma. Toxicities primarily include myelosuppression with a risk of treatment-associated myelodysplastic syndrome (MDS).
Aims
To evaluate the toxicity and treatment benefit of 90Y-IT administered to patients for consolidation and salvage treatment of non-Hodgkin lymphoma.
Methods
Retrospective cohort analysis of patients with B-cell NHL who received 90Y-IT from 2010 to 2015 at Geisinger Medical Center. 90Y-IT was administered according to recommended dosing guidelines and cytopenia was monitored at routine intervals.
Results
Sixty-five patients with NHL received 90Y-IT at median age of 68 years (range 32-91), 32 (49.2%) patients were male, and 36 (55.8%) were older than 65 years of age. Thirty patients (46.1%) had aggressive NHL and 37 (56.9%) had stage III/IV disease. Twenty-nine (44.6%) patients received >1 line of treatment prior to 90Y-IT therapy and 62 (97%) received Rituximab based regimens. No patient received fludarabine based therapy. Prior to administration of 90Y-IT, the median bone marrow involvement was 0%, median platelet count was 183 x 109/L, median hemoglobin count was 12.7 g/dL, and median absolute neutrophil count was 3.8 x 109/L.The median follow-up period was 16 months (range 4-68). The overall response rate was 89.2% with a PR-to-CR conversion rate of 36%. The response rate was 54.5% in the salvage setting. The median PFS and OS were 12 and 15 months, respectively. There was no significant difference in PFS and OS between patients younger and older than 65 years of age or between patients in CR and not in CR at the time of 90Y-IT.Patients on Rituximab maintenance after 90Y-IT treatment (n=14, 21.5%) had PFS and OS improvement (p<0.0001), with median PFS and OS of 45.5 and 48 months, respectively. In the population without Rituximab maintenance (n=51, 78.4%), the median PFS and OS were 10 and 13 months respectively.Patients not in CR at the time of 90Y-IT were found to be responsive to Rituximab maintenance: PFS improved from median 10.0 to 48.0 months (p <0.0001) and OS improved from median 14.0 to 53.0 months (p=0.0003).Among patients with grade 3/4 hematologic toxicities, 6 patients required blood transfusion, 4 needed platelet transfusion, and 17 (26.1%) received pegfilgastrim. One patient required hospitalization for febrile neutropenia. Seven patients relapsed after 90Y-IT and one patient (1.5%) developed MDS (del 5q, del 20q) 54 months after treatment. There were 9 deaths (six were secondary to progressive lymphoma or chemotherapy-related neutropenic sepsis).
Conclusion
This is one of the largest reported single-center experience of 90Y-IT administered to a predominantly elderly population with B-NHL in the United States. This study demonstrates the safety and feasibility of 90Y-IT in the elderly population with manageable toxicity and similar outcomes between patients younger and older than 65 years of age. Furthermore, treatment with 90Y-IT did not negatively impact continued sensitivity and benefit from Rituximab maintenance.
Session topic: E-poster
Keyword(s): Elderly, Non-Hodgkin's lymphoma, Radiotherapy, Zevalin
Type: Eposter Presentation
Background
90Y-Ibritumomab tiuxetan (90Y-IT) as radioimmunotherapy in the treatment of B-cell non-Hodgkin lymphoma (NHL) has been approved for consolidation and salvage treatment of follicular and indolent lymphoma. It has also been studied in the treatment of diffuse large B-cell and mantle cell lymphoma. Toxicities primarily include myelosuppression with a risk of treatment-associated myelodysplastic syndrome (MDS).
Aims
To evaluate the toxicity and treatment benefit of 90Y-IT administered to patients for consolidation and salvage treatment of non-Hodgkin lymphoma.
Methods
Retrospective cohort analysis of patients with B-cell NHL who received 90Y-IT from 2010 to 2015 at Geisinger Medical Center. 90Y-IT was administered according to recommended dosing guidelines and cytopenia was monitored at routine intervals.
Results
Sixty-five patients with NHL received 90Y-IT at median age of 68 years (range 32-91), 32 (49.2%) patients were male, and 36 (55.8%) were older than 65 years of age. Thirty patients (46.1%) had aggressive NHL and 37 (56.9%) had stage III/IV disease. Twenty-nine (44.6%) patients received >1 line of treatment prior to 90Y-IT therapy and 62 (97%) received Rituximab based regimens. No patient received fludarabine based therapy. Prior to administration of 90Y-IT, the median bone marrow involvement was 0%, median platelet count was 183 x 109/L, median hemoglobin count was 12.7 g/dL, and median absolute neutrophil count was 3.8 x 109/L.The median follow-up period was 16 months (range 4-68). The overall response rate was 89.2% with a PR-to-CR conversion rate of 36%. The response rate was 54.5% in the salvage setting. The median PFS and OS were 12 and 15 months, respectively. There was no significant difference in PFS and OS between patients younger and older than 65 years of age or between patients in CR and not in CR at the time of 90Y-IT.Patients on Rituximab maintenance after 90Y-IT treatment (n=14, 21.5%) had PFS and OS improvement (p<0.0001), with median PFS and OS of 45.5 and 48 months, respectively. In the population without Rituximab maintenance (n=51, 78.4%), the median PFS and OS were 10 and 13 months respectively.Patients not in CR at the time of 90Y-IT were found to be responsive to Rituximab maintenance: PFS improved from median 10.0 to 48.0 months (p <0.0001) and OS improved from median 14.0 to 53.0 months (p=0.0003).Among patients with grade 3/4 hematologic toxicities, 6 patients required blood transfusion, 4 needed platelet transfusion, and 17 (26.1%) received pegfilgastrim. One patient required hospitalization for febrile neutropenia. Seven patients relapsed after 90Y-IT and one patient (1.5%) developed MDS (del 5q, del 20q) 54 months after treatment. There were 9 deaths (six were secondary to progressive lymphoma or chemotherapy-related neutropenic sepsis).
Conclusion
This is one of the largest reported single-center experience of 90Y-IT administered to a predominantly elderly population with B-NHL in the United States. This study demonstrates the safety and feasibility of 90Y-IT in the elderly population with manageable toxicity and similar outcomes between patients younger and older than 65 years of age. Furthermore, treatment with 90Y-IT did not negatively impact continued sensitivity and benefit from Rituximab maintenance.
Session topic: E-poster
Keyword(s): Elderly, Non-Hodgkin's lymphoma, Radiotherapy, Zevalin
Abstract: E1163
Type: Eposter Presentation
Background
90Y-Ibritumomab tiuxetan (90Y-IT) as radioimmunotherapy in the treatment of B-cell non-Hodgkin lymphoma (NHL) has been approved for consolidation and salvage treatment of follicular and indolent lymphoma. It has also been studied in the treatment of diffuse large B-cell and mantle cell lymphoma. Toxicities primarily include myelosuppression with a risk of treatment-associated myelodysplastic syndrome (MDS).
Aims
To evaluate the toxicity and treatment benefit of 90Y-IT administered to patients for consolidation and salvage treatment of non-Hodgkin lymphoma.
Methods
Retrospective cohort analysis of patients with B-cell NHL who received 90Y-IT from 2010 to 2015 at Geisinger Medical Center. 90Y-IT was administered according to recommended dosing guidelines and cytopenia was monitored at routine intervals.
Results
Sixty-five patients with NHL received 90Y-IT at median age of 68 years (range 32-91), 32 (49.2%) patients were male, and 36 (55.8%) were older than 65 years of age. Thirty patients (46.1%) had aggressive NHL and 37 (56.9%) had stage III/IV disease. Twenty-nine (44.6%) patients received >1 line of treatment prior to 90Y-IT therapy and 62 (97%) received Rituximab based regimens. No patient received fludarabine based therapy. Prior to administration of 90Y-IT, the median bone marrow involvement was 0%, median platelet count was 183 x 109/L, median hemoglobin count was 12.7 g/dL, and median absolute neutrophil count was 3.8 x 109/L.The median follow-up period was 16 months (range 4-68). The overall response rate was 89.2% with a PR-to-CR conversion rate of 36%. The response rate was 54.5% in the salvage setting. The median PFS and OS were 12 and 15 months, respectively. There was no significant difference in PFS and OS between patients younger and older than 65 years of age or between patients in CR and not in CR at the time of 90Y-IT.Patients on Rituximab maintenance after 90Y-IT treatment (n=14, 21.5%) had PFS and OS improvement (p<0.0001), with median PFS and OS of 45.5 and 48 months, respectively. In the population without Rituximab maintenance (n=51, 78.4%), the median PFS and OS were 10 and 13 months respectively.Patients not in CR at the time of 90Y-IT were found to be responsive to Rituximab maintenance: PFS improved from median 10.0 to 48.0 months (p <0.0001) and OS improved from median 14.0 to 53.0 months (p=0.0003).Among patients with grade 3/4 hematologic toxicities, 6 patients required blood transfusion, 4 needed platelet transfusion, and 17 (26.1%) received pegfilgastrim. One patient required hospitalization for febrile neutropenia. Seven patients relapsed after 90Y-IT and one patient (1.5%) developed MDS (del 5q, del 20q) 54 months after treatment. There were 9 deaths (six were secondary to progressive lymphoma or chemotherapy-related neutropenic sepsis).
Conclusion
This is one of the largest reported single-center experience of 90Y-IT administered to a predominantly elderly population with B-NHL in the United States. This study demonstrates the safety and feasibility of 90Y-IT in the elderly population with manageable toxicity and similar outcomes between patients younger and older than 65 years of age. Furthermore, treatment with 90Y-IT did not negatively impact continued sensitivity and benefit from Rituximab maintenance.
Session topic: E-poster
Keyword(s): Elderly, Non-Hodgkin's lymphoma, Radiotherapy, Zevalin
Type: Eposter Presentation
Background
90Y-Ibritumomab tiuxetan (90Y-IT) as radioimmunotherapy in the treatment of B-cell non-Hodgkin lymphoma (NHL) has been approved for consolidation and salvage treatment of follicular and indolent lymphoma. It has also been studied in the treatment of diffuse large B-cell and mantle cell lymphoma. Toxicities primarily include myelosuppression with a risk of treatment-associated myelodysplastic syndrome (MDS).
Aims
To evaluate the toxicity and treatment benefit of 90Y-IT administered to patients for consolidation and salvage treatment of non-Hodgkin lymphoma.
Methods
Retrospective cohort analysis of patients with B-cell NHL who received 90Y-IT from 2010 to 2015 at Geisinger Medical Center. 90Y-IT was administered according to recommended dosing guidelines and cytopenia was monitored at routine intervals.
Results
Sixty-five patients with NHL received 90Y-IT at median age of 68 years (range 32-91), 32 (49.2%) patients were male, and 36 (55.8%) were older than 65 years of age. Thirty patients (46.1%) had aggressive NHL and 37 (56.9%) had stage III/IV disease. Twenty-nine (44.6%) patients received >1 line of treatment prior to 90Y-IT therapy and 62 (97%) received Rituximab based regimens. No patient received fludarabine based therapy. Prior to administration of 90Y-IT, the median bone marrow involvement was 0%, median platelet count was 183 x 109/L, median hemoglobin count was 12.7 g/dL, and median absolute neutrophil count was 3.8 x 109/L.The median follow-up period was 16 months (range 4-68). The overall response rate was 89.2% with a PR-to-CR conversion rate of 36%. The response rate was 54.5% in the salvage setting. The median PFS and OS were 12 and 15 months, respectively. There was no significant difference in PFS and OS between patients younger and older than 65 years of age or between patients in CR and not in CR at the time of 90Y-IT.Patients on Rituximab maintenance after 90Y-IT treatment (n=14, 21.5%) had PFS and OS improvement (p<0.0001), with median PFS and OS of 45.5 and 48 months, respectively. In the population without Rituximab maintenance (n=51, 78.4%), the median PFS and OS were 10 and 13 months respectively.Patients not in CR at the time of 90Y-IT were found to be responsive to Rituximab maintenance: PFS improved from median 10.0 to 48.0 months (p <0.0001) and OS improved from median 14.0 to 53.0 months (p=0.0003).Among patients with grade 3/4 hematologic toxicities, 6 patients required blood transfusion, 4 needed platelet transfusion, and 17 (26.1%) received pegfilgastrim. One patient required hospitalization for febrile neutropenia. Seven patients relapsed after 90Y-IT and one patient (1.5%) developed MDS (del 5q, del 20q) 54 months after treatment. There were 9 deaths (six were secondary to progressive lymphoma or chemotherapy-related neutropenic sepsis).
Conclusion
This is one of the largest reported single-center experience of 90Y-IT administered to a predominantly elderly population with B-NHL in the United States. This study demonstrates the safety and feasibility of 90Y-IT in the elderly population with manageable toxicity and similar outcomes between patients younger and older than 65 years of age. Furthermore, treatment with 90Y-IT did not negatively impact continued sensitivity and benefit from Rituximab maintenance.
Session topic: E-poster
Keyword(s): Elderly, Non-Hodgkin's lymphoma, Radiotherapy, Zevalin
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