Treatment with yttrium-90 (90Y)-ibritumomab tiuxetan (Zevalin®) in diffuse large B-cell lymphoma: a meta-analysis

Abstract

Background: Diffuse large B-cell lymphoma (DLBCL) is the most frequently diagnosed non-Hodgkin's lymphoma (NHL). Current treatment paradigm in first line, is based on immunochemotherapy and, in case of relapse or refractory, on a salvage therapy with high-dose chemotherapy followed by autologous stem cell transplantation (ASCT).  Yttrium-90 (90Y)-ibritumomab tiuxetan (Zevalin®), off label, offers a new therapeutic approach for DLBCL, both as first-line induction or consolidation and in relapsed or refractory disease. Data on this subject is increasingly being reported as well in consolidation as alone, in first line or after. To assess efficacy and find the best place of Zevalin in DCLL, we conducted a literature review and meta-analysis of randomized clinical trials and observational studies on the effect of Zevalin treatment in this setting, except in ASCT.

Materials and Methods: The primary goal was to assess the effect of Zevalin on overall response rate (ORR) and complete response rate (CRR) then assess the 2-year overall survival (OS2y) and 2-year progression-free survival rates (PFS2y)

Results: Sixteen studies were identified (399 patients) with DLBCL receiving Zevalin as consolidation or as treatment alone. The ORR and CRR were 74.8% (n=374) and 67.4% (n=365), respectively. Outcomes were superior when Zevalin is used in consolidation after immunochemotherapy induction at first line of treatment. OS2y and PFS2y were 87.5% and 82.8%, respectively. The primary toxicity was neutropenia (49.9%). Conclusion: The use of Zevalin in patients with DLBCL is safe and effective.