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Conlon KC, Sportes C, Brechbiel MW, Fowler DH, Gress R, Miljkovic MD, Chen CC, Whatley MA, Bryant BR, Corcoran EM, Kurdziel KA, Pittaluga S, Paik CH, Lee JH, Fleisher TA, Carrasquillo JA, Waldmann TA. 90Y-Daclizumab (Anti-CD25), High-Dose Carmustine, Etoposide, Cytarabine, and Melphalan Chemotherapy and Autologous Hematopoietic Stem Cell Transplant Yielded Sustained Complete Remissions in 4 Patients with Recurrent Hodgkin's Lymphoma. Cancer Biother Radiopharm 2020; 35:249-261. [PMID: 32275165 DOI: 10.1089/cbr.2019.3298] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Despite advances in therapy of Hodgkin's lymphoma (HL), a proportion of patients will not respond or relapse. The authors had previously identified CD25, IL-2Rα, as a target for systemic radioimmunotherapy of HL since most normal cells do not express CD25, but it is expressed by a minority of Hodgkin/Reed-Sternberg (HRS) cells and most Tregs rosetting around HRS cells. Study Design and Treatment: This was a single institution, nonrandomized, open-label phase I/II trial of radiolabeled 90Y-daclizumab, an anti-CD25 monoclonal antibody, BEAM (carmustine, etoposide, cytarabine, and melphalan) conditioning treatment followed by autologous hematopoietic stem cell transplant (ASCT). Four patients with refractory and relapsed HL were treated in this trial with 3 patients receiving a single dose of 564.6-574.6 MBq 90Y-daclizumab and the fourth patient receiving two doses of 580.9-566.1 MBq 90Y-daclizumab followed by high-dose chemotherapy and ASCT. Results: All 4 evaluable patients treated with 90Y-daclizumab obtained complete responses (CRs) that are ongoing 4.5-7 years following their stem cell transplant. The spectrum and severity of adverse events were mild and more importantly none of the patients, including several with multiple therapies before this treatment, developed the myelodysplastic syndrome. Discussion: Targeting by daclizumab was not directed primarily at tumor cells, but rather the nonmalignant CD25-expressing T cells adjacent to the HRS cells and 90Y-daclizumab provided strong enough β emissions to kill CD25-negative tumor cells at a distance by a crossfire effect. Furthermore, the strong β irradiation killed normal cells in the tumor microenvironment. Conclusions: 90Y-daclizumab (anti-CD25), high-dose BEAM chemotherapy and ASCT was well tolerated and yielded sustained complete remissions in all 4 patients with recurrent HL patients who completed their treatment. Significance: Despite advances, a proportion of patients with HL will not have a CR to their initial treatment, and some with CRs will relapse. They demonstrated that the addition of 90Y-daclizumab into the preconditioning regimen for refractory and relapsed HL patients with high-dose BEAM chemotherapy and ASCT provided sustained CRs in the 4 patients studied. Two of these patients were highly refractory to multiple prior treatments with bulky disease at entry into this study, including 1 patient who never entered a remission and had failed 6 different therapeutic regimens. Despite the small number of patients treated in this study, the sustained clinical benefit in these patients indicates a highly effective treatment. The daclizumab was directed primarily not at HRS cells themselves but toward nonmalignant T cells rosetting around malignant cells. 90Y provided strong β emissions that killed antigen nonexpressing tumor cells at a distance by a crossfire effect. Furthermore, the strong β radiation killed normal cells in the tumor microenvironment that nurtured the malignant cells in the lymphomatous mass. The present study supports expanded analysis of 90Y-daclizumab as part of the regimen of ASCT in patients with refractory and relapsed HL.
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Affiliation(s)
- Kevin C Conlon
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Claude Sportes
- Experimental Transplantation and Immunology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Martin W Brechbiel
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Daniel H Fowler
- Experimental Transplantation and Immunology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Ronald Gress
- Experimental Transplantation and Immunology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Milos D Miljkovic
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Clara C Chen
- Nuclear Medicine Department, Radiation and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Millie A Whatley
- Nuclear Medicine Department, Radiation and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Bonita R Bryant
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Erin M Corcoran
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Karen A Kurdziel
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Stefania Pittaluga
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Chang H Paik
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jae Ho Lee
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Thomas A Fleisher
- Department of Laboratory Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Jorge A Carrasquillo
- Nuclear Medicine Department, Radiation and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Thomas A Waldmann
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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Cahan B, Leong L, Wagman L, Yamauchi D, Shibata S, Wilzcynski S, Williams LE, Yazaki P, Colcher D, Frankel P, Wu A, Raubitschek A, Shively J, Wong JYC. Phase I/II Trial of Anticarcinoembryonic Antigen Radioimmunotherapy, Gemcitabine, and Hepatic Arterial Infusion of Fluorodeoxyuridine Postresection of Liver Metastasis for Colorectal Carcinoma. Cancer Biother Radiopharm 2018; 32:258-265. [PMID: 28910150 DOI: 10.1089/cbr.2017.2223] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES Report the feasibility, toxicities, and long-term results of a Phase I/II trial of 90Y-labeled anticarcinoembryonic antigen (anti-CEA) (cT84.66) radioimmunotherapy (RIT), gemcitabine, and hepatic arterial infusion (HAI) of fluorodeoxyuridine (FUdR) after maximal hepatic resection of metastatic colorectal cancer to the liver. METHODS Patients with metastatic colorectal cancer to the liver postresection or ablation to minimum disease were eligible. Each cohort received HAI of FUdR for 14 days on a dose escalation schedule. The maximum HAI FUdR dose level planned was 0.2 mg/kg/day, which is the standard dose for HAI FUdR alone. On day 9, 90Y-cT84.66 anti-CEA at 16.6 mCi/m2 as an i.v. bolus infusion and on days 9-11 i.v. gemcitabine at 105 mg/m2 were given. Patients could receive up to three cycles every 6 weeks of protocol therapy. Four additional cycles of HAI FUdR were allowed after RIT. RESULTS Sixteen patients were treated on this study. A maximum tolerated dose of 0.20 mg/kg/day of HAI FUdR combined with RIT at 16.6 mCi/m2 and gemcitabine at 105 mg/m2 was achieved with only 1 patient experiencing grade 3 reversible toxicity (mucositis). After surgery, 10 patients had no evidence of visible disease and remained without evidence of disease after completion of protocol therapy. The remaining 6 patients demonstrated radiological visible disease after surgery and after protocol therapy 2 patients had a CR, 1 patient had PR, 2 had stable disease, and 1 had progression. With a median follow-up of 41.8 months (18.7-114.6), median progression free survival was 9.6 months. Two patients demonstrated long-term disease control out to 45+ and 113+ months. CONCLUSION This study demonstrates the safety, feasibility, and potential utility of HAI FUdR, RIT, and systemic gemcitabine. The trimodality approach does not have higher hematologic toxicities than seen in prior RIT-alone studies. Future efforts evaluating RIT in colorectal cancer should integrate RIT with systemic and regional therapies in the minimal tumor burden setting.
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Affiliation(s)
- Benjamin Cahan
- Department of Radiation Oncology, City of Hope National Medical Center , Duarte, California
| | - Lucille Leong
- Department of Radiation Oncology, City of Hope National Medical Center , Duarte, California
| | - Lawrence Wagman
- Department of Radiation Oncology, City of Hope National Medical Center , Duarte, California
| | - David Yamauchi
- Department of Radiation Oncology, City of Hope National Medical Center , Duarte, California
| | - Stephen Shibata
- Department of Radiation Oncology, City of Hope National Medical Center , Duarte, California
| | - Sharon Wilzcynski
- Department of Radiation Oncology, City of Hope National Medical Center , Duarte, California
| | - Lawrence E Williams
- Department of Radiation Oncology, City of Hope National Medical Center , Duarte, California
| | - Paul Yazaki
- Department of Radiation Oncology, City of Hope National Medical Center , Duarte, California
| | - David Colcher
- Department of Radiation Oncology, City of Hope National Medical Center , Duarte, California
| | - Paul Frankel
- Department of Radiation Oncology, City of Hope National Medical Center , Duarte, California
| | - Anna Wu
- Department of Radiation Oncology, City of Hope National Medical Center , Duarte, California
| | - Andrew Raubitschek
- Department of Radiation Oncology, City of Hope National Medical Center , Duarte, California
| | - John Shively
- Department of Radiation Oncology, City of Hope National Medical Center , Duarte, California
| | - Jeffrey Y C Wong
- Department of Radiation Oncology, City of Hope National Medical Center , Duarte, California
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90Y-daclizumab, an anti-CD25 monoclonal antibody, provided responses in 50% of patients with relapsed Hodgkin's lymphoma. Proc Natl Acad Sci U S A 2015; 112:13045-50. [PMID: 26438866 DOI: 10.1073/pnas.1516107112] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Despite significant advances in the treatment of Hodgkin's lymphoma (HL), a significant proportion of patients will not respond or will subsequently relapse. We identified CD25, the IL-2 receptor alpha subunit, as a favorable target for systemic radioimmunotherapy of HL. The scientific basis for the clinical trial was that, although most normal cells with exception of Treg cells do not express CD25, it is expressed by a minority of Reed-Sternberg cells and by most polyclonal T cells rosetting around Reed-Sternberg cells. Forty-six patients with refractory and relapsed HL were evaluated with up to seven i.v. infusions of the radiolabeled anti-CD25 antibody (90)Y-daclizumab. (90)Y provides strong β emissions that kill tumor cells at a distance by a crossfire effect. In 46 evaluable HL patients treated with (90)Y-daclizumab there were 14 complete responses and nine partial responses; 14 patients had stable disease, and nine progressed. Responses were observed both in patients whose Reed-Sternberg cells expressed CD25 and in those whose neoplastic cells were CD25(-) provided that associated rosetting T cells expressed CD25. As assessed using phosphorylated H2AX (γ-H2AX) as a bioindicator of the effects of radiation exposure, predominantly nonmalignant cells in the tumor microenvironment manifested DNA damage, as reflected by increased expression of γ-H2AX. Toxicities were transient bone-marrow suppression and myelodysplastic syndrome in six patients who had not been evaluated with bone-marrow karyotype analyses before therapy. In conclusion, repeated (90)Y-daclizumab infusions directed predominantly toward nonmalignant T cells rosetting around Reed-Sternberg cells provided meaningful therapy for select HL patients.
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Abstract
Radiation therapy and immunotherapy are both well-established treatments for malignant disease. Radiotherapy has long been utilized for purposes of providing local tumor control, and the recent success with novel immunomodulatory agents has brought immunotherapy into the forefront of clinical practice for the treatment of many tumor types. Although radiotherapy has traditionally been thought to mediate tumor regression through direct cytotoxic effects, it is now known that radiation also alters the local tumor microenvironment with effects on both the local and systemic anti-tumor immune response. There is growing evidence that the rational integration of the immunomodulatory effects of radiotherapy with the expanding armamentarium of clinically approved immunotherapeutics can yield potent anti-tumor responses exceeding the benefit of either therapy alone. Here we summarize current approaches to the combination of immunotherapy with radiation therapy.
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Affiliation(s)
- Susan M Hiniker
- Department of Radiation Oncology, Stanford University, Stanford, CA.
| | - Susan J Knox
- Department of Radiation Oncology, Stanford University, Stanford, CA
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Lim I, Park JY, Kang HJ, Hwang JP, Lee SS, Kim KM, Choi TH, Yang SH, Kim BI, Choi CW, Lim SM. Prognostic significance of pretreatment ¹⁸F-FDG PET/CT in patients with relapsed/refractory B-cell non-Hodgkin's lymphoma treated by radioimmunotherapy using ¹³¹I-rituximab. Acta Haematol 2013; 130:74-82. [PMID: 23548464 DOI: 10.1159/000346436] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 11/22/2012] [Indexed: 01/04/2023]
Abstract
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.
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Affiliation(s)
- Ilhan Lim
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Seoul, Republic of Korea
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6
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7
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Akudugu JM, Howell RW. A method to predict response of cell populations to cocktails of chemotherapeutics and radiopharmaceuticals: validation with daunomycin, doxorubicin, and the alpha particle emitter (210)Po. Nucl Med Biol 2012; 39:954-61. [PMID: 22503536 DOI: 10.1016/j.nucmedbio.2012.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 01/28/2012] [Indexed: 01/17/2023]
Abstract
UNLABELLED There is considerable interest in the use of α-emitting radionuclides in radioimmunotherapy. However, the high toxicity of α-emitting radionuclides often does not permit administration of high activities for fear of normal tissue toxicity. Accordingly, targeting procedures need to be optimized for improved tumor control and minimized normal tissue toxicity. To guide design of effective cocktails of α-emitting radiopharmaceuticals and chemotherapy drugs, approaches that can predict biological response of a cell population on a cell-by-cell basis are needed. METHODS Cells were concomitantly treated with the α-particle emitting radiochemical (210)Po-citrate and daunomycin, or with (210)Po-citrate and doxorubicin. The responses of the treated cell populations were measured with a colony forming assay. The nonuniform cellular incorporation of the radiochemical and drugs was determined simultaneously on a cell-by-cell basis using flow cytometry. Monte Carlo methods were used to simulate cell survival on the basis of individual cell incorporation of each cytotoxic agent and validated by direct comparison with the experimental clonogenic cell survival. RESULTS Both daunomycin and doxorubicin enhanced the toxicity of the α-particles with a magnitude greater than expected based on single-agent toxicities. Cell survival obtained by Monte Carlo simulation was in good agreement with clonogenic cell survival for the combination treatments. CONCLUSION Flow cytometry assisted Monte Carlo simulations can be used to predict toxicity of cocktails of α-emitting radiopharmaceuticals and chemotherapy drugs in a manner that takes into account the effects of nonuniform distributions of agents within cell populations.
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Affiliation(s)
- John M Akudugu
- Division of Radiation Research, Department of Radiology, UMDNJ - New Jersey Medical School Cancer Center, Newark, NJ 07103, USA.
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8
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Wildes TM, Bartlett NL. Drug development for recurrent and refractory classical Hodgkin lymphoma. Leuk Lymphoma 2009; 50:529-40. [DOI: 10.1080/10428190902756586] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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9
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Kasamon YL, Ambinder RF. Immunotherapies for Hodgkin's lymphoma. Crit Rev Oncol Hematol 2008; 66:135-44. [PMID: 18023356 PMCID: PMC5792053 DOI: 10.1016/j.critrevonc.2007.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2007] [Revised: 09/19/2007] [Accepted: 10/03/2007] [Indexed: 11/17/2022] Open
Abstract
Multiple immune evasion strategies characterize the pathobiology of Hodgkin's lymphoma. These must be considered when developing and testing immunotherapeutic approaches for this disease. The clinical experience with adoptive immunotherapy of Epstein-Barr virus positive tumors, and with monoclonal antibodies directed against CD30, CD20, and other antigens, is herein reviewed.
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Affiliation(s)
- Yvette L Kasamon
- Division of Hematologic Malignancies, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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Chapuy B, Hohloch K, Trümper L. Yttrium 90 ibritumomab tiuxetan (Zevalin®): A new bullet in the fight against malignant lymphoma? Biotechnol J 2007; 2:1435-43. [PMID: 17886241 DOI: 10.1002/biot.200700043] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Targeted immunotherapy utilizing monoclonal antibodies has improved survival in both indolent and aggressive lymphoma significantly. Since malignant lymphomas are also responsive to radiation, the combination of targeted immunotherapy and radiation with radionuclide coupled to monoclonal antibodies is an attractive option to further improve treatment results. Zevalin is a commercially available variation of the murine anti-CD20 antibody ibritumomab coupled to Yttrium 90 via the tiuxetan chelator. The development of this novel drug as well as the results of the pivotal studies and clinical strategies to implement this treatment into the routine practice of lymphoma oncology are presented in this review.
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Affiliation(s)
- Bjoern Chapuy
- Department of Hematology and Oncology, Georg August University, Göttingen, Germany
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11
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Witzig TE, Molina A, Gordon LI, Emmanouilides 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; 109:1804-10. [PMID: 17380530 DOI: 10.1002/cncr.22617] [Citation(s) in RCA: 145] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Radioimmunotherapy with radiolabeled monoclonal antibodies to CD20 produces a high response rate in patients with recurring non-Hodgkin lymphoma (NHL), but the durability of those remissions is not well defined. METHODS Data on patients with recurring NHL treated with yttrium Y 90 ibritumomab tiuxetan in 4 clinical trials were reviewed to identify patients with a long-term response, defined as a time to progression of 12 months or longer. RESULTS Long-term responses were seen in 37% (78/211) of patients. At a median follow-up of 53.5 months (range, 12.7-88.9) the median duration of response was 28.1 months and the median time to progression was 29.3 months. A third of these patients had been treated with at least 3 previous therapies, and 37% of them had not responded to their last therapy. The findings in patients with follicular lymphoma (n=59) were similar to those in the overall population of long-term responders. The estimated overall survival at 5 years was 53% for all patients treated with 90Y ibritumomab tiuxetan and 81% for long-term responders. CONCLUSIONS A single dose of 90Y ibritumomab tiuxetan can produce durable responses and prolonged overall survival in a substantial number of patients in whom previous therapies have failed.
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Affiliation(s)
- Thomas E Witzig
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Wong JYC. Systemic targeted radionuclide therapy: potential new areas. Int J Radiat Oncol Biol Phys 2006; 66:S74-82. [PMID: 16979445 DOI: 10.1016/j.ijrobp.2005.05.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2005] [Revised: 05/31/2005] [Accepted: 05/31/2005] [Indexed: 10/24/2022]
Abstract
Radiation oncology is entering an exciting new era with therapies being delivered in a targeted fashion through an increasing number of novel approaches. External beam radiotherapy now integrates functional and anatomic tumor imaging to guide delivery of conformal radiation to the tumor target. Systemic targeted radionuclide therapy (STaRT) adds an important new dimension by making available to the radiation oncologist biologically targeted radiation therapy. Impressive clinical results with antibody-targeted radiotherapy, leading to the Food and Drug Administration's approval of two anti-CD20 radiolabeled antibodies, highlight the potential of STaRT. Optimization strategies will further improve the efficacy of STaRT by improving delivery systems, modifying the tumor microenvironment to increase targeted dose, and maximizing dose effect. Ultimately, the greatest potential for STaRT will not be as monotherapy, but as therapy integrated into established multimodality regimens and used as adjuvant or consolidative therapy in patients with minimal or micrometastatic disease.
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Affiliation(s)
- Jeffrey Y C Wong
- Division of Radiation Oncology and Radiation Research, City of Hope National Medical Center and Beckman Research Institute, Duarte, CA, USA.
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Sui X, Bensinger W, Press O. Improved conditioning regimens for autologous transplantation using targeted radiotherapy. Acta Haematol 2005; 114:230-8. [PMID: 16269863 DOI: 10.1159/000088414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Most patients undergoing autologous hematopoietic stem cell transplantation for malignant diseases suffer recurrences of their neoplasms and die due to the inability of conventional high-dose conditioning regimens to eradicate their malignancies. As a result, intensive efforts to develop more effective conditioning regimens are currently under way at many institutions. Encouraging results have been obtained using targeted radiotherapy with radiolabeled antibodies or bone-seeking isotopes as components of novel conditioning regimens for autologous transplantation of patients with lymphomas, multiple myeloma and bone metastases. Results with radiolabeled antibodies targeting epithelial antigens on solid tumors, however, have been less encouraging. This report reviews the status of clinical studies using myeloablative doses of targeted radiotherapy in patients undergoing autologous stem cell transplantation for hematological malignancies or solid tumors.
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Affiliation(s)
- Xingwei Sui
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.
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Pagel JM, Appelbaum FR, Eary JF, Rajendran J, Fisher DR, Gooley T, Ruffner K, Nemecek E, Sickle E, Durack L, Carreras J, Horowitz MM, Press OW, Gopal AK, Martin PJ, Bernstein ID, Matthews DC. 131I-anti-CD45 antibody plus busulfan and cyclophosphamide before allogeneic hematopoietic cell transplantation for treatment of acute myeloid leukemia in first remission. Blood 2005; 107:2184-91. [PMID: 16254140 PMCID: PMC1895719 DOI: 10.1182/blood-2005-06-2317] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
In an attempt to improve outcomes for patients with acute myeloid leukemia (AML) after allogeneic hematopoietic cell transplantation (HCT), we conducted a phase 1/2 study in which targeted irradiation delivered by 131I-anti-CD45 antibody was combined with targeted busulfan (BU; area-under-curve, 600-900 ng/mL) and cyclophosphamide (CY; 120 mg/kg). Fifty-two (88%) of 59 patients receiving a trace 131I-labeled dose of 0.5 mg/kg anti-CD45 murine antibody had higher estimated absorbed radiation in bone marrow and spleen than in any other organ. Forty-six patients were treated with 102 to 298 mCi (3774-11 026 MBq) 131I, delivering an estimated 5.3 to 19 (mean, 11.3) Gy to marrow, 17-72 (mean, 29.7) Gy to spleen, and 3.5 Gy (n = 4) to 5.25 Gy (n = 42) to the liver. The estimated 3-year nonrelapse mortality and disease-free survival (DFS) were 21% and 61%, respectively. These results were compared with those from 509 similar International Bone Marrow Transplant Registry patients who underwent transplantation using BU/CY alone. After adjusting for differences in age and cytogenetics risk, the hazard of mortality among all antibody-treated patients was 0.65 times that of the Registry patients (95% CI 0.39-1.08; P = .09). The addition of targeted hematopoietic irradiation to conventional BU/CY is feasible and well tolerated, and phase 2 results are sufficiently encouraging to warrant further study.
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Affiliation(s)
- John M Pagel
- Division of Clinical Research, Fred Hutchinson Cancer Research Center D5-380, 1100 Fairview Ave N, PO Box 19024, Seattle, WA 98109, USA.
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15
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Schnell R, Dietlein M, Staak JO, Borchmann P, Schomaecker K, Fischer T, Eschner W, Hansen H, Morschhauser F, Schicha H, Diehl V, Raubitschek A, Engert A. Treatment of refractory Hodgkin's lymphoma patients with an iodine-131-labeled murine anti-CD30 monoclonal antibody. J Clin Oncol 2005; 23:4669-78. [PMID: 16034043 DOI: 10.1200/jco.2005.09.098] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Hodgkin's lymphoma (HL) has been demonstrated to be a good target for immunotherapy since lymphocyte activation markers such as CD30 are expressed in high numbers on the malignant cells. Thus, we developed a new radioimmunoconjugate consisting of the murine anti-CD30 monoclonal antibody (MAb) Ki-4 labeled with iodine-131 ((131)I). PATIENTS AND METHODS The biodistribution of (131)I-Ki-4 was assessed via dosimetry after preinfusion of 5 mg native Ki-4 followed by 250 to 300 MBq (131)I-labeled Ki-4. Whole-body scintigraphy was performed 1 hour, 24 hours, 48 hours, 72 hours, and 6 days after the infusion. Dosimetry was calculated using the programs NucliDose ICON-IDL (version 5.0.2; Siemens, Erlanger, Germany) and MIRDOSE (version 3.1; Oak Ridge National Laboratories; Oak Ridge, TN). The therapeutic dose was given on day 8 after preinfusion of unlabeled Ki-4. RESULTS We treated 22 patients with relapsed or refractory CD30-positive HL. Preinfusion of 5 mg native Ki-4 was sufficient to bind the soluble CD30. Imaging demonstrated localization of involved areas measuring 5 cm in diameter or more in four patients and 2.5 cm in one patient. Patients received total body doses of 0.035 Gy to 0.99 Gy. Acute toxicity was mild with grade 1 fatigue in 19 of 22 assessable patients. Seven patients experienced grade 4 degrees hematotoxicity 4 to 8 weeks after treatment. Response included one complete remission, five partial remissions, and three minor responses. CONCLUSION Treatment with (131)I-Ki-4 is effective but can be associated with severe hematotoxicity.
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Affiliation(s)
- Roland Schnell
- Department of Internal Medicine I, Department of Nuclear Medicine, University of Cologne, Germany
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Jaeger G, Linkesch W, Temmel W, Neumeister P. AntiCD20 monoclonal antibody-based radioimmunotherapy of relapsed chemoresistant aggressive post-transplantation B-lymphoproliferative disorder in heart-transplant recipient. Lancet Oncol 2005; 6:629-31. [PMID: 16054575 DOI: 10.1016/s1470-2045(05)70286-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Gerald Jaeger
- Department of Internal Medicine, Division of Haematology, Medical University, Graz, Austria.
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17
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18
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Nemecek ER, Hamlin DK, Fisher DR, Krohn KA, Pagel JM, Appelbaum FR, Press OW, Matthews DC. Biodistribution of Yttrium-90–Labeled Anti-CD45 Antibody in a Nonhuman Primate Model. Clin Cancer Res 2005. [DOI: 10.1158/1078-0432.787.11.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: Radioimmunotherapy may improve the outcome of hematopoietic cell transplantation for hematologic malignancies by delivering targeted radiation to hematopoietic organs while relatively sparing nontarget organs. We evaluated the organ localization of yttrium-90-labeled anti-CD45 (90Y-anti-CD45) antibody in macaques, a model that had previously predicted iodine-131-labeled anti-CD45 (131I-anti-CD45) antibody biodistribution in humans.
Experimental Design: Twelve Macaca nemestrina primates received anti-CD45 antibody labeled with 1 to 2 mCi of 90Y followed by serial blood sampling and marrow and lymph node biopsies, and necropsy. The content of 90Y per gram of tissue was determined by liquid scintillation spectrometry. Time-activity curves were constructed using average isotope concentrations in each tissue at measured time points to yield the fractional residence time and estimate radiation absorbed doses for each organ per unit of administered activity. The biodistribution of 90Y-anti-CD45 antibody was then compared with that previously obtained with 131I-anti-CD45 antibody in macaques.
Results: The spleen received 2,120, marrow 1,060, and lymph nodes 315 cGy/mCi of 90Y injected. The liver and lungs were the nontarget organs receiving the highest radiation absorbed doses (440 and 285 cGy/mCi, respectively). Ytrrium-90-labeled anti-CD45 antibody delivered 2.5- and 3.7-fold more radiation to marrow than to liver and lungs, respectively. The ratios previously observed with 131I-anti-CD45 antibody were 2.5-and 2.2-fold more radiation to marrow than to liver and lungs, respectively.
Conclusions: This study shows that 90Y-anti-CD45 antibody can deliver relatively selective radiation to hematopoietic tissues, with similar ratios of radiation delivered to target versus nontarget organs, as compared with the 131I immunoconjugate in the same animal model.
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Affiliation(s)
- Eneida R. Nemecek
- 1Division of Clinical Research, Fred Hutchinson Cancer Research Center; Departments of
- 2Pediatrics,
| | - Donald K. Hamlin
- 5Radiation Oncology, University of Washington, Seattle, Washington; and
| | | | | | - John M. Pagel
- 1Division of Clinical Research, Fred Hutchinson Cancer Research Center; Departments of
- 3Medicine,
| | - Frederick R. Appelbaum
- 1Division of Clinical Research, Fred Hutchinson Cancer Research Center; Departments of
- 3Medicine,
| | - Oliver W. Press
- 1Division of Clinical Research, Fred Hutchinson Cancer Research Center; Departments of
- 3Medicine,
| | - Dana C. Matthews
- 1Division of Clinical Research, Fred Hutchinson Cancer Research Center; Departments of
- 2Pediatrics,
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19
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Abstract
The development of therapeutic monoclonal antibodies had been a significant advance in the treatment of B-cell non-Hodgkin's lymphoma (NHL). In the setting of blood and marrow transplantation (BMT), initial research was focused on in vitro graft purging. More recently, investigators have designed in vivo purging protocols using rituximab with the goal of obtaining tumor-free grafts. Exciting developments stem from the use of iodine 131 ((131)I)-tositumomab as well as yttrium 90 ((90)Y)-ibritumomab in myeloablative doses in blood and marrow transplantation protocols for high-risk patients. Finally, vigilance towards complications in particular unusual infections is advised given the profound immunosupressive state caused by these antibodies.
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Affiliation(s)
- Sami N Malek
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
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20
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Scappaticci FA, Contreras A, Boswell CA, Lewis JS, Nolan G. Polyclonal antibodies to xenogeneic endothelial cells induce apoptosis and block support of tumor growth in mice. Vaccine 2003; 21:2667-77. [PMID: 12744904 DOI: 10.1016/s0264-410x(02)00693-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In this study, we demonstrate that vaccination of rabbits with murine endothelial cells yields polyclonal immunoglobulin (IgG) with potent antiangiogenic activity. The mechanism of this response appears to be through apoptosis of endothelial cells in vitro. Induction of polyclonal IgG in a xenogeneic host may be useful in passive immunotherapy of a variety of cancers. In fact, the antibody showed antitumor activity in three mouse tumor models (murine B16F10 melanoma, murine SVR angiosarcoma, and human DLD-1 colorectal adenocarcinoma). The polyclonal antibody generated here demonstrated utility in radioimaging of tumors in vivo, using positron emission tomography (PET) imaging, and suggested an antitumor effect in vivo. The results suggest that the antitumor effect in vivo may be related to antiangiogenic effects. Furthermore, anti-endothelial cell antibodies such as these could be useful reagents in isolating specific targets that comprise and induce the antiangiogenic effect.
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MESH Headings
- 3T3 Cells
- Animals
- Antibodies/immunology
- Antibodies/therapeutic use
- Cell Division/immunology
- Cell Survival/immunology
- Endothelium, Vascular/transplantation
- Humans
- Immunoglobulin G/immunology
- Immunoglobulin G/therapeutic use
- Leukemia L1210/pathology
- Leukemia L1210/therapy
- Mammary Neoplasms, Experimental/blood supply
- Mammary Neoplasms, Experimental/pathology
- Mammary Neoplasms, Experimental/therapy
- Melanoma, Experimental/blood supply
- Melanoma, Experimental/pathology
- Melanoma, Experimental/therapy
- Mice
- Neovascularization, Pathologic/immunology
- Rabbits
- Transplantation, Heterologous/immunology
- Tumor Cells, Cultured
- Umbilical Veins
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Affiliation(s)
- F A Scappaticci
- Department of Pathology, Stanford University Medical Center, 269 Campus Drive CCSR 3220, Stanford, CA 94305-5332, USA
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21
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Yuen AR, Higgins JP, Baker R, Kamel OW, Warnke RA, Knox SJ. Distribution of monoclonal antiferritin antibody in Kaposi's sarcoma, Hodgkin's disease, and hepatocellular carcinoma. Hum Pathol 2003; 34:381-4. [PMID: 12733120 DOI: 10.1053/hupa.2003.62] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The immunotherapeutic treatment of cancers using antibodies (naked or conjugated to a drug, toxin, or radionuclide) relies upon the preferential expression of a targeted antigen on the cancer cell compared to normal tissues. Polyclonal antiferritin antisera have shown selective distribution and therapeutic efficacy when radiolabeled in Hodgkin's disease and hepatoma. In this immunohistochemical study, we investigated the distribution of ferritin in tumors from 6 patients with Kaposi's sarcoma, 12 patients with Hodkgin's disease, and 9 patients with hepatoma, as well as in selected normal tissues. We found that the monoclonal antiferritin antibody binds primarily to histiocytes in samples from Kaposi's sarcoma and Hodgkin's disease. One hepatocellular carcinoma showed diffuse cytoplasmic staining with ferritin. Deposition of the monoclonal antibody was not detectable in the remaining hepatocellular carcinoma samples.
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Affiliation(s)
- Alan R Yuen
- Departments of Medicine, Pathology, and Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
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22
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Affiliation(s)
- F G Cavalli
- Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
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23
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Vriesendorp HM, Vriesendorp FJ. A review of the intravenous administration of radiolabeled immunoglobulin G to cancer patients. High or low protein dose? Cancer Biother Radiopharm 2003; 18:35-46. [PMID: 12667307 DOI: 10.1089/108497803321269313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This retrospective analysis of preclinical and clinical radiolabeled immunoglobulin studies focuses on three well-known observations: (1) IV tumor reactive IgG provides higher response rates in patients with hematological malignancies than in patients with solid tumors. (2) Patients with CD20 positive B cell lymphoma require a high IV IgG protein dose for effective tumor targeting. (3) Most patients experience high uptake of IV administered radiolabeled IgG in normal liver. This review supports the following new hypotheses: (1) The blood-tumor barrier in most solid tumors is higher than in most hematological malignancies. (2) The blood-tumor barrier in CD20 positive B cell lymphomas is lowered by the IV administration of high doses [> 100 mg] of anti-CD20 IgG, presumably due to IgG induced intra-tumoral production of vaso-active biological response modifiers. (3) The blood-tumor barrier is low in Hodgkin's disease, presumably due to the continuous and innate production of biological response modifiers in tissues containing Hodgkin's disease. (4) The uptake of tumor reactive IgG in the normal liver is controlled by the Fc portion of the IgG. The radioimmunoconjugate is not catabolized in the liver. This appears to indicate that the F(c) portion of the IgG binds to the MHC class I like, F(c)gammaRn receptors in liver endothelium and hepatocytes and not to F(c)gamma RI, RII or RIII receptors The new hypotheses require verification and can be instrumental in the design of new more effective clinical RIT studies.
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Affiliation(s)
- Huib M Vriesendorp
- Department of Radiation Oncology, Marshfield Clinic, Marshfield, Wisconsin, USA.
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24
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Schnell R, Borchmann P, Schulz H, Engert A. Current strategies of antibody-based treatment in Hodgkin's disease. Ann Oncol 2002; 13 Suppl 1:57-66. [PMID: 12078905 DOI: 10.1093/annonc/13.s1.57] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Many new approaches involving antibody-based agents have given promising results in experimental Hodgkin's disease (HD) models. Clinical trials with monoclonal antibodies, immunotoxins, bispecific constructs and radioimmunoconjugates have demonstrated some clinical efficacy in patients with advanced refractory HD. Although it seems unlikely that resistant patients with larger tumor masses will be cured by either of these approaches, it might be feasible to treat bulky disease by conventional therapy and then administer biological agents to kill residual Hodgkin and Reed-Sternberg cells. Future phase III trials will have to prove a possible superior effect of this combined immunochemotherapy. Currently, the evaluation of the most promising approaches continues.
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Affiliation(s)
- R Schnell
- Klinik I für Innere Medizin, Universität zu Köln, Germany
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25
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Witzig TE, Gordon LI, Cabanillas F, Czuczman MS, Emmanouilides C, Joyce R, Pohlman BL, Bartlett NL, Wiseman GA, Padre N, Grillo-López AJ, Multani P, White CA. Randomized controlled trial of yttrium-90-labeled ibritumomab tiuxetan radioimmunotherapy versus rituximab immunotherapy for patients with relapsed or refractory low-grade, follicular, or transformed B-cell non-Hodgkin's lymphoma. J Clin Oncol 2002; 20:2453-63. [PMID: 12011122 DOI: 10.1200/jco.2002.11.076] [Citation(s) in RCA: 772] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Radioimmunotherapy combines biologic and radiolytic mechanisms to target and destroy tumor cells, thus offering a needed therapeutic alternative for refractory non-Hodgkin's lymphoma (NHL) patients. This phase III randomized study compares the novel radioimmunotherapy yttrium-90 ((90)Y) ibritumomab tiuxetan with a control immunotherapy, rituximab, in 143 patients with relapsed or refractory low-grade, follicular, or transformed CD20(+) transformed NHL. PATIENTS AND METHODS Patients received either a single intravenous (IV) dose of (90)Y ibritumomab tiuxetan 0.4 mCi/kg (n = 73) or rituximab 375 mg/m(2) IV weekly for four doses (n = 70). The radioimmunotherapy group was pretreated with two rituximab doses (250 mg/m(2)) to improve biodistribution and one dose of indium-111 ibritumomab tiuxetan for imaging and dosimetry. The primary end point, overall response rate (ORR), was assessed by an independent, blinded, lymphoma expert panel. RESULTS ORR was 80% for the (90)Y ibritumomab tiuxetan group versus 56% for the rituximab group (P =.002). Complete response (CR) rates were 30% and 16% in the (90)Y ibritumomab tiuxetan and rituximab groups, respectively (P =.04). An additional 4% achieved an unconfirmed CR in each group. Kaplan-Meier estimated median duration of response was 14.2 months in the (90)Y ibritumomab tiuxetan group versus 12.1 months in the control group (P =.6), and time to progression was 11.2 versus 10.1 months (P =.173) in all patients. Durable responses of > or = 6 months were 64% versus 47% (P =.030). Reversible myelosuppression was the primary toxicity noted with (90)Y ibritumomab tiuxetan. CONCLUSION Radioimmunotherapy with (90)Y ibritumomab tiuxetan is well tolerated and produces statistically and clinically significant higher ORR and CR compared with rituximab alone.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Murine-Derived
- Antigens, CD19/metabolism
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- Cell Transformation, Neoplastic
- Disease Progression
- Disease-Free Survival
- Female
- Humans
- Liver/diagnostic imaging
- Liver/pathology
- Lymphoma, B-Cell/immunology
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/therapy
- Lymphoma, Follicular/immunology
- Lymphoma, Follicular/pathology
- Lymphoma, Follicular/therapy
- Lymphoma, Non-Hodgkin/immunology
- Lymphoma, Non-Hodgkin/pathology
- Lymphoma, Non-Hodgkin/therapy
- Male
- Middle Aged
- Radioimmunotherapy/methods
- Radionuclide Imaging
- Rituximab
- Survival Rate
- Treatment Outcome
- Yttrium Radioisotopes/adverse effects
- Yttrium Radioisotopes/therapeutic use
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Affiliation(s)
- Thomas E Witzig
- Division of Internal Medicine and Hematology, Nuclear Medicine, Mayo Clinic and Mayo Foundation, 60 Stabile Building, Rochester, MN 55905, USA.
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26
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Thompson KJ, Fried MG, Ye Z, Boyer P, Connor JR. Regulation, mechanisms and proposed function of ferritin translocation to cell nuclei. J Cell Sci 2002; 115:2165-77. [PMID: 11973357 DOI: 10.1242/jcs.115.10.2165] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Ferritin is traditionally considered a cytoplasmic iron-storage protein,but recent reports indicate that it is also found in cell nuclei. Nuclear ferritin has been proposed to be involved in both the protection of DNA and the exacerbation of iron-induced oxidative damage to DNA. We demonstrate that H-rich ferritin is present in the nucleus of human astrocytoma tumor cells. To study the mechanism and regulation of ferritin translocation to the nucleus,we developed a cell culture model using SW1088 human astrocytoma cells. Changes in cellular iron levels, cytokine treatments and hydrogen peroxide exposure affected the distribution of ferritin between the cytosol and the nucleus. Ferritin enters the nucleus via active transport through the nuclear pore and does not require NLS-bearing cytosolic factors for transport. Furthermore, H-rich ferritin is preferred over L-rich ferritin for uptake into the nucleus. Whole cell crosslinking studies revealed that ferritin is associated with DNA. Ferritin protected DNA from iron-induced oxidative damage in both in vitro and in cell culture models. These results strongly suggest a novel role for ferritin in nuclear protection. This work should lead to novel characterization of ferritin functions in the context of genomic stability and may have unparalleled biological significance in terms of the accessibility of metals to DNA. The knowledge generated as a result of these studies will also improve our understanding of iron-induced damage of nuclear constituents.
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Affiliation(s)
- Khristy J Thompson
- Department of Neuroscience and Anatomy, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, 17033, USA.
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27
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Pagel JM, Matthews DC, Appelbaum FR, Bernstein ID, Press OW. The use of radioimmunoconjugates in stem cell transplantation. Bone Marrow Transplant 2002; 29:807-16. [PMID: 12058230 DOI: 10.1038/sj.bmt.1703524] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Radiolabeled monoclonal antibodies have been used with encouraging results in conjunction with stem cell transplantation for patients with hematologic malignancies targeting a variety of surface antigens including CD33, CD45 and CD66 for leukemias, CD20 and CD22 for non-Hodgkin's lymphomas, and ferritin for Hodgkin's disease. The results obtained targeting epithelial antigens on solid tumors, however, have generally been less encouraging, primarily due to the relative insensitivity of these malignancies to ionizing radiation. In this report we review clinical studies that have incorporated myeloablative doses of targeted radiation using radiolabeled antibodies in conjunction with stem cell transplant regimens.
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Affiliation(s)
- J M Pagel
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
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28
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Aksentijevich I, Flinn IW. Monoclonal antibody therapy with autologous peripheral blood stem cell transplantation for non-Hodgkin's lymphoma. Cancer Control 2002; 9:99-105. [PMID: 12008655 DOI: 10.1177/107327480200900202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND With the introduction of novel monoclonal antibody products into the clinic, significant new strategies are being developed to improve upon existing treatment for non-Hodgkin's lymphoma. METHODS Monoclonal antibodies are being used alone, in combination with chemotherapy, or as adjuncts to autologous bone marrow transplantation for the purpose of purging bone marrow of neoplastic cells. RESULTS Monoclonal antibodies when used in vivo in conjunction with autologous bone marrow transplantation have been relatively well tolerated. Results from several trials seem to demonstrate a therapeutic benefit for the use of such combinations. CONCLUSIONS Before these agents can be included in standard bone marrow transplantation regimen, long-term survival outcomes need to be obtained from randomized trials. We review the results from recent trials using monoclonal antibodies in conjunction with autologous stem cell transplantation for the treatment of non-Hodgkin's lymphoma.
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Affiliation(s)
- Ivan Aksentijevich
- Division of Hematologic Malignancies, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD 21231, USA
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29
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Flinn IW, Lazarus HM. Monoclonal antibodies and autologous stem cell transplantation for lymphoma. Bone Marrow Transplant 2001; 27:565-9. [PMID: 11319583 DOI: 10.1038/sj.bmt.1702857] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2000] [Accepted: 01/18/2001] [Indexed: 11/09/2022]
Abstract
The introduction of monoclonal antibodies into the clinic has paved the way for new approaches to stem cell transplantation for patients with lymphoma. These approaches include the development of new high-dose regimens with radiolabeled antibodies, in vivo purging techniques with the unlabeled antibodies, and post-transplant adjuvant immunotherapy. Numerous trials have demonstrated the feasibility of these approaches. However, questions remain regarding the application of these antibodies including the ultimate efficacy. The recent results of the incorporation of monoclonal antibodies into stem cell transplantation and current research directions are reviewed.
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Affiliation(s)
- I W Flinn
- Johns Hopkins Oncology Center, Division of Hematologic Malignancies, Baltimore, MD 21231, USA
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30
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Abstract
Radioimmunotherapy (RIT) is a promising new therapy for the treatment of a variety of malignancies. General principles of RIT are discussed, including important considerations in the selection of monoclonal antibodies (MAb) and radionuclides for RIT. Results of clinical trials using RIT for the treatment of lymphoma, leukemia, and solid tumors are summarized. The results from many of these trials are promising, especially for the treatment of lymphohematopoietic malignancies, in which a variety of MAb, radionuclides, and study designs have resulted in high response rates with a number of durable responses. Encouraging results have also been obtained using RIT to treat some solid tumors, primarily in patients with relatively low tumor burdens. RIT is generally well tolerated, with the primary toxicity being transient reversible myelosuppression in most nonmyeloablative studies. Nonhematologic toxicity, especially at nonmyeloablative doses, has been minimal in most studies. Approaches for increasing the therapeutic index of RIT are reviewed, which may further potentiate the efficacy and decrease the toxicity of RIT.
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Affiliation(s)
- S J Knox
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305, USA
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31
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Murray S, Rowlinson-Busza G, Morris JF, Chu AC. Diagnostic and therapeutic evaluation of an anti-Langerhans cell histiocytosis monoclonal antibody (NA1/34) in a new xenograft model. J Invest Dermatol 2000; 114:127-34. [PMID: 10620128 DOI: 10.1046/j.1523-1747.2000.00831.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Scintigraphy using monoclonal antibodies has been suggested as a possible adjunct to conventional staging techniques for the routine staging and diagnosis of Langerhans cell histiocytosis. In this study we have developed a model for Langerhans cell histiocytosis comprising a CD1a-positive subcutaneous xenograft in the flanks of nude (nu/nu) mice. The anti-CD1a murine monoclonal antibody NA1/34 was investigated for its potential both as an imaging and as a therapeutic targeting agent in this model. Biodistribution with NA1/34 compared with irrelevant isotype-matched monoclonal antibody demonstrated specific accumulation within the xenografts of 10.0%id per g (percentage injected dose per gram) and 3.3%id per g at 48 h postinjection, respectively. NA1/34 displayed no specific accumulation to CD1a-negative xenografts. F(ab')2 fragments of NA1/34 displayed a faster clearance time of 19.6 h compared with the intact antibody, 122.4 h, resulting in a more rapid maximum xenograft uptake time of 5 h compared with 48 h postinjection for the intact antibody. Although the overall xenograft/tissue ratio for the F(ab')2 was at no time greater than that for the intact antibody, the F(ab')2 did display dramatically greater xenograft/blood ratios, reaching 19:1 at 120 h postinjection Xenograft regression using single doses of 350 microCi and 500 microCi 131I-labeled NA1/34 significantly (p < 0.001) delayed xenograft progression compared with control nonirradiated xenografts, with average delays of 3.2 and 5.7 times the control, respectively. This study suggests that the anti-CD1a monoclonal antibody, NA1/34, offers advantages in the prognosis and staging of Langerhans cell histiocytosis, in a human setting. We discuss the advantages of radioimmunoscintigraphy over conventional differential diagnostic techniques. The potential for the future radioimmunotherapy of Langerhans cell histiocytosis is also discussed.
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Affiliation(s)
- S Murray
- Unit of Dermatology, Department of Medicine, Hammersmith Campus, London, UK.
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32
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Phase I Study of 131I-Anti-CD45 Antibody Plus Cyclophosphamide and Total Body Irradiation for Advanced Acute Leukemia and Myelodysplastic Syndrome. Blood 1999. [DOI: 10.1182/blood.v94.4.1237] [Citation(s) in RCA: 228] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Delivery of targeted hematopoietic irradiation using radiolabeled monoclonal antibody may improve the outcome of marrow transplantation for advanced acute leukemia by decreasing relapse without increasing toxicity. We conducted a phase I study that examined the biodistribution of 131I-labeled anti-CD45 antibody and determined the toxicity of escalating doses of targeted radiation combined with 120 mg/kg cyclophosphamide (CY) and 12 Gy total body irradiation (TBI) followed by HLA-matched related allogeneic or autologous transplant. Forty-four patients with advanced acute leukemia or myelodysplasia received a biodistribution dose of 0.5 mg/kg131I-BC8 (murine anti-CD45) antibody. The mean ± SEM estimated radiation absorbed dose (centigray per millicurie of 131I) delivered to bone marrow and spleen was 6.5 ± 0.5 and 13.5 ± 1.3, respectively, with liver, lung, kidney, and total body receiving lower amounts of 2.8 ± 0.2, 1.8 ± 0.1, 0.6 ± 0.04, and 0.4 ± 0.02, respectively. Thirty-seven patients (84%) had favorable biodistribution of antibody, with a higher estimated radiation absorbed dose to marrow and spleen than to normal organs. Thirty-four patients received a therapeutic dose of 131I-antibody labeled with 76 to 612 mCi131I to deliver estimated radiation absorbed doses to liver (normal organ receiving the highest dose) of 3.5 Gy (level 1) to 12.25 Gy (level 6) in addition to CY and TBI. The maximum tolerated dose was level 5 (delivering 10.5 Gy to liver), with grade III/IV mucositis in 2 of 2 patients treated at level 6. Of 25 treated patients with acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS), 7 survive disease-free 15 to 89 months (median, 65 months) posttransplant. Of 9 treated patients with acute lymphoblastic leukemia (ALL), 3 survive disease-free 19, 54, and 66 months posttransplant. We conclude that 131I-anti-CD45 antibody can safely deliver substantial supplemental doses of radiation to bone marrow (∼24 Gy) and spleen (∼50 Gy) when combined with conventional CY/TBI.
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33
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Phase I Study of 131I-Anti-CD45 Antibody Plus Cyclophosphamide and Total Body Irradiation for Advanced Acute Leukemia and Myelodysplastic Syndrome. Blood 1999. [DOI: 10.1182/blood.v94.4.1237.416k34_1237_1247] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Delivery of targeted hematopoietic irradiation using radiolabeled monoclonal antibody may improve the outcome of marrow transplantation for advanced acute leukemia by decreasing relapse without increasing toxicity. We conducted a phase I study that examined the biodistribution of 131I-labeled anti-CD45 antibody and determined the toxicity of escalating doses of targeted radiation combined with 120 mg/kg cyclophosphamide (CY) and 12 Gy total body irradiation (TBI) followed by HLA-matched related allogeneic or autologous transplant. Forty-four patients with advanced acute leukemia or myelodysplasia received a biodistribution dose of 0.5 mg/kg131I-BC8 (murine anti-CD45) antibody. The mean ± SEM estimated radiation absorbed dose (centigray per millicurie of 131I) delivered to bone marrow and spleen was 6.5 ± 0.5 and 13.5 ± 1.3, respectively, with liver, lung, kidney, and total body receiving lower amounts of 2.8 ± 0.2, 1.8 ± 0.1, 0.6 ± 0.04, and 0.4 ± 0.02, respectively. Thirty-seven patients (84%) had favorable biodistribution of antibody, with a higher estimated radiation absorbed dose to marrow and spleen than to normal organs. Thirty-four patients received a therapeutic dose of 131I-antibody labeled with 76 to 612 mCi131I to deliver estimated radiation absorbed doses to liver (normal organ receiving the highest dose) of 3.5 Gy (level 1) to 12.25 Gy (level 6) in addition to CY and TBI. The maximum tolerated dose was level 5 (delivering 10.5 Gy to liver), with grade III/IV mucositis in 2 of 2 patients treated at level 6. Of 25 treated patients with acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS), 7 survive disease-free 15 to 89 months (median, 65 months) posttransplant. Of 9 treated patients with acute lymphoblastic leukemia (ALL), 3 survive disease-free 19, 54, and 66 months posttransplant. We conclude that 131I-anti-CD45 antibody can safely deliver substantial supplemental doses of radiation to bone marrow (∼24 Gy) and spleen (∼50 Gy) when combined with conventional CY/TBI.
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34
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Abstract
The new approach to the treatment of cancer or to immunomodulation is drug targeting. Cellular uptake of drugs bound to a targeting carrier or to a targetable polymeric carrier is mostly restricted to receptor-mediated endocytosis. Factors that influence the efficiency of receptor-mediated uptake of targeted drug conjugate are the affinity of the targeting moieties, the affinity and nature of the target antigen, density of the target antigen, the epitope of the target antigen, the type of cell target, the rate of endocytosis, the route of internalization of the ligand-receptor complex, the ability of the drug or toxin to release from its targeted carrier, the ability of the drug or toxin to escape from a vesicular compartment into the cytosol, the affinity of the carrier to the drug and the concentration of the carrier. Targeted chemotherapy is also significantly influenced by the antigenic modulation and/or immunoselection of tumor cells. The binding of drug (toxin) to targetable polymeric carrier considerably decreases unwanted side toxicity.
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DeNardo SJ, Kroger LA, MacKenzie MR, Mirick GR, Shen S, DeNardo GL. Prolonged survival associated with immune response in a patient treated with Lym-1 mouse monoclonal antibody. Cancer Biother Radiopharm 1998; 13:1-12. [PMID: 10850337 DOI: 10.1089/cbr.1998.13.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A patient with aggressive, chemotherapy-resistant non-Hodgkins lymphoma (NHL) was treated with 131I-Lym-1, a mouse antibody, on a protocol designed for serial therapy. Human anti-mouse antibody (HAMA) developed within 1 month of initial therapy. The patient also developed an antibody to the hypervariable region of the Lym-1 antibody (Lym-1 specific). Because the patient was responding to therapy, plasmaphoresis was used to reduce the level of HAMA followed by unlabeled Lym-1 calculated to be sufficient to block residual HAMA. This allowed additional therapy on three subsequent occasions over 5 months. Despite very high HAMA levels, no untoward effects from administrations of Lym-1 were observed. The HAMA response of the patient included anti-Lym-1 specific antibodies containing anti-idiotypic antibodies. The anti-Lym-1 antibody level has been sustained over the 9 year interval since 131I-Lym-1 therapy and has been associated with a uniquely long remission of the patient's disease. These observations demonstrate that, under certain circumstances, radioimmunotherapy (RIT) can be given safely and effectively despite HAMA. Anti-idiotypic antibodies could have induced an immune cascade that contributed to the prolonged disease-free survival of the patient.
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MESH Headings
- Animals
- Antibodies, Anti-Idiotypic/blood
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Female
- Humans
- Iodine Radioisotopes/therapeutic use
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/radiotherapy
- Mice
- Middle Aged
- Radioimmunotherapy
- Radiopharmaceuticals/therapeutic use
- Recurrence
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Affiliation(s)
- S J DeNardo
- Department of Internal Medicine, University of California Davis, School of Medicine, Sacramento, USA
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Vriesendorp HM, Quadri SM, Andersson BS, Wyllie CT, Dicke KA. Recurrence of hodgkin's disease after indium-111 and yttrium-90 labeled antiferritin administration. Cancer 1997. [DOI: 10.1002/(sici)1097-0142(19971215)80:12+<2721::aid-cncr51>3.0.co;2-a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Vriesendorp FJ, Quadri SM, Flynn RE, Malone MR, Cromeens DM, Stephens LC, Vriesendorp HM. Preclinical analysis of radiolabeled anti-GD2 immunoglobulin G. Cancer 1997. [DOI: 10.1002/(sici)1097-0142(19971215)80:12+<2642::aid-cncr40>3.0.co;2-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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38
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Morris G, DeNardo SJ, DeNardo GL, Leshchinsky T, Wu B, Mack PC, Winthrop MD, Gumerlock PH. Decreased C-MYC and BCL2 expression correlates with methylprednisolone-mediated inhibition of Raji lymphoma growth. BIOCHEMICAL AND MOLECULAR MEDICINE 1997; 60:108-15. [PMID: 9169090 DOI: 10.1006/bmme.1997.2568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Methylprednisolone (MP) and related corticosteroids are a fundamental part of regimens used to treat lymphoma and leukemia. In many of these malignancies, oncogenic activation of C-MYC and BCL2 is seen. Abnormalities of the tumor suppressor p53, which exerts growth-suppressing and apoptosis-enhancing functions through the transcriptional regulation of downstream genes including CDKN1, GADD45, and BCL2, are also often found. The goal was to determine the modulation of expression of the oncogenes (C-MYC and BCL2), the p53 pathway described above, and the apoptosis marker TGF-beta 1 in the human Raji lymphoma following MP treatment. Raji xenografts were grown in nude mice and growth curves characterized by sequential measurement. Mice were treated daily for 8 days with MP. Tumors were harvested untreated, or at 1 or 8 days after cessation of MP treatment, and the RNA was extracted. RT-PCR was used to determine the level of mRNA expression of the genes. Tumor growth was greatly reduced in the MP-treated mice. Gene expression levels for C-MYC and BCL2 were reduced at 1 day following MP and approached control levels 8 days after MP treatment. Expression levels of p53, CDKN1, and GADD45 were moderately and coordinately decreased at 1 day after cessation of MP treatment and remained repressed a week later. TGF-beta 1 exhibited no change in expression levels. These results suggest that decreased expression of C-MYC and BCL2 may play a role in the molecular events that initiate and are responsible for the growth inhibition of Raji lymphoma xenografts by MP.
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MESH Headings
- Animals
- Apoptosis/genetics
- Base Sequence
- Cell Cycle/genetics
- DNA Primers/genetics
- Female
- Gene Expression Regulation, Neoplastic/drug effects
- Genes, bcl-2/drug effects
- Genes, myc/drug effects
- Glucocorticoids/pharmacology
- Humans
- Lymphoma/drug therapy
- Lymphoma/genetics
- Lymphoma/pathology
- Methylprednisolone/pharmacology
- Mice
- Mice, Nude
- Neoplasm Transplantation
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- RNA, Neoplasm/genetics
- RNA, Neoplasm/metabolism
- Transplantation, Heterologous
- Tumor Cells, Cultured
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Affiliation(s)
- G Morris
- Section of Radiodiagnosis and Therapy, University of California, Davis, School of Medicine, Sacramento 95817, USA
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Vooijs WC, Otten HG, van Vliet M, van Dijk AJ, de Weger RA, de Boer M, Bohlen H, Bolognesi A, Polito L, de Gast GC. B7-1 (CD80) as target for immunotoxin therapy for Hodgkin's disease. Br J Cancer 1997; 76:1163-9. [PMID: 9365164 PMCID: PMC2228107 DOI: 10.1038/bjc.1997.528] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
In this preclinical study, the potential applicability of an anti-B7-1 immunotoxin (IT) for the treatment of Hodgkin's disease (HD) was investigated. Immunohistochemical analysis demonstrated strong expression of B7-1 on Hodgkin and Reed-Sternberg (R-S) cells and clear expression on dendritic cells, macrophages and some B-cells in tissues, but not on other tissue cells. Flow cytometric analysis demonstrated that B7-1 was expressed on a few monocytes, but not on CD34+ cells from bone marrow, resting T- or B-cells from peripheral blood or epithelial and endothelial cell lines. An anti-B7-1 immunotoxin containing the anti-B7-1 monoclonal antibody (MAb) B7-24 and saporin as toxin moiety was constructed and showed an affinity similar to that shown by the native MAb. It exhibited strong cytotoxicity against the B7-1+ B-cell line Raji (IC50 10(-11) M), R-S cell lines HDLM2, KM/H2 and L428 and also against a B7-1-transfected epithelial cell line, A431, whose parental line lacks expression of B7-1. In clonogenic assays with Raji cells or KM/H2 cells, a 3- or 4-log kill, respectively, was observed. No cytotoxicity was found against the B7-1- epithelial and endothelial cell lines or against haematopoietic progenitor cells. In conclusion, an anti-B7-1 immunotoxin was developed that had good cytotoxicity against R-S cell lines and that may be used in the elimination of R-S cells in vivo. A concomitant elimination of activated antigen-presenting cells may avoid development of antitoxin and anti-mouse Ig responses and allow repeated administration.
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Affiliation(s)
- W C Vooijs
- Department of Immuno-haematology, University Hospital Utrecht, The Netherlands
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40
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Matthews DC, Appelbaum FR, Press OW, Eary JF, Bernstein ID. The use of radiolabeled antibodies in bone marrow transplantation for hematologic malignancies. Cancer Treat Res 1997; 77:121-39. [PMID: 9071501 DOI: 10.1007/978-1-4615-6349-5_6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- D C Matthews
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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41
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42
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Vriesendorp HM, Quadri SM, Jaeckle KA, Freedman RS, Cromeens DM. Proposal for translational analysis and development of clinical radiolabeled immunoglobulin therapy. Radiother Oncol 1996; 41:151-61. [PMID: 9004359 DOI: 10.1016/s0167-8140(96)01829-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE Radiolabeled immunoglobulin therapy (RIT) can be a selective, effective, low-toxicity outpatient cancer therapy. A consensus on the best approach for the preclinical and clinical development of RIT reagents needs to be developed. We report the M.D. Anderson Cancer Center prior experience in translating RIT from laboratory to clinic for the treatment of Hodgkin's disease and propose a flow diagram for the development of RIT for other malignancies. MATERIAL AND METHODS Three different animal models are described: nude mice bearing human tumor xenografts, normal beagle dogs, and normal rhesus monkeys. We produced and purified antibodies and prepared chelate-immunoconjugates reactive with six different human tumor-associated antigens. The Igs used were derived from rabbits, mice, and humans (human-derived RIT reagents being less immunogenic in human patients). Eighty patients with refractory Hodgkin's disease were treated with radiolabeled antiferritin. RESULTS We recommend a two-injection scheme using, (1) an indium-111-labeled radioimmunoconjugate for diagnosis, pharmacokinetic studies, and dosimetry, and (2) a yttrium-90-labeled radioimmunoconjugate for therapy. The animal models provide useful data on tumor targeting, radiotoxicology, and undesirable biodistributions. A 70% response rate is obtained in patients with advanced recurrent Hodgkin's disease. More extensive preclinical testing allows for safer and more effective clinical RIT studies. CONCLUSIONS We recommend, (1) preclinical optimization of chelation chemistry, Ig size, Ig origin, route of administration, and fractionation, (2) new clinical Phase I-III studies more appropriate for RIT development than the classical Phase I-III studies used for the development of chemotherapeutic agents, and (3) more extensive preclinical testing of RIT reagents.
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Affiliation(s)
- H M Vriesendorp
- Department of Radiotherapy, University of Texas, M.D. Anderson Cancer Center, Houston 77030, USA
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43
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Schnell R, Barth S, Diehl V, Engert A. Hodgkin's disease. Future treatment strategies: fact or fiction? BAILLIERE'S CLINICAL HAEMATOLOGY 1996; 9:573-93. [PMID: 8922247 DOI: 10.1016/s0950-3536(96)80028-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Many new approaches involving biological agents have given promising results in experimental HD models. Clinical trials with immunotoxins, IL-2, Bi-Moabs or radioimmunoconjugates have demonstrated some clinical efficacy in patients with advanced refractory HD. Although it looks very unlikely to cure patients with larger tumour masses by either of these approaches, it might be feasible to treat bulky disease by conventional therapy first and then administer biological drugs to kill residual H-RS cells. Future phase-III trials will have to prove a possible superior effect of this combined immuno-/chemotherapy. In the meantime, the search for the most promising approach continues.
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Affiliation(s)
- R Schnell
- Department I of Internal Medicine, University of Cologne, Germany
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44
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Rösch F, Herzog H, Plag C, Neumaier B, Braun U, Müller-Gärtner HW, Stöcklin G. Radiation doses of yttrium-90 citrate and yttrium-90 EDTMP as determined via analogous yttrium-86 complexes and positron emission tomography. EUROPEAN JOURNAL OF NUCLEAR MEDICINE 1996; 23:958-66. [PMID: 8753686 DOI: 10.1007/bf01084371] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Yttrium-90 is used for palliative therapy for the treatment of skeletal metastases, but because it is a pure beta- emitter, data on the pharmacokinetics and radiation doses to metastases and unaffected organs are lacking. To obtain such data, the present study employed yttrium-86 as a substitute for 90Y, with detection by positron emission tomography (PET). The study compared the properties of two different 86Y complexes - 86Y-citrate and 86Y-ethylene diamine tetramethylene phosphonate (EDTMP) - in ten patients with prostatic cancer who had developed multiple bone metastases (the ten patients being divided into two groups of five). Early dynamics were measured up to 1 h post injection (p.i.) over the liver region, followed by subsequent whole-body PET scans up to 3 days p.i. Absolute uptake data were determined for normal bone, bone metastases, liver and kidney. Radiation doses were calculated according to the MIRD recommendations. Based on the pharmacokinetic measurements of the distribution of the 86Y complexes, it was possible to calculate radiation doses for the bone metastases and the red bone marrow delivered by complexes containing 90Y. In 1 cm3 of bone metastasis, doses of 26+/-11 mGy/MBq and 18+/-2 mGy/MBq were determined per MBq of injected 90Y-citrate and 90Y-EDTMP, respectively. The doses to the bone marrow were 2.5+/-0.4 mGy/MBq for 90Y-citrate and 1.8+/-0.6 mGy/MBq for 90Y-EDTMP. 86Y and PET provide quantitative information applicable to the clinical use of 90Y. This method may also be useful for the design of other 90Y radiopharmaceuticals and for planning radiotherapy dosages.
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Affiliation(s)
- F Rösch
- Institut für Nuklearchemie, Forschungszentrum Jülich, Jülich, Germany
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45
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Abstract
Bispecific monoclonal antibodies, with a dual specificity for tumor associated antigens on target cells and for surface markers on immune effector cells, have been shown (in vitro) to be effective in directing and triggering effector cells to kill target cells resulting in target cell lysis. Bispecific monoclonal antibodies (BsAb) against the CD3 antigen on T cells and the CD19 antigen on B cell were developed. Data obtained by in vitro experiments might indicate that clinical responses in BsAb immunotherapy, will only be obtained in patients with minimal tumor load, and may need additional T cell stimulation via cytokines such as IL-2. Although these experiments have shown us their limitations, they also include the promise of BsAb-directed immunotherapy in B cell malignancy as further demonstrated during a Phase I trail, showing little toxicity. Clearly, much remains to be done before this BsAb is routinely used for therapy, but, the results presented show that the CD3xCD19 BsAb has a potential as a therapeutic agent in B cell malignancy. This report describes the experiments performed to test a new immunotherapeutic approach for the treatment of B cell malignancy. Bispecific antibodies are described that can target cytotoxic T cells to tumor cells and elicit a cytolytic action towards these cancer cells.
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MESH Headings
- Antibodies, Bispecific/immunology
- Antibodies, Bispecific/therapeutic use
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/therapeutic use
- Antibody Specificity
- Antibody-Dependent Cell Cytotoxicity
- Antigens, CD19/immunology
- Antigens, Neoplasm/immunology
- B-Lymphocytes/immunology
- CD3 Complex/immunology
- Clinical Trials, Phase I as Topic
- Humans
- Immunotherapy, Adoptive
- Interleukin-2/pharmacology
- Interleukin-2/therapeutic use
- Killer Cells, Lymphokine-Activated/immunology
- Leukemia, B-Cell/immunology
- Leukemia, B-Cell/pathology
- Leukemia, B-Cell/therapy
- Lymphoma, B-Cell/immunology
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/therapy
- Muromonab-CD3/therapeutic use
- Neoplastic Stem Cells/immunology
- T-Lymphocytes, Cytotoxic/drug effects
- T-Lymphocytes, Cytotoxic/immunology
- Tumor Stem Cell Assay
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Affiliation(s)
- I A Haagen
- Department of Immunology, University Hospital Utrecht, The Netherlands
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46
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Press OW, Eary JF, Appelbaum FR, Martin PJ, Nelp WB, Glenn S, Fisher DR, Porter B, Matthews DC, Gooley T. Phase II trial of 131I-B1 (anti-CD20) antibody therapy with autologous stem cell transplantation for relapsed B cell lymphomas. Lancet 1995; 346:336-40. [PMID: 7623531 DOI: 10.1016/s0140-6736(95)92225-3] [Citation(s) in RCA: 323] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
25 patients with relapsed B-cell lymphomas were evaluated with trace labelled doses (2.5 mg/kg, 185-370 MBq [5-10 mCi]) of 131I-labelled anti-CD20 (B1) antibody in a phase II trial. 22 patients achieved 131I-B1 biodistributions delivering higher doses of radiation to tumour sites than to normal organs and 21 of these were treated with therapeutic infusions of 131I-B1 (12.765-29.045 GBq) followed by autologous haemopoietic stem cell reinfusion. 18 of the 21 treated patients had objective responses, including 16 complete remissions. One patient died of progressive lymphoma and one died of sepsis. Analysis of our phase I and II trials with 131I-labelled B1 reveal a progression-free survival of 62% and an overall survival of 93% with a median follow-up of 2 years. 131I-anti-CD20 (B1) antibody therapy produces complete responses of long duration in most patients with relapsed B-cell lymphomas when given at maximally tolerated doses with autologous stem cell rescue.
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Affiliation(s)
- O W Press
- Department of Medicine, University of Washington, Seattle 98195, USA
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47
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48
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Siddiqui A, Quadri SM, Griffiths GL, Goldenberg DM, Vriesendorp HM. Tumor targeting and pharmacokinetics of unmodified and modified F(ab)2 fragments of an anti-CEA murine monoclonal antibody (Immu-14). Nucl Med Biol 1995; 22:425-35. [PMID: 7550018 DOI: 10.1016/0969-8051(94)00130-c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Pharmacokinetic studies were performed with two different 111In-labeled F(ab)2 fragments of an anti-CEA murine monoclonal immunoglobulin G (Immun-14). Unmodified F(ab)2 and modified Fab-BMH-Fab fragments were compared in nude mice bearing a LS-174T human colon carcinoma tumor xenograft. Tumor accumulation is significantly higher for modified fragments than for unmodified fragments at all time points. At 24 h post injection, tumor uptake for modified and unmodified fragments reached 40 and 25% ID g, respectively. The retention of radioactivity in the liver was approx. 2-fold higher for modified fragments. Kidney uptake of modified fragments was at least 2-fold lower than that of unmodified fragments. Although blood radioactivity decreased rapidly for both fragments, the cumulative tumor activity was 40% higher for Fab-BMH-Fab fragment. Modified F(ab)2 fragments can deliver higher radiation doses to the tumor.
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Affiliation(s)
- A Siddiqui
- Department of Experimental Radiotherapy, University of Texas M. D. Anderson Cancer Center, Houston 77030-4095, USA
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49
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Abstract
B-cell malignancies, such as malignant lymphoma and chronic lymphocytic leukemia, commonly present with advanced disease and multiple sites of involvement. Consequently, systemic combination chemotherapy is the standard therapeutic approach and cures about one half of these patients. Development of novel therapies is required if the remaining patients are to be cured of their malignancy. Lym-1, a mouse monoclonal antibody that is reactive with these malignancies, has been coupled with 131I or 67Cu and used to treat 55 patients with advanced B-cell malignancies that had proven resistant to standard therapy. The majority of the patients responded to this therapy and the survival of responders was longer than that of non-responders. Similar results have recently been reported by others. These results represent a remarkable achievement for single agent therapy because these trials were exploratory in nature and most of the patients had failed many chemotherapy regimens. The toxicities were in general mild and readily manageable. It appears that enhancing strategies are likely to improve upon these results by increasing the therapeutic index.
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MESH Headings
- Animals
- Antibodies, Monoclonal/therapeutic use
- Clinical Trials as Topic
- Copper Radioisotopes/adverse effects
- Copper Radioisotopes/therapeutic use
- Dose-Response Relationship, Radiation
- Humans
- Immunotoxins/therapeutic use
- Iodine Radioisotopes/adverse effects
- Iodine Radioisotopes/therapeutic use
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/radiotherapy
- Lymphoma, B-Cell/immunology
- Lymphoma, B-Cell/radiotherapy
- Mice
- Radioimmunotherapy
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Affiliation(s)
- J P Lewis
- Department of Internal Medicine, University of California Davis Medical Center 95816, USA
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50
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Thomas GE, Esteban JM, Raubitschek A, Wong JY. gamma-Interferon administration after 90yttrium radiolabeled antibody therapy: survival and hematopoietic toxicity studies. Int J Radiat Oncol Biol Phys 1995; 31:529-34. [PMID: 7852116 DOI: 10.1016/0360-3016(94)00363-p] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Hematopoietic toxicity is the dose-limiting factor for radioimmunotherapeutic regimens. Cytokines have been shown to decrease hematopoietic toxicity in animals exposed to whole-body irradiation. The purpose of this study was to investigate the effects of murine gamma-interferon (gamma-IFN) on survival and hematopoietic toxicity in mice treated with high dose 90yttrium labeled anticarcinoembryonic antigen (CEA) monoclonal antibody. METHODS AND MATERIALS Balb/c nu/nu mice were injected intravenously with 250 Ci 90Y-T84.66 (a murine anti-CEA monoclonal antibody). Thirty thousand units of gamma-IFN was administered i.v. 24 h later. Control mice received either 250 Ci 90Y-T84.66 alone or 30,000 units gamma-IFN alone. Survival, antibody biodistribution, and bone marrow histologic studies were then performed. RESULTS Only 7% of the animals treated with 90Y-T84.66 survived up to 40 days posttreatment, when the study was terminated. In contrast, 52% of the mice treated with both 90Y-T84.66 and gamma-IFN survived 40 days posttherapy. No toxic deaths were seen in the control group administered gamma-interferon alone. Histologic examination of the bone marrow of animals receiving 90Y-T84.66 and gamma-IFN showed cellular depletion of 40-70% of the hematopoietic cells by 48 h. Cell depletion was 50-70% and 20% by 72 h and 8 days posttherapy, respectively. The marrow of the 90Y-T84.66-treated control group was depleted to a level of 50-80% at 48 h, and remained depleted at 90% at 72 h and 8 days posttherapy. No marrow cell reduction was seen in the gamma-IFN-only treated group. Biodistribution studies showed no alterations in antibody biodistribution or kinetics that could account for the changes in bone marrow toxicity after gamma-IFN. CONCLUSION These results demonstrate that gamma-IFN can reduce the hematologic toxicity resulting from high dose radioimmunotherapy. Histologic studies of bone marrow suggest that gamma-IFN acts primarily to accelerate myelorestoration of the bone marrow. Further studies exploring the use of gamma-IFN as an adjunct to radioimmunotherapy are therefore warranted.
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Affiliation(s)
- G E Thomas
- Department of General and Oncologic Surgery, City of Hope National Medical Center, Duarte, CA 91010
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