Myeloablative doses of yttrium-90-ibritumomab tiuxetan and the risk of secondary myelodysplasia/acute myelogenous leukemia

Anna Guidetti, Carmelo Carlo-Stella, Marco Ruella, Rosalba Miceli, Lilli Devizzi, Silvia L. Locatelli, Arianna Giacomini, Adele Testi, Stefano Buttiglieri, Alessandra Risso, Luigi Mariani, Massimo Di Nicola, Roberto Passera, Corrado Tarella, Alessandro M. Gianni

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Because the long-term toxicity of myeloablative radioimmunotherapy remains a matter of concern, the authors evaluated the hematopoietic damage and incidence of secondary myelodysplastic syndrome and acute myelogenous leukemia (sMDS/AML) in patients who received myeloablative doses of the radiolabeled antibody yttrium-90 ( 90Y)-ibritumomab tiuxetan. METHODS: The occurrence of sMDS/AML was investigated prospectively in 53 elderly patients with non-Hodgkin lymphoma (NHL) who underwent an autograft after high-dose radioimmunotherapy (HD-RIT) myeloablative conditioning with 90Y-ibritumomab tiuxetan. Bone marrow (BM) hematopoietic progenitors and telomere length (TL) also were investigated. RESULTS: At a median follow-up of 49 months, 4 patients developed sMDS/AML at 6 months, 12 months, 27 months, and 36 months after HD-RIT, and the 5-year cumulative incidence of sMDS/AML was 8.29%. A significant but transient decrease in BM granulocyte-macrophage progenitors was observed; whereas multilineage, erythroid, and fibroblast progenitors were unaffected. A significant and persistent shortening of BM TL also was detected. A matched-pair analysis comparing the study patients with 55 NHL patients who underwent autografts after chemotherapy-based myeloablative conditioning demonstrated a 8.05% 5-year cumulative incidence of sMDS/AML. CONCLUSIONS: HD-RIT for patients with NHL was associated with 1) limited toxicity on hematopoietic progenitors, 2) accelerated TL shortening, and 3) non-negligible incidence of sMDS/AML, which nevertheless was comparable to the incidence observed in a matched group of patients who received chemotherapy-based conditioning. Thus, in the current series of elderly patients with NHL, the development of sMDS/AML was not influenced substantially by HD-RIT. Cancer

Original languageEnglish
Pages (from-to)5074-5084
Number of pages11
JournalCancer
Volume117
Issue number22
DOIs
Publication statusPublished - Nov 15 2011

Keywords

  • high-dose radioimmunotherapy
  • non-Hodgkin lymphoma
  • secondary myelodysplastic syndrome and acute myelogenous leukemia
  • telomere length
  • yttrium-90-ibritumomab tiuxetan

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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