Aims: It was the aim of this paper to identify prognostic factors in patients with relapsed or refractory B-cell non-Hodgkin's lymphomas, treated by radioimmunotherapy (RIT) with radioiodinated human/murine chimeric anti-CD20 monoclonal antibody rituximab (131I-rituximab). Methods: Twenty-four patients were enrolled prospectively and were treated with unlabeled rituximab 70 mg and a therapeutic activity (median 7.3 GBq) of 131I-rituximab. Contrast-enhanced 18F-FDG PET/CT scans were performed before and after 1 month of RIT. Tumor sizes and maximum standardized uptake values (SUVmax) of scans were measured. Results: Four of the 24 patients survived. High SUVmax in a pretreatment scan was found to be related to poorer overall survival (OS) and progression-free survival (p = 0.04 and 0.02, respectively). Furthermore, a large tumor size in a pretreatment scan was associated with poorer OS but not with progression-free survival (p < 0.01 and p = 0.07, respectively). By multivariate analyses, a high SUVmax, a large tumor size in a pretreatment scan and diffuse large B-cell lymphoma histology were significantly associated with poorer OS [p = 0.04/hazard ratio (HR) = 3.54, p < 0.01/HR = 5.52, and p = 0.02/HR = 3.38, respectively). Conclusion: SUVmax and tumor size determined by a pretreatment 18F-FDG PET/CT result as significant predictors of OS in patients with relapsed or refractory B-cell non-Hodgkin's lymphoma treated by RIT.

Kaminski MS, Tuck M, Estes J, Kolstad A, Ross CW, Zasadny K, Regan D, Kison P, Fisher S, Kroll S, Wahl RL: 131I-tositumomab therapy as initial treatment for follicular lymphoma. N Engl J Med 2005;352:441-449.
Witzig TE, Flinn IW, Gordon LI, Emmanouilides C, Czuczman MS, Saleh MN, Cripe L, Wiseman G, Olejnik T, Multani PS, White CA: Treatment with ibritumomab tiuxetan radioimmunotherapy in patients with rituximab-refractory follicular non-Hodgkin's lymphoma. J Clin Oncol 2002;20:3262-3269.
Leahy MF, Seymour JF, Hicks RJ, Turner JH: Multicenter phase II clinical study of iodine-131-rituximab radioimmunotherapy in relapsed or refractory indolent non-Hodgkin's lymphoma. J Clin Oncol 2006;24:4418-4425.
Bishton MJ, Hicks RJ, Westerman DA, Prince MH, Wolf M, Seymour JF: A prospective study of the separate predictive capabilities of 18[F]-FDG-PET and molecular response in patients with relapsed indolent non-Hodgkin's lymphoma following treatment with iodine-131-rituximab radio-immunotherapy. Haematologica 2008;93:789-790.
Bodet-Milin C, Kraeber-Bodere F, Dupas B, Morschhauser F, Gastinne T, Le Gouill S, Campion L, Harousseau JL, Wegener WA, Goldenberg DM, Huglo D: Evaluation of response to fractionated radioimmunotherapy with 90Y-epratuzumab in non-Hodgkin's lymphoma by 18F-fluorodeoxyglucose positron emission tomography. Haematologica 2008;93:390-397.
Jacene HA, Filice R, Kasecamp W, Wahl RL: 18F-FDG PET/CT for monitoring the response of lymphoma to radioimmunotherapy. J Nucl Med 2009;50:8-17.
Lopci E, Santi I, Tani M, Maffione AM, Montini G, Castellucci P, Stefoni V, Rubello D, Fonti C, Zinzani P, Fanti S: FDG PET and 90Y ibritumomab tiuxetan in patients with follicular lymphoma. Q J Nucl Med Mol Imaging 2010;54:436-441.
Torizuka T, Zasadny KR, Kison PV, Rommelfanger SG, Kaminski MS, Wahl RL: Metabolic response of non-Hodgkin's lymphoma to 131I-anti-B1 radioimmunotherapy: evaluation with FDG PET. J Nucl Med 2000;41:999-1005.
Lopci E, Santi I, Derenzini E, Fonti C, Savelli G, Bertagna F, Bello M, Botto B, Huglo D, Morschhauser F, Zinzani P, Fanti S: FDG-PET in the assessment of patients with follicular lymphoma treated by ibritumomab tiuxetan Y 90: multicentric study. Ann Oncol 2010;21:1877-1883.
Cheson BD, Pfistner B, Juweid ME, Gascoyne RD, Specht L, Horning SJ, Coiffier B, Fisher RI, Hagenbeek A, Zucca E, Rosen ST, Stroobants S, Lister TA, Hoppe RT, Dreyling M, Tobinai K, Vose JM, Connors JM, Federico M, Diehl V: Revised response criteria for malignant lymphoma. J Clin Oncol 2007;25:579-586.
Cazaentre T, Morschhauser F, Vermandel M, Betrouni N, Prangere T, Steinling M, Huglo D: Pre-therapy 18F-FDG PET quantitative parameters help in predicting the response to radioimmunotherapy in non-Hodgkin lymphoma. Eur J Nucl Med Mol Imaging 2010;37:494-504.
Witzig TE, Molina A, Gordon LI, Emmanoui-lides C, Schilder RJ, Flinn IW, Darif M, Macklis R, Vo K, Wiseman GA: Long-term responses in patients with recurring or refractory B-cell non-Hodgkin lymphoma treated with yttrium 90 ibritumomab tiuxetan. Cancer 2007;109:1804-1810.
Witzig TE, White CA, Wiseman GA, Gordon LI, Emmanouilides C, Raubitschek A, Janakiraman N, Gutheil J, Schilder RJ, Spies S, Silverman DH, Parker E, Grillo-Lopez AJ: Phase I/II trial of IDEC-Y2B8 radioimmunotherapy for treatment of relapsed or refractory CD20(+) B-cell non-Hodgkin's lymphoma. J Clin Oncol 1999;17:3793-3803.
Gordon LI, Molina A, Witzig T, Emmanouilides C, Raubtischek A, Darif M, Schilder RJ, Wiseman G, White CA: Durable responses after ibritumomab tiuxetan radioimmunotherapy for CD20+ B-cell lymphoma: long-term follow-up of a phase 1/2 study. Blood 2004;103:4429-4431.
Haioun C, Itti E, Rahmouni A, Brice P, Rain JD, Belhadj K, Gaulard P, Garderet L, Lepage E, Reyes F, Meignan M: [18F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) in aggressive lymphoma: an early prognostic tool for predicting patient outcome. Blood 2005;106:1376-1381.
Kostakoglu L, Coleman M, Leonard JP, Kuji I, Zoe H, Goldsmith SJ: PET predicts prognosis after 1 cycle of chemotherapy in aggressive lymphoma and Hodgkin's disease. J Nucl Med 2002;43:1018-1027.
Mikhaeel NG, Hutchings M, Fields PA, O'Doherty MJ, Timothy AR: FDG-PET after two to three cycles of chemotherapy predicts progression-free and overall survival in high-grade non-Hodgkin lymphoma. Ann Oncol 2005;16:1514-1523.
Spaepen K, Stroobants S, Dupont P, Van Steenweghen S, Thomas J, Vandenberghe P, Vanuytsel L, Bormans G, Balzarini J, De Wolf-Peeters C, Mortelmans L, Verhoef G: Prognostic value of positron emission tomography (PET) with fluorine-18 fluorodeoxyglucose ([18F]FDG) after first-line chemotherapy in non-Hodgkin's lymphoma: is [18F]FDG-PET a valid alternative to conventional diagnostic methods? J Clin Oncol 2001;19:414-419.
Song MK, Chung JS, Sung-Yong O, Lee GW, Kim SG, Seol YM, Shin HJ, Choi YJ, Cho GJ, Shin DH, Yun EY: Clinical impact of bulky mass in the patient with primary extranodal diffuse large B cell lymphoma treated with R-CHOP therapy. Ann Hematol 2010;89:985-991.
Gaudio F, Giordano A, Perrone T, Pastore D, Curci P, Delia M, Napoli A, de' Risi C, Spina A, Ricco R, Liso V, Specchia G: High Ki67 index and bulky disease remain significant adverse prognostic factors in patients with diffuse large B cell lymphoma before and after the introduction of rituximab. Acta Haematol 2011;126:44-51.
Nourigat C, Badger CC, Bernstein ID: Treatment of lymphoma with radiolabeled antibody: elimination of tumor cells lacking target antigen. J Natl Cancer Inst 1990;82:47-50.
Knox SJ, Goris ML, Trisler K, Negrin R, Davis T, Liles TM, Grillo-Lopez A, Chinn P, Varns C, Ning SC, Fowler S, Deb N, Becker M, Marquez C, Levy R: Yttrium-90-labeled anti-CD20 monoclonal antibody therapy of recurrent B-cell lymphoma. Clin Cancer Res 1996;2:457-470.
Vriesendorp HM, Herpst JM, Germack MA, Klein JL, Leichner PK, Loudenslager DM, Order SE: Phase I-II studies of yttrium-labeled antiferritin treatment for end-stage Hodgkin's disease, including radiation therapy oncology group 87-01. J Clin Oncol 1991;9:918-928.
Fisher RI, Kaminski MS, Wahl RL, Knox SJ, Zelenetz AD, Vose JM, Leonard JP, Kroll S, Goldsmith SJ, Coleman M: Tositumomab and iodine-131 tositumomab produces durable complete remissions in a subset of heavily pretreated patients with low-grade and transformed non-Hodgkin's lymphomas. J Clin Oncol 2005;23:7565-7573.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.