Judith Estes

Iodine-131-anti-B1 radioimmunotherapy for B-cell lymphoma.

PURPOSE The CD20 B-lymphocyte surface antigen expressed by B-cell lymphomas is an attractive target for radioimmunotherapy, treatment using radiolabeled antibodies. We conducted a phase I dose-escalation trial to assess the toxicity, tumor targeting, and efficacy of nonmyeloablative doses of an anti-CD20 monoclonal antibody (anti-B1) labeled with iodine-131 (131I) in 34 patients with B-cell lymphoma who had failed chemotherapy. PATIENTS AND METHODS Patients were first given tracelabeled doses of 131I-labeled anti-B1 (15 to 20 mg, 5 mCi) to assess radiolabeled antibody biodistribution, and then a radioimmunotherapeutic dose (15 to 20 mg) labeled with a quantity of 131I that would deliver a specified centigray dose of whole-body radiation predicted by the tracer dose. Whole-body radiation doses were escalated from 25 to 85 cGy in sequential groups of patients in 10-cGy increments. To evaluate if radiolabeled antibody biodistribution could be optimized, initial patients were given one or two additional tracer doses on successive weeks, each dose preceded by an infusion of 135 mg of unlabeled anti-B1 one week and 685 mg the next. The unlabeled antibody dose resulting in the most optimal tracer biodistribution was also given before the radioimmunotherapeutic dose. Later patients were given a single tracer dose and radioimmunotherapeutic dose preceded by infusion of 685 mg of unlabeled anti-B1. RESULTS Treatment was well tolerated. Hematologic toxicity was dose-limiting, and 75 cGy was established as the maximally tolerated whole-body radiation dose. Twenty-eight patients received radioimmunotherapeutic doses of 34 to 161 mCi, resulting in complete remission in 14 patients and a partial response in eight. All 13 patients with low-grade lymphoma responded, and 10 achieved a complete remission. Six of eight patients with transformed lymphoma responded. Thirteen of 19 patients whose disease was resistant to their last course of chemotherapy and all patients with chemotherapy-sensitive disease responded. The median duration of complete remission exceeds 16.5 months. Six patients remain in complete remission 16 to 31 months after treatment. CONCLUSION Nonmyeloablative radioimmunotherapy with 131I-anti-B1 is associated with a high rate of durable remissions in patients with B-cell lymphoma refractory to chemotherapy.

Nursing expertise and the evaluation of psychosocial distress in patients with cancer and survivors.

The number of cancer survivors in the United States will continue to grow because of improved screening, early detection practices, and advances in treatment. The cancer experience has a significant impact on the patient and his or her family, which increases the risk for psychosocial distress. Untreated distress experienced by a patient with cancer contributes to poorer treatment adherence, medical outcomes, and quality of life. To provide high-quality, safe patient care, oncology nurses must increase clinical expertise and knowledge. The current article provides an overview of clinical tools available for nurses to use when screening for distress in patients throughout the cancer care continuum.

Duration of remission using I-131 tositumomab in patients with B-cell lymphoma relapsing after autologous stem cell transplant.

8071 Background: Despite progress in systemic therapy, advanced stage indolent B-cell non-Hodgkin lymphoma (NHL) is considered incurable. Long-term remissions are attainable with both autologous stem cell transplant (ASCT) and radioimmunotherapy (RIT). ASCT has been performed on younger pts in first or second relapse, but options for salvage post-ASCT may be limited and poorly tolerated. We present an update of our original single-center phase I/II study of RIT in post ASCT relapsed pts. Methods: From 4/24/1990 to 1/17/1996, 59 adult pts with relapsed/refractory B-cell NHL and <25% bone marrow (BM) involvement by NHL were treated with I-131 tositumomab. Separate dose escalations using total body radiation dose (TBD) were performed in pts with or without prior ASCT. Results: Twelve pts who had prior ASCTs received TBDs of 33-93 cGy. The maximally tolerated TBD was established at 45 cGy, as opposed to 65- 75 cGY for non-ASCT pts. Median pt age was 46. Ten pts had stage III/IV disease with 4 having BM involv...