Radioimmunotherapy: A Review of I-131 Tositumomab and Y-90 Ibritumomab Tiuxetan for the Treatment of NHL

Vesper Grantham, MEd, R.T.(N)(ARRT)®, CNMT, Linda Alfred, MEd, R.T.(T)(ARRT)®, Stacy Anderson, MS, R.T.(T)(ARRT)®, CMD, and Cara Argo, CNMT

^*Associate Professor, Nuclear Medicine Program Director; Vice-Chairman, Department of Medical Imaging and Radiation Sciences, University of Oklahoma Health Sciences Center, College of Allied Health, Oklahoma City, Oklahoma.
^†Assistant Professor, Radiation Therapy Clinical Coordinator, Department of Medical Imaging and Radiation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
^‡Radiation Therapy Program Director; Chair, Department of Medical Imaging and Radiation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
^§Nuclear Medicine Technologist; Graduate, Nuclear Medicine Technology Program, Department of Medical Imaging and Radiation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
Address correspondence to: Vesper Grantham, MEd, R.T.(N)(ARRT)®, Associate Professor, Nuclear Medicine Program Director; Vice-Chairman, Department of Medical Imaging and Radiation Sciences, University of Oklahoma Health Sciences Center, College of Allied Health, 1200 North Stonewall, AHB-3021, Oklahoma City, OK 73117. E-mail: Vesper-Grantham@ouhsc.edu.

Disclosures: The authors report having no significant financial or advisory relationships with corporate organizations related to this activity.

ABSTRACT

Non-Hodgkin lymphoma (NHL) is currently the second fastest rising cancer in the United States, with a doubling in incidence over the last 30 years. In addition to more conventional therapy for NHL with chemotherapy, external beam radiation therapy, bone marrow or stem cell transplantation, or a combination of these strategies, radioimmunotherapy (RIT) has been introduced during the past decade and represents a promising therapeutic strategy in patients with B-cell NHL. However, the safe and effective delivery of RIT for NHL requires advanced coordination of care between diverse members of the patient's clinical team, including the nuclear medicine physician, medical oncologist, radiation oncologist, as well as nurses, pharmacists and radiologic technologists. Consequently, radiologic technologists and other professionals responsible for these patients require an understanding of NHL disease, in addition to knowledge of the important operating parameters and safety issues surrounding RIT in these patients. This article will review the signs and symptoms, diagnosis, staging, and treatment options for NHL, with a focus on B-cell NHL. In addition, current options for RIT will be reviewed, with special attention to initial patient evaluation and dosing, follow-up imaging, and important radiation safety concerns for patients, caregivers, family members and institutions delivering care.