Radioimmunotherapy of the non-Hodgkin's lymphomas

Abstract

Radioimmunotherapy (RIT) is a promising new therapeutic modality for the treatment of non-Hodgkin's lymphoma. General principles of RIT are discussed and the various monoclonal antibodies (MAB) and radionuclides used to date in clinical trials are reviewed. Important determinants of radiolabeled MAB biodistribution include spleen size, tumor burden, and the preinfusion or coinfusion of unlabeled MAB. Clinical trials using RIT for the treatment of non-Hodgkin's lymphoma are summarized. The results from these trials are promising and show that a variety of MAB, radionuclides, and study designs have resulted in high response rates with a number of durable partial and complete responses at both myeloablative and nonmyeloablative doses in patients with recurrent or refractory disease. Determinants of efficacy and toxicity are discussed and the dosimetry of RIT is reviewed. The biology of RIT and relative efficacy of RIT compared with conventional external beam radiation therapy is discussed. Areas of active research and approaches for increasing the therapeutic index of RIT are reviewed. Important areas of future research are discussed that may ultimately potentiate efficacy and decrease the toxicity of RIT, and help determine how to optimally combine RIT with other therapeutic modalities.