● Radiation Safety
Zevalin®: Risk of Radiation Exposure to Others Is Negligible *
Most activity is retained; urinary excretion = 7.3% ± 3.2% over 7 days
• Assuming maximum 32-mCi dose and excretion of 7% over a week, total urinary excretion over a week = 2.3 mCi
• Activity per urination = microcuries
• Ordinary amounts of blood (eg, menstruation, bad cuts, hemorrhoids) will not contain appreciable levels of radioactivity
Zevalin Precautions = Universal Precautions
• Isolation room not required
• Outpatient administration without restrictions
• No need to determine activity limits or dose rate limits prior to patient release
• Patients can be released immediately after treatment
Zevalin: Radiation Safety
• Zevalin should be administered by physicians and other professionals qualified by training and experienced in the safe use and handling of radiopharmaceuticals (e.g., nuclear medicine physicians or radiation oncologists)
*Wagner et al. J Nucl Med.2002:43:267-272
Radiation Safety Issues Are Less With Pure Beta Decay (90Y):
• 90Y is a pure beta emitter
• Risk of exposure to personnel from treated patient is minimal
The risks of radiation exposure can be minimized by limiting the duration of exposure, maximizing the distance from the
radiation source, and using shielding. Doses, exposure, and the likelihood of being exposed should be kept as low as reasonably achievable (ALARA). In preparing and transporting a radioactive chemical, precautions must be taken to minimize exposure. With pure beta emitters like 90Y, a plastic shield is sufficient to absorb the beta particles. With gamma emitters like 131I, thick lead shielding is required to absorb the longer gamma rays.
Penetration of Particulate and Electromagnetic Radiation
Zevalin®: Risk of Radiation Exposure to Others Is Negligible*
*Wiseman et al. Eur J Nucl Med.200:28: Abstract PS479
• Prospective study in 13 family members of patients treated with Zevalin
• Family members with closest contact wore DoseGUARD Plus personal dosimeter for 7 days
• Family was instructed to avoid body wastes, but no other precautions were given
• Median deep dose equivalent over 7 days = 3.5 mrem (range, 1.4–7.9 mrem)
• Conclusion: Exposure to others is negligible, in the range of background radiation (300 mrem/year)
90Y Zevalin: Minimal Exposure: Mayo Clinic Experience
• Wiseman et al measured doses to personnel during preparation and infusion of 12 doses of
90Y Zevalin
•90Y hand dose (plastic shields used)
• Median 50 mrem
• Range 30-80 mrem
• Conclusion: Exposures to healthcare workers can be low even when giving multiple therapies each year
G.A. Wiseman and D.N. Gansen (abstract submitted to Soc. Nuc. Med. 2002)
Zevalin® Patient Release Instructions*
• For 3 days after treatment
• Clean up spilled urine and dispose of body-fluid- contaminated material so that others will not inadvertently handle it (ie, flush down toilet or place in plastic bag in household trash)
• Wash hands thoroughly after using the toilet
• For 1 week after treatment
• Use condoms for sexual relations
• Use good contraceptive method for 1 year following Zevalin Therapy
*Wagner et al. J Nucl Med.2002:43:267-272
● Patient Safety and Efficacy: Summary
• High ORR and CR in relapsed or refractory LG,F, T NHL
• Efficacy in Rituxan® nonresponders
• Well tolerated; hematologic toxicity is dose limiting
• Patient selection is important to ensure safety
• Regimen completed in 7 to 9 days in an OP setting
• Universal Precautions = Zevalin Precautions
• Team approach to therapy
Zevalin: Most Common Nonhematologic Adverse Events
Coiffier et al. N Engl J Med. 2002; 346:235
CHOP: Most Common Nonhematologic Adverse Events
Coiffier et al. N Engl J Med. 2002; 346:235
Zevalin Reimbursement
• Refer professionals to RESULTS™ hotline for questions on current billing or reimbursement and to pre-qualify patients
• RESULT (Reimbursement Support Line-Trained Specialists)
• 1-800-386-9997
• Mon - Fri, 0900 - 2000 ET
Zevalin Concierge Program
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