Subsequent therapy can be administered after tositumomab and iodine I-131 tositumomab for non-Hodgkin lymphoma

BACKGROUND. Iodine I-131 tositumomab is a well tolerated and effective therapy for recurrent low-grade and transformed low-grade non-Hodgkin lymphoma (NHL). Hematologic reserve after radioimmunotherapy (RIT) is an important consideration when subsequent therapy is required. METHODS. One hundred fifty-five patients who received treatment with I-131 tositumomab were assessed, and 68 patients had progressive disease after RIT. The median age (n = 68 patients) was 59 years (range, 18-82 yrs), and patients received a median of 2 pre-RIT regimens (range, 1-8 regimens), including 66% who received anthracycline, 19% who received platinum, and 50% who received fludarabine. RESULTS. The median time to disease progression (among progressors) was 168 days (range, 19-771 days). At the time they developed recurrent disease, patients had median white blood cell count (WBC) of 4.9 K cells/μL (range, 1.1-21.4 K cells/μL), a median absolute neutrophil count (ANC) of 3.25 K cells/μL (range, 0.59-8.20 K cells/μL), a median platelet count of 130 K cells/μL (range, 9-440 K cells/μL), and there was no significant difference between pre-RIT and recurrence values except for the platelet count (P < 0.05). No patient demonstrated a WBC < 1.0 K cells/μL or an ANC < 0.5 K cells/μL, although 1 patient had a platelet count < 10 K cells/μL. Twenty-four patients subsequently received no further chemotherapy; and, in 21 patients (88%), hematologic parameters appeared to allow subsequent chemotherapy if necessary (blood counts: National Cancer Institute Grade 0-2). Among 44 patients (65%) who received further chemotherapy (median, 2 regimens; range, 1-4 regimens), 19 patients (43%) were treated with anthracyclines, 17 patients (39%) were treated with platinum, 10 patients (23%) were treated with fludarabine, and 13 patients (30%) underwent stem cell transplantation. Disease improvement occurred in most patients, although 18 patients died (40%) after further chemotherapy, predominantly from refractory lymphoma. CONCLUSIONS. Most patients with progressive disease after treatment with iodine I-131 tositumomab were able to receive subsequent therapy, including cytotoxic chemotherapy and stem cell transplantation.