Congress Abstracts 2005

11

SUCCESSFUL RADIOIMMUNOTHERAPY WITH ZEVALIN IN A 90-YEAR-OLD PATIENT WITH RELAPSED NON-HODGKIN LYMPHOMA. Stella Ortiz, RN, and Robert H. Joseph, MD, Westlake Village, CA.

Zevalin^® is a second-generation radioimmunoconjugate, indicated for the treatment of relapsed or refractory low-grade, follicular, or transformed B-cell NHL. The effects of Zevalin therapy in patients over 85 years old have not been reported previously, and any additional measures for managing complications in this population are not defined. The administration of Zevalin in the very elderly may require increased observation of hematological recovery and follow-up from the oncology nurse.

The safety and efficacy of Zevalin have been documented in 4 registrational trials of patients with NHL, where the oldest patient was 85 years old at the time of Zevalin administration. Our team evaluated the Zevalin regimen in a 90-year-old, female patient having a 15-year history of low-grade lymphoplasmacytoid type lymphoma. The patient presented with non-bulky disease and bone marrow involvement of 25% prior to Zevalin administration. Previous treatments for NHL included 4 chemotherapy regimens consisting of vincristine, cyclophosphamide, prednisone, and dexamethasone in various combinations. An 8-week course of rituximab therapy was also employed.

In October 2002, the patient received the standard Zevalin regimen, consisting of an initial infusion of rituximab (250 mg/m²) followed immediately thereafter by an intravenous injection of an imaging dose of 111In Zevalin (5 mCi). One week later, a second infusion of rituximab proceeded by a slow intravenous injection of 90Y Zevalin (0.3 mCi/kg) was administered. Initial therapy was well tolerated without complications. At 6 weeks post treatment, RBC and platelet transfusions (X2) were given because of hemoglobin and platelet nadir.

Post-treatment bone marrow showed no evidence of lymphoma, although some involvement by monoclonal plasma cells was noted. The patient later received dexamethasone and growth factors and was treated with a maintenance dose of rituximab.

Two years after Zevalin treatment, the patient is in good overall health. The patient is able to live independently and is not restricted by her condition. She continues to receive growth factors for anemia.

This case demonstrates that Zevalin is safe and efficacious in elderly patients with relapsed B-cell NHL, with little impact on patient quality of life. Particular attention in managing hematological recovery may be needed because of the possibility of prolonged cytopenia.