Ibritumomab tiuxetan

Ibritumomab tiuxetan
Mechanism of action	Monoclonal antibody that targets CD20+ protein on the B cell in follicular non-Hodgkin lymphoma and carries with it yttrium-90 to induce cell death.
Dose	The therapeutic regimen is administered in two steps: Step 1: rituximab 250 mg/m² preceding a fixed dose of 5 mCi of In111 Zevalin as 10-minute IV push. Followed by image 1, 2–24 hours after In111 ibritumomab, image 2, 48–72 hours after Ibritumomab, and image 3 is optional after 90–120 hours after Ibritumomab dose. Step 2: 7–9 days later, rituximab 250 mg/m² prior to 0.4 mCi/kg of Y-90 Zevalin as a 10-minute IV push. Note that the dose of rituximab is lower when used as part of the Zevalin therapeutic regimen, as compared to the dose of rituximab when used as a single agent. Do not administer rituximab as an IV push or bolus. The maximum allowed dose of Y-90 Zevalin is 32 mCi or 1,184 MBq.
Indications	Indicated for the treatment of patients with relapsed or refractory low-grade, follicular or transformed B-cell non-Hodgkin lymphoma, including patients with rituximab-refractory follicular non-Hodgkin lymphoma. (Accelerated approval, clinical benefit was not yet established.) Contraindicated in patients with known hypersensitivity or anaphylactic reactions to murine proteins or to any component of this treatment, including rituximab, yttrium chloride, or indium chloride.
Side Effects	Thrombocytopenia, neutropenia, infusion reactions, which may include pulmonary infiltrates, and secondary malignancies. If given when platelet count is > 150,000, can give whole dose. Reduced dose of 90Y is recommended when platelet count is < 149,000.
Nursing Considerations	Premedication with acetaminophen and diphenhydramine is recommended before the rituximab. Radiation precautions of time, distance, and shielding are important, based on dose delivered. Nuclear medicine healthcare professionals will prepare and administer ibritumomab, whereas the nurse is primarily responsible for administration of rituximab. Nadirs ranged from seven to nine weeks and lasted for 22–35 days. Not to be given to patients with > 25% bone marrow involvement of lymphoma, if platelet count < 100,000 cells/mm³, if neutrophils count < 1,500 cells/mm³, if hypocellular bone marrow, or if patient has a history of failed stem cell collection.

Mechanism of action

Monoclonal antibody that targets CD20+ protein on the B cell in follicular non-Hodgkin lymphoma and carries with it yttrium-90 to induce cell death.

Dose

The therapeutic regimen is administered in two steps:

Step 1: rituximab 250 mg/m² preceding a fixed dose of 5 mCi of In111 Zevalin as 10-minute IV push. Followed by image 1, 2–24 hours after In111 ibritumomab, image 2, 48–72 hours after Ibritumomab, and image 3 is optional after 90–120 hours after Ibritumomab dose.
Step 2: 7–9 days later, rituximab 250 mg/m² prior to 0.4 mCi/kg of Y-90 Zevalin as a 10-minute IV push.

Note that the dose of rituximab is lower when used as part of the Zevalin therapeutic regimen, as compared to the dose of rituximab when used as a single agent. Do not administer rituximab as an IV push or bolus.

The maximum allowed dose of Y-90 Zevalin is 32 mCi or 1,184 MBq.

Indications

Indicated for the treatment of patients with relapsed or refractory low-grade, follicular or transformed B-cell non-Hodgkin lymphoma, including patients with rituximab-refractory follicular non-Hodgkin lymphoma. (Accelerated approval, clinical benefit was not yet established.)

Contraindicated in patients with known hypersensitivity or anaphylactic reactions to murine proteins or to any component of this treatment, including rituximab, yttrium chloride, or indium chloride.

Side Effects

Thrombocytopenia, neutropenia, infusion reactions, which may include pulmonary infiltrates, and secondary malignancies. If given when platelet count is > 150,000, can give whole dose. Reduced dose of 90Y is recommended when platelet count is < 149,000.

Nursing Considerations

Premedication with acetaminophen and diphenhydramine is recommended before the rituximab.

Radiation precautions of time, distance, and shielding are important, based on dose delivered.

Nuclear medicine healthcare professionals will prepare and administer ibritumomab, whereas the nurse is primarily responsible for administration of rituximab.

Nadirs ranged from seven to nine weeks and lasted for 22–35 days.

Not to be given to patients with > 25% bone marrow involvement of lymphoma, if platelet count < 100,000 cells/mm³, if neutrophils count < 1,500 cells/mm³, if hypocellular bone marrow, or if patient has a history of failed stem cell collection.