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Absolute lymphocyte count predicts therapeutic efficacy and survival at the time of radioimmunotherapy in patients with relapsed follicular lymphomas

Leukemia volume 21, pages 2554–2556 (2007)Cite this article

Radioimmunotherapy (RIT) delivers radiation to tumor cells using antibodies as carriers of radionuclides. There are two radioimmunoconjugates that have been approved for use in B-cell non-Hodgkin lymphoma – 131I-tositumomab (Bexxar, GlaxoSmithKline, Research Triangle Park, NC, USA) and 90Y-Ibritumomab tiuxetan (Zevalin, BiogenIdec, Cambridge, MA, USA).1 Besides the cytotoxic radiation delivered to the tumor cells via antibody binding to a tumor-specific or tumor-associated antigen, several immunologic-related mechanisms have been attributed to RIT, including complement-mediated lysis (complement-dependent cytotoxicity (CDC) and antibody-dependent cellular cytotoxicity (ADCC)).1 Peripheral blood absolute lymphocyte count (ALC) recovery following autologous stem cell transplantation has been reported to be an independent prognostic factor for survival in various hematologic malignancies.2 Recently, ALC before rituximab therapy was reported to predict better response rates and clinical outcomes in patients with follicular lymphomas (FL) treated with single-agent rituximab.3 The role of ALC before RIT has not been evaluated previously. We hypothesized that the presence of a competent immune system would translate into a better response and longer survival to RIT.

We evaluated 75 consecutive patients with FL treated with 90Y-Ibritumomab tiuxetan between 1996 and 2002 at our institution. Fifty-six of these patients had participated in registrational trials and the results of tumor response and toxicity (but not related to ALC) are included in previous publications.4 Rituximab-refractory patients were classified as patients who did not respond or relapsed within 6 months of rituximab therapy before ibritumomab tiuxetan therapy. All patients were treated with 90Y ibritumomab tiuxetan 0.4 mCi/kg (maximum of 32 mCi) as described previously.4 ALC was obtained from the standard complete blood cell count and white blood cell differential before 90Y-Ibritumomab tiuxetan therapy.5 No patient refused permission for their medical records to be reviewed for research. Approval for the retrospective review of these records was obtained from the Mayo Clinic Institutional Review Board and was in accordance with US federal regulations and the Declaration of Helsinki.

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Acknowledgements

We acknowledge support from the Lymphoma SPORE grant from the National Cancer Institute CA97274.

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Authors and Affiliations

  1. Division of Hematology/Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA

    L F Porrata, K Ristow, T E Witzig, T M Habermann, D J Inwards, S M Ansell, I N Micallef, P B Johnston & S N Markovic

  2. Department of Nuclear Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA

    N Tuinistra

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  1. L F Porrata
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  2. K Ristow
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  3. T E Witzig
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  5. T M Habermann
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  6. D J Inwards
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  7. S M Ansell
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  8. I N Micallef
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  9. P B Johnston
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Correspondence to L F Porrata.

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Porrata, L., Ristow, K., Witzig, T. et al. Absolute lymphocyte count predicts therapeutic efficacy and survival at the time of radioimmunotherapy in patients with relapsed follicular lymphomas. Leukemia 21, 2554–2556 (2007). https://doi.org/10.1038/sj.leu.2404819

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