A Tutorial by Stephen M. Karesh, PhD
Adapted for the Web by Stephen M. Karesh, PhD & Marsha Lipps CNMT
This Tutorial Gives Special Thanks To:
Spectrum Pharmaceuticals, Inc.: Zevalin
CTI- Cell Therapeutics, Inc
Mike Wakefield Pharm.D.
Bobbie Miller BS CNMT
Introduction to NHL & RIT
● Non-Hodgkins Lymphoma
● Incidence: 55,000/year and increasing
● Prevalence: 300,000 cases
● NHL is classified by:
The type of lymphocyte (B-cell or T-cell)
The speed of growth (grade)
The degree of spread (stage)
● Most are B cell and express CD20- 85% of all NHLs are B-cell lymphomas*
● Over 90% of B-cell lymphomas express CD20+ antigen**
● There are 30 or so different types in the most recent classification
● Most are B cell and express CD20 antigen
● They can be divided into two main categories
Indolent (or “low-grade” or “follicular”)
■ Generally felt to be incurable
■ Patients live a long time; median survival 6.2 years
Aggressive (“high-grade,” “diffuse,” “large cell”)
■ Can be cured 30-60% of the time
■ If not cured with therapy, median survival is short
Indolent can become aggressive over time(“transformation”)
* ACS. Cancer Facts & Figures 2004.
** SEER Cancer Statistics Rev 1973-1999. Table XXIX-1.
●Incidence of NHL in the Elderly
Key Point: The incidence of NHL is increasing, especially in the elderly.
NHL is a growing problem, especially in elderly patients (>60 years), as shown above in
the graph of SEER data. Note that these data are based upon a population of males.
An increase in the incidence of NHL is seen in almost all age groups in the 20 years from
1975–1977 to 1998–2000, with the highest increase in persons older than 60 years.
1Ries LAG, Eisner MP, Kosary CL, et al, eds. SEER Cancer Statistics Review, 1975-2000, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2000, 2003. American Cancer Society. Cancer Facts and Figures 2003. Atlanta, GA: American Cancer Society; 2003
● Patient Indications:
● Approved Indication- The Zevalin regimen is indicated for the treatment of patients with :
● Relapsed or refractory, low-grade or follicular B-cell NHL, including patients with Rituximab-refractory follicular B-cell NHL.
● Previously untreated follicular NHL who achieve a partial or complete response to first-line chemotherapy.
● Patient Exclusion Criteria
● Contraindications: None
● Do not treat patients with <100,000 platelet/mm3
● Do not administer to patients with ≥ 25% lymphoma marrow involvement or impaired bone marrow reserve