WorldWideScience

Sample records for c2b8 i-131 rituximab

  1. Radioimmunotherapy in refractory b-cell nonhodgkins lymphoma with I-131-labeled chimeric anti cd-20 c2b8 (I-131 rituximab): preliminary result

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Hye Jin; Park, Yeon Hee; Kim, Sung Eun and others [Korea University Medical School, Seoul (Korea, Republic of)

    2005-07-01

    Recently, the native chimeric human-mouse anti CD-20 antibody IDEC-C2B8 (Rituximab) has been widely applied in NHL. This ongoing phase study was to evaluate whether radioimmunotherapy (RIT) with I-131 rituximab is effective in refractory B-cell NHL. Inclusion criteria were as follows: B-cell NHL with relapsed or refractory to primary standard therapy, measurable disease, adequate hematologic, renal, and hepatic function, informed consent. The rituximab (Mabthera, Roach) was radiolabeled with iodine-131(I-131) using a modified chloramine T method with high radiochemical purity (95%) and preservation of immuno-reactivity. All patients received loading doses of unlabeled rituximab (median, 40 mg: range, 20{approx}70 mg) immediately prior to administration of therapeutic dose (51.4{approx}152.2 MBq/kg), and then underwent gamma camera scan. 11 patients were enrolled (4 low-grade B-cell NHL, 7 DLBCL, median age 63 years). Patients had received a median of three prior chemotherapy regimens. The objective response rate was 36.4% (1 CR, 3 PRs). These all responses were observed in low-grade B-cell NHL, except one with DLBCL. Adverse events were primarily hematologic toxicities; the incidence of grade 3/4 neutropenia, thrombocytopenia, and anemia was 27.3%, 45.5%, and 18.2%, respectively. The treatment-related mortality was observed in one patient, who had been previously treated with high-dose chemotherapy plus TBI with autologous stem cell transplantation. RIT with I-131 rituximab seems to be effective tolerable in refractory low-grade B-cell NHL, although modest activity in refractory DLBCL. Further studies to define the efficacy of I-131 rituximab in DLBCL are warranted.

  2. High-dose radioimmunotherapy in refractory b-celI non-Hodgikin's lymphoma with I-131-labeled chimeric anti CD-20 C2B8 (I-131 rituximab): pilot trial

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sung Eun; Park, Yeon Hee; Cheon, Gi Jeong; Ryoo, Baek Yeol; Lee, Seung Sook; Choi, Chang Woon; Lim, Sang Moo [Korea Institute of Radiological and Medical Science, Seoul (Korea, Republic of)

    2004-07-01

    The native chimeric human-mouse anti CD-20 antibody IDEC-C2B8 (rituximab) is therapeutically applied in relapsed or refractory NHL. This ongoing pilot study was to evaluate whether high-dose radioimmunotherapy (RIT) with I-131 rituximab is therapeutically effective in refractory B-cell NHL. 5 patients (5 male, aged 50.89{+-}16.89) with chemorefractory NHL of B-cell origin (2 diffuse large B cell, 1 burkitt's lymphoma, and 2 mantle cell Iymphoma) oe, with a life expectancy of at least 3 months, and with a Kamofsky performance score of 60 and above were studied. The chimeric IgG1 anti CD 20 monoclonal antibody rituximab (mabthera, Roche) was radiolabelled with iodine-131 (I-131) using a modified chloaramine T method with high radiochemical purity (95%{+-}0.9) and preservation of immunoreactivity. All patients received therapeutic loading doses of unlabelled rituximab (18.5 MBq/kg) immediately prior to administration of therapeutic dose (3.7 GBq-8.5 GBq), and then underwent gamma camera scan and pre-and post-RIT FDG PET (within 7 day and day 30). Blood cell nadirs were reached at 2-3 weeks after therapy infusion, but all patients recovered at 6 weeks after treatment. Non hematologic toxicity was restricted to mild-to moderate nausea, fever, transient bilirubin, or liver enzyme elevation. Two (8.5 GBq) with mantle cell lymphoma and one with burkitt's lymphoma experienced good partial remissions, and one (5.5 GBq, DLBL) with bulky disease had a partial remission, and one patient (3.7 GBq, DLBL) with bulky disease had a mixed response. High-dose RIT with I-131 labelled rituximab seems to be effective and moderate toxicity. Further follow-up to monitor the long-term outcome are indicated.

  3. Biodistribution and kinetics of {sup 131}I-labelled anti-CD20 MAB IDEC-C2B8 (rituximab) in relapsed non-Hodgkin's lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Scheidhauer, Klemens; Wolf, Ingo; Baumgartl, Hans-Joachim; Reidel, Guenther; Schwaiger, Markus [Klinik und Poliklinik fuer Nuklearmedizin, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Muenchen (Germany); Schilling, Christoph von; Schmidt, Burkhard; Peschel, Christian [III. Medizinische Klinik, Klinikum rechts der Isar, Technische Universitaet Muenchen (Germany)

    2002-10-01

    The native chimeric human-mouse anti-CD20 antibody IDEC-C2B8 (rituximab) is therapeutically applied in relapsed non-Hodgkin's lymphoma (NHL). The purpose of this study was to evaluate the distribution and pharmacokinetics of iodine-131 labelled rituximab in humans for radioimmunotherapy of relapsed CD20-positive NHL. Thirty-five patients with relapsed NHL were administered 20-40 mg rituximab labelled with 250 MBq {sup 131}I. Biodistribution was determined by the gamma camera whole-body scans, whole-body probe measurements and the analysis of serial blood and urine samples. Dosimetry was performed using the MIRDOSE 3 program. Antibody administration was well tolerated. The whole-body activity showed a mono-exponential decrease with a wide range of effective half-lives, the mean value (88 h) being significantly longer than the half-life of its murine counterpart, tositumomab. This led to appropriately higher dose factors for the whole body and organs. Activity was excreted mainly through the kidneys. Normal organs showed decreasing ratios of organ to whole-body activity over time, whereas the tumour tissue presented different kinetics, with increasing ratios of tumour to whole-body activity as evidence for specific antibody binding. It is concluded that {sup 131}I-labelled rituximab is suitable for pretherapeutic dosimetry. Due to the wide range of whole-body and organ dose factors, individual dosimetry is necessary for radioimmunotherapy with {sup 131}I-labelled rituximab. The therapeutic activities of {sup 131}I-labelled rituximab required to deliver similar doses should be lower than those of its murine counterpart. (orig.)

  4. Quantitative Analysis of High Dose Radioimmunotherapy with I-131 Anti-CD20 Monoclonal Antibody (Rituximab) in Patients with Non-Hodgkin's Lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kyeong Min; Kang, Hye Jin; Choi, Tae Hyun; Cheon, Gi Jeong; Choi, Chang Woon; Lim, Sang Moo [Korea Institute of Radiological and Medical Sciences, Seoul (Korea, Republic of)

    2006-07-01

    Radioimmunotherapy (RIT) is therapeutic method for treatment of patient with incurable disease. I-131 is an radioisotope widely used for both diagnostic imaging and therapy, because of simultaneous emitting both gamma- and beta-ray. Recently, RIT using I-131 anti- CD20 rituximab has been introduced as one of the promising therapeutic model to treat patient with non- Hodgkin's Lymphoma (NHL). Although dosimetric approaches of low-dose I-131 rituximab imaging have been reported, there is no study of dosimetry with high dose imaging in patient with NHL yet. In this study, we evaluated strategy of high-dose RIT and investigated the kinetic behavior and absorbed dose to bone marrow and whole body in RIT study with high-dose strategy using I-131 rituximab for NHL.

  5. Assessment of absorbed dose and therapeutic response of tumor in repeated high-dose I-131 anti-CD20 monoclonal antibody (rituximab) radioimmunotherapy for non-Hodgkin's lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Byun, Byung Hyun; Lim, Sang Moo; Kim, Kyeong Min [Korea Institute of Radiological and Medical Sciences, Seoul (Korea, Republic of)] (and others)

    2007-07-01

    We assessed the therapeutic dose absorbed to the tumor and response in repeated RIT with I-131 rituximab for NHL. Patients with NHL (n=6) were administered a therapeutic dose of I-131 rituximab (192.527.0 mCi). The number of repeated administration was 3 for all patients. Total 12 measurable tumor regions were assessed at the time of each RIT. Whole-body (WB) planar images with anterior and posterior views were acquired sequentially at 5 min, 5hr, 24hr, 48hr, and 72hr post-injection using gamma camera. F-18-FDG PET/CT was performed before (within 7 days) and after (on Day 30) RIT. From PET/CT image acquired before RIT, maximum intensity projection (MIP) image of coronal view was acquired. Serial WB planar images were overlaid to the coronal MIP PET image, respectively, by means of registration using 4 fiducial marks (bilateral shoulder and buttock) implemented in AMIDE software. On registered MIP PET and WB planar images, both 2D-ROIs were drawn on the region of tumor and background nearby tumor. The shape of 2D-ROI of tumor was determined from the MIP PET image. The volume of tumor was measured from the CT image, the % change of tumor volume before and after RIT was used in evaluation of the therapeutic response. The values of CT-based tumor volume were 8.216.3cc. The values of absorbed dose for tumor and the % changes of tumor volume before and after RIT were 231.8603.0rad, and 55.548.7%, respectively, and did not show the linear relationship (r=0.2787). The values of absorbed dose for tumor and the % changes of tumor volume did not correlate with the number of repeated administration (p>0.05, ANOVA). Aligning PET and planar images could estimate the quantitative values of absorbed dose to tumor. The data suggest that repeated RIT with I-131 rituximab is necessary for NHL, because single-RIT is insufficient to achieve remission of disease.

  6. Sequential Camouflage of the arachno-6,9-C2B8H14 Cage by Substituents.

    Science.gov (United States)

    Bakardjiev, Mario; Štíbr, Bohumil; Holub, Josef; Tok, Oleg L; Švec, Petr; Růžičková, Zdeňka; Růžička, Aleš

    2016-07-18

    Sequential methylation of arachno-6,9-C2B8H14 (1) led to a series of methyl derivatives and finally to the camouflaging of all boron positions by mixed persubstitution. Thus, deprotonation of 1 produced the [arachno-6,9-C2B8H13] anion (1(-)), the methylation of which with MeI in tetrahydrofuran proceeded on the open-face boron vertexes with the formation of 5-Me-arachno-6,9-C2B8H13 (2; yield 28%) and 5,8-Me2-arachno-6,9-C2B8H12 (3; yield 36%). Observed in this reaction was also a side formation of 2-Me-closo-1,6-C2B8H9 (4; yield 6%).The electrophilic AlCl3-catalyzed CH3(+) attack of the neutral 1 in neat MeI at ambient temperature afforded 1,3-Me2-arachno-6,9-C2B8H12 (5), while a 76-h heating at 120 °C generated a mixture of the di- and triiodo derivatives 1,2,3,4,8,10-Me6-5,7-I2-arachno-6,9-C2B8H6 (6) and 1,2,3,4,7-Me5-5,7,10-I3-arachno-6,9-C2B8H6 (7). On the other hand, a HOTf-catalyzed reaction between 1 and MeOTf at reflux resulted in the isolation of 2-TfO-1,3.4,5,7,8,10-Me7-arachno-6,9-C2B8H6 (8; Tf = CF3SO2; yield 65%). The compounds were characterized by multinuclear ((11)B, (1)H, (13)C, and (19)F) NMR spectroscopy, mass spectrometry, and elemental analysis, and the structures of compounds 1, 1(-), 5, and 6 were established by X-ray diffraction analysis. PMID:27351461

  7. Radioactive Iodine (I-131) Therapy for Hyperthyroidism

    Science.gov (United States)

    ... with I-131. Depending on the amount of radioactivity administered during your treatment, your endocrinologist or radiation ... it begins destroying the gland's cells. Although the radioactivity from this treatment remains in the thyroid for ...

  8. Radiopharmaceutical potential of I-131 labelled diazepam

    International Nuclear Information System (INIS)

    In this study, diazepam is a derivative of the 1.4 benzodiazepine family that the most widely used drug as anticonvulsant agent has been labeled with I-131, as a new radiopharmaceutical and its radiopharmaceutical potential has been determined. Labeling of diazepam has been performed by iodogen method and optimum labeling conditions have been determined. Optimum reaction conditions are 1 mg for iodogen amount; 1-5 mg for diazepam amount, 15-20 minutes for reaction time and room temperature for reaction temperature. Specific activity of labeled compound was 0,15 Ci/mmol level. N-octanol/water ratio was found 1.9 for 131IDZ (131I labeled diazepam). In vivo experiments have been carried out to determine radiopharmaceutical potentials of labeled compound. Biodistribution studies on rats showed that 131IDZ have accumulated in kidneys, liver, lungs and brain tissues. Scintigraphic results taken with gamma camera on rabbits agree with biodistribution results of rats. (author)

  9. Scintigraphic depiction of an insulinoma by I-131 metaiodobenzylguanidine

    Energy Technology Data Exchange (ETDEWEB)

    Geatti, O.; Shapiro, B.; Barillari, B. (Istituto di Medicina Nucleare, Ospedale Civile di Udine (Italy))

    1989-12-01

    Scintigraphy with I-131 metaiodobenzylguanidine (MIBG) was effective in depicting a pancreatic insulinoma in a patient suffering from intermittent hypoglycemia. This observation widens the range of neuroendocrine tumors that take up to I-131 MIBG and supports the concept that many tumors of the amine precursor uptake and decarboxylation system may be imaged in this way.

  10. Scintigraphic depiction of an insulinoma by I-131 metaiodobenzylguanidine

    International Nuclear Information System (INIS)

    Scintigraphy with I-131 metaiodobenzylguanidine (MIBG) was effective in depicting a pancreatic insulinoma in a patient suffering from intermittent hypoglycemia. This observation widens the range of neuroendocrine tumors that take up to I-131 MIBG and supports the concept that many tumors of the amine precursor uptake and decarboxylation system may be imaged in this way

  11. Metabolism of I-131-meta-iodobenzylguanidine (MIBG) in humans

    International Nuclear Information System (INIS)

    I-131-MIBG is used to image and treat human pheochrmocytoma. As part of a pharmacodynamic study, the authors have evaluated its excretion and metabolism in 8 pheochromocytoma patients undergoing MIBG therapy. Following diagnostic doses (0.42-0.53 mCi) of I-131-MIBG given prior to therapy, 40-55% of the administered radioactivity appears in the urine within 24 h with 70-90% recoverable within 4 days. HPLC was used to identify potential metabolites following therapeutic doses (130-213 mCi) of I-131-NIBG. Aliquots of daily urine samples were prepared for HPLC analysis by passage through C-18 Sep-pak cartridges. A reverse-phase HPLC system (μBondapak C-18; 0.2 M ammonium phosphate/THF, 80/20) with both ultraviolet (254 nm) and radioactive (Flo-one detector, solid scintillant cell) detection was used. Radioactive metabolites were identified by co-chromatography with authentic compounds at elution solvent pH's of 4.6 and 7.0. Unaltered I-131-MIBG was the primary radioactive urinary component in all 8 patients studied, representing 74-90% of the total recovered. Two ''major'' metabolites were identified: I-131-iodide and I-131-m-iodohippuric acid, representing, respectively, 2-6% and 2-16% of the total urinary radioactivity. Of 4 additional ''minor'' metabolites (< 2% of total urinary radioactivity) detected, 2 have been identified: I-131-4-hydroxy-MIBG and I-131-m-iodobenzoic acid. The 4-5 day metabolism profiles varied from patient to patient but did not change in 2 patients given 2 therapy doses 4 months apart. No obvious correlation was observed between the presence of metabolites and the location of the tumors or the plasma or urinary catecholamine levels. I-131-MIBC is a rapidly excreted, relatively stable radiopharmaceutical agent

  12. I-131 HIPPURAN FOR THE ESTIMATION OF RENAL PLASMA-FLOW - REQUIREMENTS FOR RADIOCHEMICAL PURITY

    NARCIS (Netherlands)

    KENGEN, RAM; MEIJER, S; VANZANTEN, AK; BEEKHUIS, H; KOSTERINK, JGW; PIERS, DA

    1995-01-01

    For many years iodide-131 Hippuran has been used as a tracer to measure effective renal plasma flow (ERPF). Because of the low renal clearance of free I-131-iodide and the inability to count it separately from I-131-Hippuran, free I-131-iodide will lower the calculated I-131-Hippuran clearance, resu

  13. False-positive I-131 uptake in meningioma

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Shin Young; Seo, Ji Hyoung; Bae, Jin Ho; Hwang, Jeong Hyun; Ahn, Byeong Cheol; Lee, Jae Tae; Lee, Kyu Bo [School of Medicine, Kyungpook National Univ., Daegu (Korea, Republic of)

    2004-06-01

    We experienced a case with meningioma showing false positive I-131 uptake. A 55-years old female patient underwent high dose (150 mCi) radioactive iodine therapy to ablate remnant tissue after total thyroidectomy for papillary thyroid cancer. In addition to intense tracer uptake in thyroid bed, there was mild but focal abnormal uptake in left frontal lobe of the brain on post-therapy I-131 whole body scan. Subsequent brain MR imaging showed single mass lesion in left frontal lobe and the mass was resected under the impression of brain metastasis of thyroid carcinoma. Pathologic report confirmed meningioma from the surgical specimen.

  14. Carcinoid tumor of the thymus visualized with I 131-MIBG

    International Nuclear Information System (INIS)

    Iodine 131 Metaiodobenzylguanidine is usually used in the diagnosis of pheochromocytoma, neuroblastoma and bronchus and gut carcinoid tumors. This radiopharmaceutical is sometimes applied in therapy. We report the case of a patient with an exceptional carcinoid tumor of the thymus studied by I 131-MIBG scintigraphy before and after surgery. The results are in agreement with the other investigations

  15. Does I-131-MIBG underestimate skeletal disease burden in neuroblastoma?

    Directory of Open Access Journals (Sweden)

    Barai Sukanta

    2004-10-01

    Full Text Available Background: Controversy persists as to the need for both MIBG and bone scanning in routine evaluation of neuroblastoma. Aim: To compare the efficacy of I-131- metaiodobenzylguanidine (MIBG scan against that of conventional Tc99m- methylene diphosphonate (MDP bone scan for the detection of skeletal deposition of neuroblastoma. Methods and Material: The study included 57 patients (36 boys, 21 girls: age range 1-14 years of neuroblastoma who underwent both bone scan with Tc99m-MDP and I-131-MIBG scan within 15 days of each other at presentation and during follow-up. Results: At presentation 11(19.2% patients had evidence of skeletal metastases on MDP scan against 7 patients who showed bony secondaries on MIBG scan. Of the 7 patients, with positive MIBG and MDP scans, MDP scan detected 11 sites whereas MIBG scan detected 7 sites. On follow-up study, 3 patients with initial abnormal MDP scan but normal MIBG scan, developed skeletal metastases detectable on MIBG scan, whereas 3 of the 46 patients who had normal MDP and MIBG scan at presentation; developed skeletal metastases detectable on MDP scan. MIBG scan was concordant in 2 of them but was normal in the third patient. Conclusion: I-131-MIBG underestimates skeletal disease burden in neuroblastoma. Therefore, Tc99m-MDP bone scan should remain a part of routine assessment of patients with neuroblastoma.

  16. Adjuvant radioactive iodine (I131) therapy in patients with papillary thyroid cancer: comparison of ablation outcome post low and high doses of I131

    International Nuclear Information System (INIS)

    Full text of publication follows. Introduction: I131 ablation post total thyroidectomy is a well established adjuvant therapy in patients with papillary thyroid cancer. Many factors can affect ablation outcome including size of remnant thyroid tissue, stage of the disease and given dose of I131. Some authors stated that small doses of I131 can achieve successful complete ablation outcome comparable to high ablative dose. Aim: the aim of the current study is to compare successful complete ablation rate using low I131 ablation dose (30 mCi) versus high dose (100 mCi) post total thyroidectomy in patients with papillary thyroid cancer confined to the thyroid gland. Patients and methods: 129 patients with papillary thyroid cancer confined to the thyroid gland, with no regional lymph nodal or systemic metastases, candidates for I131 ablation therapy post total thyroidectomy, were included in the current study. 61 patients received 30 mCi ablative dose on our patient basis. The remaining 68 patients received high ablation dose (100 mCi). All patients performed follow up I131 whole body scan, neck ultrasound and unsuppressed serum thyroglobulin level (Tg) 6-9 months post I131 therapy. Successful complete ablation was considered in absence of any I131 avid thyroid tissue in the neck, free neck ultrasound and Tg level < 2 ng/ml. Results: successful complete ablation post 30 mCi of I131 was noted in 36 out of 61 patients (59%). On the other hand, this was observed post 100 mCi in 56 out of 68 patients (82.3%), with a statistically significant difference between both groups (p<0.05). Conclusion: in patients with papillary thyroid cancer confined to the thyroid gland, candidates for I131 ablation therapy post total thyroidectomy, high ablation dose of I131 (100 mCi) has significantly higher successful complete ablation rate compared to small I131 dose (30 mCi). (authors)

  17. Vocal cord paralysis following I-131 ablation of a postthyroidectomy remnant

    Energy Technology Data Exchange (ETDEWEB)

    Lee, T.C.; Harbert, J.C.; Dejter, S.W.; Mariner, D.R.; VanDam, J.

    1985-01-01

    Vocal cord paralysis has been reported following I-131 therapy of thyrotoxicosis and following ablation of the whole thryoid. However, this rare complication has not previously been described following I-131 ablation of a postthyroidectomy remnant. The authors report a patient who required tracheostomy for bilateral vocal cord paralysis following I-131 ablation after near-total thyroidectomy for papillary thyroid carcinoma.

  18. Comparison of thallium-201, Tc-99m MIBI and I-131 scan in the follow-up assessment after I-131 ablative therapy in differentiated thyroid cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Jae Sung; Lee, Sung Keun; Kim, Doe Min; Park, Sae Jong; Jang, Kyong Sun; Kim, Eun Sil; Kim, Chong Soon [Hanil General Hospital, Seoul (Korea, Republic of)

    1999-08-01

    We conducted a comparative study to evaluate the diagnostic values of Tl-201, Tc-99m MIBI and I-131 scans in the follow-up assessment after ablative I-131 therapy in differentiated thyroid cancer. The study population consisted of 20 patients who underwent surgical removal of thyroid cancer and ablative radioactive iodine therapy, and followed by one or more times of I-131 retreatment (33 cases). In all patients, Tl-201, Tc-99m MIBI, diagnostic and therapeutic I-131 scans were performed and the results were analyzed retrospectively. Also serum thyroglobulin levels were measured in all patients. The final diagnosis of recurrent or metastatic thyroid cancer was determined by clinical, biochemical, radiologic and/or biopsy findings. Positive rates (PR) of Tc-99m MIBI, Tl-201, diagnostic and therapeutic I-131 scans in detecting malignant thyroid tissue lesions were 70% (19/27), 54% (15/28), 35% (17/48) and 63% (30/48), respectively. The PR in the group of 20 cases (28 lesions) who underwent concomitant Tl-201 and I-131 scans were in the order of therapeutic 131 scan 71%, Tl-201 scan 54% and diagnostic I-131 scan 36%. There was no statistically significant difference between Tl-201 and diagnostic I-131 scans (p>0.05). In the group of 20 cases (27 lesions) who underwent concomitant Tc-99m MIBI and I-131 scans, the PR were in the order of Tc-99m MIBI scan 70%, I-131 therapeutic scan 52% and I-131 diagnostic scan 33%. The PR of Tc-99m MIBI was significantly higher than that of diagnostic I-131 scan (p<0.05). Tc-99m MIBI scan is superior to diagnostic I-131 scan in detecting recurrent or metastatic thyroid cancer following ablation therapy in patients with differentiated thyroid cancer. Tl-201 scan did not showed significantly higher positive rate than diagnostic I-131 scan. Instead of diagnostic I-131 scan before the I-131 retreatment, Tc-99m MIBI scan without discontinuing thyroid hormone replacement would be a prudent and effective approach in the management of these

  19. Dosimetry prior to I-131-therapy of benign thyroid disease

    International Nuclear Information System (INIS)

    The activity to be administered in I-131 therapy of benign thyroid disease is determined by the radiation absorbed dose necessary to cure the disease, the target mass, and the residence time of the I-131 in the target volume. Data from 73 patients with complete sets of uptake measurements 2, 6, 24, 48, and 96 (n = 53) or 120 (n = 20) hours after oral administration of 1 MBq I-131 were used to deduce residence times from subsets of 3, 2, or only 1 measurement for each individual. The values were compared to those obtained with the reference method, i.e. a fit of an uptake function based on a 2-compartment model to all 5 measurements, to quantify the errors introduced by the less demanding assessments. Deviations are less than 10% if the 2- compartment uptake function is fitted to only 3 values measured after 6, 24, and 96-120 h. Use of 2, 24, and 96-120 h data results in errors > 20% in individual patients. The effective half-lives as determined from 2 measurements after 24 and 96-120 h correlate well with those deduced from the reference method with larger deviations in individuals with slow iodine kinetics and late maximal uptake. Residence times determined from the 24 h uptake, assuming linear increase during the first day, and the effective half-life limited to maximum 8 days underestimate the actual values systematically in patients with long and short half-lives. These errors can be eliminated by a modification of the calculation method resulting in deviations less than 14% in all but one individual for this procedure. The accuracy of methods based on only one retention value increases with the time of measurement after the administration of I-131. While systematic errors up to a factor of two occur if the 24 h uptake is used for the estimate, deviations are less than 18% for measurements after 120 h. The results suggest that only one late uptake assessment warrants residence time estimates with an acceptable error. Given the high inherent uncertainties in the

  20. Rituximab done

    DEFF Research Database (Denmark)

    Walker, Ulrich A; Jaeger, Veronika K; Chatzidionysiou, Katerina;

    2016-01-01

    OBJECTIVE: To compare the effectiveness of biologics after rituximab (RTX) treatment in RA. METHODS: The effectiveness of TNF-α inhibitors (TNFi), abatacept (ABA) or tocilizumab (TCZ) was examined in patients previously treated with RTX using clinical data collected in the Collaborative Registries...... for the Evaluation of Rituximab in RA Collaborative registry. Patients had stopped RTX 6 months or less prior to the new biologic and had a baseline visit within 21 days of starting the new biologic. RESULTS: Two hundred and sixty-five patients were analysed after 6 months of treatment. Patients on TCZ (n = 86) had...... a greater decline of DAS28-ESR and clinical disease activity index than patients on TNFi (n = 89) or ABA (n = 90). This effect was also seen after adjusting for baseline prednisone use and the number of previous biologics. The mean DAS28-ESR scores in patients on TCZ were 1.0 (95% CI: 0.2, 1.7) and 1.8 (95...

  1. I-131 remnant ablation after thyroidectomy induced hepatotoxicity in a case of thyroid cancer

    OpenAIRE

    Lin, Rong; Banafea, Omar; Ye, Jin

    2015-01-01

    Background Radioactive iodine (I-131) is routinely used for the treatment of differentiated thyroid cancer following surgery. Drug-induced liver injury (DILI) is a leading cause of acute liver failure. Here we reported a rare case of diffuse hepatic uptake (DHU) of radioactive iodine (I-131) induced hepatotoxicity in patient with I-131 ablation therapy after thyroidectomy. Case presentation A 57-year-old woman was admitted due to jaundice, itching and dark urine with abnormally elevated liver...

  2. Bioassay program: determination of I-131 body burden among radiation workers and nuclear medicine laboratory technicians

    Energy Technology Data Exchange (ETDEWEB)

    Duran, E.B.; Napenas, D.; San Jose, V.; Juan, N.

    The body burden of I-131 was determined among the radiation workers of the Philippine Atomic Energy Commission (PAEC) who are directly involved in I-131 processing and nuclear laboratory technicians of University of Santo Tomas and Veterans Hospital, who handle and dispense I-131 to patients. The routine monitoring was done by urine analysis. The untreated urine samples were counted directly for 4000 seconds using Nal(Tl) scintillation detector coupled to an ND66 microcomputer-based multichannel analyzer. Urine samples of radiation workers of PAEC who are not involved in I-131 processing and non-radiation workers were also assayed for comparison. For radiation workers of PAEC who are directly involved in processing I-131, the estimated body burden of I-131 ranged from <0.055 to 8.53 uCi (282 urine samples). These values were higher than those observed for radiation workers not involved in the handling or processing of I-131 with estimated body burden of I-131 ranging from <0.055 to 0.52 uCi (48 urine samples) or than those observed from non-radiation workers (<0.055 uCi). The maximum permissible burden of I-131 is 0.7 uCi.

  3. Impact of reconstruction parameters on quantitative I-131 SPECT

    Science.gov (United States)

    van Gils, C. A. J.; Beijst, C.; van Rooij, R.; de Jong, H. W. A. M.

    2016-07-01

    Radioiodine therapy using I-131 is widely used for treatment of thyroid disease or neuroendocrine tumors. Monitoring treatment by accurate dosimetry requires quantitative imaging. The high energy photons however render quantitative SPECT reconstruction challenging, potentially requiring accurate correction for scatter and collimator effects. The goal of this work is to assess the effectiveness of various correction methods on these effects using phantom studies. A SPECT/CT acquisition of the NEMA IEC body phantom was performed. Images were reconstructed using the following parameters: (1) without scatter correction, (2) with triple energy window (TEW) scatter correction and (3) with Monte Carlo-based scatter correction. For modelling the collimator-detector response (CDR), both (a) geometric Gaussian CDRs as well as (b) Monte Carlo simulated CDRs were compared. Quantitative accuracy, contrast to noise ratios and recovery coefficients were calculated, as well as the background variability and the residual count error in the lung insert. The Monte Carlo scatter corrected reconstruction method was shown to be intrinsically quantitative, requiring no experimentally acquired calibration factor. It resulted in a more accurate quantification of the background compartment activity density compared with TEW or no scatter correction. The quantification error relative to a dose calibrator derived measurement was found to be  images.

  4. Post-laryngectomy localization of I-131 at tracheostomy site on a total body scan

    Energy Technology Data Exchange (ETDEWEB)

    Kirk, G.A.; Schulz, E.E.

    1984-07-01

    A post-thyroidectomy, post-I-131-therapy patient had a laryngectomy and neck dissection for recurrent papillary thyroid carcinoma. A subsequent I-131 total body scan revealed persistent anterior neck activity, which disappeared upon removal of the tracheostomy tube and dressings.

  5. Monitoring of I-131 after Fukushima nuclear power plant disaster and a correction of contribution of I-131 in the discharges of Slovenske elektrarne, Bohunice nuclear power plant

    International Nuclear Information System (INIS)

    After the earthquake and subsequent tsunami in March 2011 Fukushima nuclear power reactors in Japan were damaged. As a result of damage of reactors escaped into air iodine radioactive isotopes which were dispersed by air masses over Europe and Slovakia. Isotope I-131 was identified in samples of the atmosphere and the abstraction of Radiation Control SE EBO. The air from the atmosphere contaminated with isotopes of iodine from the Fukushima ventilation systems that do not contain iodine filters, sucked into the interior of the controlled area, then released in organised way and then measured in the ventilation chimneys of EBO NPP. The measured values thus entered a balance of radioactive discharges. Drain of I-131 from SE EBO was in that period plus a contribution coming from Fukushima NPP and measured activity I-131 had to be corrected.

  6. Effects of Dosimetrically Guided I-131 Therapy on Hematopoiesis in Patients With Differentiated Thyroid Cancer.

    Science.gov (United States)

    Bikas, Athanasios; Schneider, Mark; Desale, Sameer; Atkins, Frank; Mete, Mihriye; Burman, Kenneth D; Wartofsky, Leonard; Van Nostrand, Douglas

    2016-04-01

    A retrospective analysis was performed to evaluate the effects of dosimetrically-guided I-131 treatment on hematopoiesis. Statistically significant decreases in CBC parameters following a specific time-pattern were shown.

  7. False-positive I-131 scan by contaminated muffler in a patient with thyroid carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Han Kyung; Kim, Min Woo; Jeong, Hwan Jeong; Sohn, Myung Hee [Chonbuk National University Hospital, Chonju (Korea, Republic of)

    2006-02-15

    A 39-year-old female patient who had undergone a total thyroidectomy for a papillary thyroid carcinoma underwent a whole body scan with I-131. The I-131 scan was performed 72 hours after administering 185 MBq (5 mGi) of an I-131 solution. The anterior image of head, neck, and upper chest showed multiple areas of increased uptake in the mediastinal area considering of functional metastasis. However, radioactivity was not evident in the image taken after removing her clothes and muffler. The image obtained after placing the muffler on the pallet showed that the radioactivity was still present. It is well known that artifacts on an I-131 scan can be produced by styling hair sputum, drooling during sleep, chewing gum, and paper or a cloth handkerchief that is contaminated with the radioactive iodine from either perspiration or saliva. This activity might be mistaken for a functional metastasis. Therefore, it is essential that an image be obtained after removing the patient's clothes. In this study, artifacts due to a contaminated muffler on the I-131 scan were found. These mimicked a functional metastasis of the mediastinal area in a patient with a papillary thyroid carcinoma.

  8. Unexpected Uptake by the Gallbladder in Post-Ablative I-131 Scan

    Directory of Open Access Journals (Sweden)

    Kemal Ünal

    2015-06-01

    Full Text Available A 47-year-old woman was diagnosed as papillary thyroid carcinoma. I-131 ablation therapy was applied following total thyroidectomy, and the whole-body scan revealed a focus of increased uptake in the right upper quadrant. Lateral view images of the uptake site showed that the focus was located near the right liver lobe. The patient was referred to radiology department for correlative abdominal Computed Tomography (CT and Ultrasonography (US to rule out a possible liver metastasis. CT images detected a gallstone in the corresponding area, which was verified by US. These methods did not reveal any metastatic disease in the liver or in other abdominal organs. This is the first published case report documents a rare false-positive finding of I-131 scan that was associated with an asymptomatic gallstone, and emphasizes the importance of correlative imaging in gallbladder related I-131 uptake.

  9. Evaluation of systematic I-131 thyroid measurements for nuclear medicine workers

    International Nuclear Information System (INIS)

    In Nuclear Medicine, I-131 is used intensively for the diagnosis and for the treatment of the different severities maladies of the thyroid. This radionuclide generates an important internal contamination to the patients, because of its oral administration, and, also, through inhalation, to the workers involved in the radiopharmaceuticals production , to the nursing staff and to the physicians that care and treat the patients in the hospitals. The paper presents the data obtained by systematically thyroid monitoring of the physicians and nurses from the Endocrinology Hospital, that are contaminated by I-131 inhalation because of their permanent relation with the patients treated with 3.7 MBq I-131 for investigation and with activities in the range 1100 MBq - 4000 MBq for therapy. The measurements were carried out with our Body Counter equipped with a NaI(Tl) scintillation detector, 50 mm thickness and 40mm diameter. Values of the estimated committed equivalent doses are, also, reported

  10. The value of detectable thyroglobulin in patients with differentiated thyroid cancer after initial I-131 therapy

    NARCIS (Netherlands)

    van Dijk, D.; Plukker, J. T. M.; van der Horst-Schrivers, A. N. A.; Jansen, L.; Brouwers, A. H.; Muller-Kobold, A.; Sluiter, W. J.; Links, T. P.

    2011-01-01

    Objective To assess the prognostic value of detectable thyroglobulin (Tg) after initial surgery and radioactive iodine (I-131) therapy by comparing patients with a negative post-therapeutic whole body scan (WBS) with either detectable or undetectable Tg. Background Differentiated thyroid cancer has

  11. A dynamical model predicting the transport of I-131 through the deposition pasture cow milk pathway

    International Nuclear Information System (INIS)

    A dynamical model predicting the transport of I-131 through the atmospherical deposition-pasture-cow-milk pathway has been developed and validated using data collected in a specific site (a little farm in Anguillara - Rome) during the Chernobyl accident. The main factor affecting the uncertainty of the results of the model are discussed

  12. Control system of liquid effluents generated in treatment with I-131; Sistema de control de efluentes liquidos generados en el tratamiento con I-131

    Energy Technology Data Exchange (ETDEWEB)

    Garcia M, T.; Ruiz C, M. A.; Angeles C, A.; Ramirez S, R., E-mail: teodoro.garcia@inin.gob.mx [ININ, Carretera Mexico-Toluca s/n, 52750 Ocoyoacac, Estado de Mexico (Mexico)

    2015-09-15

    In recent years, nuclear medicine has developed greatly in our country and around the world. Techniques for both medical diagnosis and therapy have increased the use of radiopharmaceuticals, notably the I-131. In Mexico there are around 150 nuclear medicine establishments authorized by the Comision Nacional de Seguridad Nuclear y Salvaguardias. Most of these establishments do not have an appropriate facility for the treatment of radioactive liquid effluents, to ensure compliance with the concentration limits established in the regulations. The Instituto Nacional de Investigaciones Nucleares (ININ) developed and implemented successfully, a control system of radioactive effluents (named SACEL) from a nuclear medicine facility. This system ensures an effective compliance with regulations and also better management and control of these radioactive effluents. Calculations and design of SACEL were made with respect to I-131, because is one of the most commonly used in radiotherapy and medical diagnostics, besides its half-life is greater in relation to other radionuclides. SACEL is comprised of four storage tanks and decay and a fifth tank for measuring the concentration of I-131 and later discharge to the drain; these tanks are connected to an automated system that controls the effluents passage. The calculation to determine the volume of the tanks was carried out according to the demand that has the hospital, to the maximum activity being poured in effluents and time required to decay. In this paper the design and installation of SACEL system, in addition to functioning as a facility that enables the Hospital meet the required standards is presented. Dose calculations performed with MCNPX and the methodology used in the calibration of the detection system is also presented. (Author)

  13. I-131 therapy for thyroid diseases: Doses, new regulations and patient advice

    International Nuclear Information System (INIS)

    I-131 therapy has been widely used in the past 50 years. Its main applications are hyperthyroidism and functioning thyroid cancer. The indications, doses, regulations, precautions and guidelines differ in various centers. The following are recommended: 1. I-131 should be indicated in agreement of the endocrinologist and the nuclear physician with the patient consent; 2. Pre-treatment I-131 thyroid uptake must be performed; 3. The only contraindication for treatment is pregnancy, in children it might be used with caution; 4. For thyrotoxicosis both a calculated or an ablative dose (555 MBq) criteria are acceptable In this case secondary hypothyroidism must be considered an objective rather than a complication; 5. In uninodular toxic goiter a 1110 MBq dose is recommended; 6. Iodine free diet is indicated only for cancer patients; 7. Propylthiouracil (PTU) must be discontinued 5 days before treatment, it should be reinitiated 5 days later; 8. Prophylactic use of corticoid in Graves' disease still require more clinical data to support its use; 9. In treatment failure, wait six months for a new dose; 10. In intrathyroid cancer disease an ablative dose of 3700 MBq should be administered 4 weeks post-thyroidectomy or with a TSH level above 30 μUI/mL; 11. A whole body scan should be done one week later; 12. Follow-up whole body scan should be used only if there is clinical suspicion of metastasis. Thyroid hormone replacement must be discontinued for 30 days or with TSH value above 30 I/mL. For follow-up scan 185 MBq of I-131 are recommended to ovoid thyroid tissue stunning; 13. For metastases, 5700 to 7400 MBq dose is recommended if there are cervical lymphatic nodes or distant metastases. We recommended to adopt the criteria proposed by the United States Nuclear Regulatory Commission (NRC) published as 10 CFR 35.75 and the Regulatory Guide 8.39 for patients release after I-131 administration. (author)

  14. Efficiency of radioiodine therapy with a fix dose of I-131 in toxic thyroid adenoma

    International Nuclear Information System (INIS)

    Purpose: The aim of this study was to estimate the results obtained using a fix dose of I-131 in the treatment of the solitary toxic thyroid adenoma. Material and Methods: We have performed radioiodine therapy m 64 patients, 49 female (50+17 yrs) and 15 male (43+-15 yrs) with solitary toxic thyroid adenoma. 45 patients received fix dose I-131 of 850 MBq, while 19 patients were treated with calculated (MBq/gr) dose 555-1100 MBq Previously 39(64%) patients were clinically hyperthyreotic and received thyreostatic meditication which were interruptecf one week before the administration of I-131. Those patients who were euthyreotic, TSH was suppressed(<0.25 MU/m1). 61(95.3%) patients received a single dose, while 3(4, 7%) patients needed two doses. Resulting thyroid matabolism and volume of nodules were evaluated 6-48 months after treatment. Results: From 45 radioiodine treated patients with fix dose 6(9, 8%) became hypothyroidism, 36(85, 3%) euthyroidism and 3(4, 9%) recurrent hyperthyroidism, in comparison with 19 treated patients with calculated I-131 dose: 2(10, 5%) hypothyroidism, 16(84, 3%) euthyroidism and 1(5, 2%) recurrent hyperthyroidism. The size of the nodules became unpalpable m 17(26, 2%), decreased evidently in 33(52, 5%) and remained unchanged in 14(21, 3%) of the treated patients. Conclusion: A fix dose of I-131 is simple, safe and efficient in the treatment of solitary toxic thyroid adenoma. There was not significant different in incidence of late follow-up results of hypothyroidism and recurrent hyperthyroidism between fix dose and calculated MBq/gr dose. (authors)

  15. Development of gamma-photon/Cerenkov-light hybrid system for simultaneous imaging of I-131 radionuclide

    Science.gov (United States)

    Yamamoto, Seiichi; Suzuki, Mayumi; Kato, Katsuhiko; Watabe, Tadashi; Ikeda, Hayato; Kanai, Yasukazu; Ogata, Yoshimune; Hatazawa, Jun

    2016-09-01

    Although iodine 131 (I-131) is used for radionuclide therapy, high resolution images are difficult to obtain with conventional gamma cameras because of the high energy of I-131 gamma photons (364 keV). Cerenkov-light imaging is a possible method for beta emitting radionuclides, and I-131 (606 MeV maximum beta energy) is a candidate to obtain high resolution images. We developed a high energy gamma camera system for I-131 radionuclide and combined it with a Cerenkov-light imaging system to form a gamma-photon/Cerenkov-light hybrid imaging system to compare the simultaneously measured images of these two modalities. The high energy gamma imaging detector used 0.85-mm×0.85-mm×10-mm thick GAGG scintillator pixels arranged in a 44×44 matrix with a 0.1-mm thick reflector and optical coupled to a Hamamatsu 2 in. square position sensitive photomultiplier tube (PSPMT: H12700 MOD). The gamma imaging detector was encased in a 2 cm thick tungsten shield, and a pinhole collimator was mounted on its top to form a gamma camera system. The Cerenkov-light imaging system was made of a high sensitivity cooled CCD camera. The Cerenkov-light imaging system was combined with the gamma camera using optical mirrors to image the same area of the subject. With this configuration, we simultaneously imaged the gamma photons and the Cerenkov-light from I-131 in the subjects. The spatial resolution and sensitivity of the gamma camera system for I-131 were respectively ~3 mm FWHM and ~10 cps/MBq for the high sensitivity collimator at 10 cm from the collimator surface. The spatial resolution of the Cerenkov-light imaging system was 0.64 mm FWHM at 10 cm from the system surface. Thyroid phantom and rat images were successfully obtained with the developed gamma-photon/Cerenkov-light hybrid imaging system, allowing direct comparison of these two modalities. Our developed gamma-photon/Cerenkov-light hybrid imaging system will be useful to evaluate the advantages and disadvantages of these two

  16. Therapy with I-131 in Hyperthyroidism with Doses Adjusted to Weight

    International Nuclear Information System (INIS)

    Objectives: To assess response to therapy with I-131 adjusting the dose to weight of the gland. Study Design: Retrospective and prospective. Descriptive study. Patients: A total of 146 patients was collected in the period between January 2002 and January 2007. The data were analyzed in Access database including age, sex, duration, approximate weight of the gland, dose, side effects, radiation measurement, outcome and response time. Conclusions: The therapeutic response in treatment with radioactive iodine is adequate if given the dose adjusted to the weight of the gland, without requiring excessive doses. Cases of treatment failures were predictable by even severe symptoms to those administered with high doses. Some of the patients had received prior therapy with high dose in other institutions and probably the failure to respond was due to thyroiditis and washing accelerated I-131

  17. A feasibility study of thyroid cancer among patients treated with I-131

    International Nuclear Information System (INIS)

    This study examined the feasibility of conducting a Canada-wide follow-up study of persons receiving I-131 before 1970, to see if current estimates of induction of thyroid cancer are well founded. It is concluded that such a study is not feasible due to the widespread destruction of old records, and the limited quantity of personal identifying information on those records that do still exist

  18. Radionuclide imaging of primary renal-cell carcinoma by I-131-labeled antitumor antibody

    International Nuclear Information System (INIS)

    A goat antibody against human renal-cell carcinoma reacted on immunofluorescence with renal-cell carcinomas from 20 patients, but not with normal adult human tissues, including kidney. After i.v. administration the I-131-linked antibody showed preferential tumor localization in six of seven patients with primary renal carcinoma. Labeled antitumor antibodies may have the specificity for tumor imaging that current radiopharmaceuticals lack

  19. Radioiodinated (I131 and I125) Fibrinogen for the Detection of Malignant Tumours in Man

    International Nuclear Information System (INIS)

    A high fibrin content has been shown in a large number of malignant tumours, both experimental and human; this finding has been referred to the high thromboplastin content within the tumour, inducing the polymerization of fibrinogen into fibrin. On the basis of these data, human fibrinogen labelled with I131 and I125 has been tested as a possible agent for detecting malignant tumours in man. The uptake of radioiodinate fibrinogen has been studied in malignant and benign tumours, as well as non-neoplastic space-occupying lesions. Seventy-three cases have been so far examined; 53 of these were represented by malignant tumours localized in the skeleton, lungs, brain, abdominal organs etc. The I131- fibrinogen uptake test gave correct results in 79% of the cases examined; no false positive results were obtained in the whole series. The technique and the results are briefly discussed. From the data obtained, it seems that fibrinogen-I131 may be usefully applied for the early detection of malignancies in man; possible improvements of the detection technique may markedly increase the diagnostic value of the method. (author)

  20. Chemical Process for Treatment of Tellurium and Chromium Liquid Waste from I-131 Radioisotope Production

    International Nuclear Information System (INIS)

    The I-131 radioisotope is used in nuclear medicine for diagnosis and therapy. The I-131 radioisotope is produced by wet distillation at Bandung Nuclear Research Center and generated about 4,875 Itr of liquid waste containing 2,532.8 ppm of tellurium and 1,451.8 ppm chromium at pH 1. Considering its negative impact to the environment caused by toxic behaviour of tellurium and chromium, it is necessary to treat chemically that's liquid waste. The research of chemical treatment of tellurium and chromium liquid waste from I-131 radioisotope production has been done. The steps of process are involved of neutralisation with NaOH, coagulation-flocculation process for step I using Ca(OH)2 coagulant for precipitation of sulphate, sulphite, oxalic, chrome Cr3+, and coagulation-flocculation process for step II using BaCI2 coagulant for precipitation of chrome Cr6+ and tellurium from the supernatant of coagulation in step I. The best result of experiment was achieved at 0.0161 ppm of chromium concentration on the supernatant from coagulation-flocculation of step I using 3.5 g Ca(OH)2 for 100 ml of liquid waste, and 0.95 ppm of tellurium concentration on the final supernatant from coagulation-flocculation by of step II using 0.7 g BaCI2 for supernatant from coagulation of step I. (author)

  1. Recurrence of pheochromocytoma in 11 years old school child, diagnosed by I-131 MIBG

    International Nuclear Information System (INIS)

    Pheocromocytoma is a paraganglioma with an incidence of arterial hypertension approximately of 1%,but its diagnosis has several important issues from the clinical point of view. 1-The tumor resection frequently cure the hypertension. 2.-Its manifestations might simulates other diseases like carcinoid Sx, hypertiroidism,etc. 3.-It is a familiar disease transmitted by an autosomic dominant way. It is 10% bilateral,10%extraadrenal,10% occur in children and 10% are malignant. We present a case of pheochromocytoma recurrency in a young girl,11 y.o. operated 8 months before, at the Clinical Hospital, National University of Paraguay, School of Medicine for a right suprarenal gland pheochromocytoma of 2cms of diameter, who consults the Pediatric Department for arterial hypertension and cefalea. She also had a Von Hippel Sx and Glaucoma. Nuclear Medicine is a non invasive method that use the I-131 Methayodobencylguanidine(MIBG-I-131) with high accuracy to diagnose and treat both neuroblastoma and pheochromocytoma I-131 MIBG is the gold standard for the diagnosis of both entities with a sensitivity between 94-100%6-7 and specificity of 100% being the best method to evaluate these diseases in the pre and post operatory (Au)

  2. Radiation exposure to nuclear medicine technologists from administering I-131 therapy dosages

    International Nuclear Information System (INIS)

    Full text: Therapeutic doses of I-131 for treatment of thyroid cancer are administered orally in liquid or capsule form. During the last few years, a total number of patients loaded in our isolation ward increased from 4 to 10 patients per week. When considering radiation safety precautions for attending technologists, it is preferable to use the dose in capsules. The purpose of this study is to compare radiation exposure to nuclear medicine technologists from administering I-131 therapy dosages in capsules and in liquid form in a closed system. Materials and Methods: Three year radiation exposure to technologists during I-131 administration was analyzed. From January 2004 to June 2005 dose administration was in liquid form (n=263) and from July 2005 to February 2007 in capsules (n=541). Radiation dose assessment was performed with an electronic personal dosimeter (PDM 112). The dose rate in μSv and time spent per patient were recorded. Results: Dose received per patient when I-131 was given in a liquid was 3.50 ± 1.67 μSv and 1.17 ± 0.66 μSv when given in capsules. Compared with the use of a liquid, capsules significantly reduced radiation dose to technologists by 66% (P < 0.001). These doses received depended not only on the administered activity but also on the time, distance and shielding. Time spent per patient, including a brief visit before the time of dosing to explain the procedure and answer questions was reduced slightly from 4.4 ± 2.2 to 3.7 ± 1.8 minutes (P < 0.01). These correspond to a reduction in a yearly dose to 1 technologist by 40%, from 0.63 mSv to 0.38 mSv from dosing to 175 and 325 patients respectively. Conclusions: The measured doses clearly showed that handling of I-131 therapy dosages either in a liquid form or capsules are not the major contributors to the technologist's radiation exposure in routine clinical practice. However, one has to be cautious and follow good work practice to avoid risk of radiation exposure and radioiodine

  3. The false-positive radioiodine I-131 uptake in the foreign body granuloma located in gluteal adipose tissue

    International Nuclear Information System (INIS)

    The purpose of using a whole-body scanning after the radioactive I-131 treatment is to screen functional residual or metastatic thyroid tissues. In whole-body scanning of some patients, false positive radioiodine I-131 uptakes may be seen in physiological uptake regions or atypical localizations. A 54 year-old woman underwent total thyroidectomy for papillary thyroid carcinoma. A positive appearance seen in the upper postero-lateral part of the right gluteal region was determined by a post-therapy I-131 whole body scan. The colour Doppler ultrasonography, magnetic resonance imaging features and histopathological characteristics of the excised lesion were presented. The lesion was demonstrated to be a foreign body granuloma. Unexpected positive findings in the post-therapy I-131 whole body scan should be confirmed with other imaging modalities in order to avoid unnecessary treatments. In uncertain situations, the diagnosis should be established histopathologically

  4. Radioiodine Contamination Artifacts and Unusual Patterns of Accumulation in Whole-body I-131 Imaging: A Case Series

    OpenAIRE

    Ozcan Kara, Pelin; Gunay, Emel Ceylan; Erdogan, Alihan

    2014-01-01

    Introduction: Radioactive iodine has been used for more than 50 years for the treatment of thyroid diseases. Differentiated thyroid cancers have the ability to trap iodine. Therefore, radioiodine can be used both diagnostically and therapeutically. In the follow-up of patients, it is critical to interpret radioiodine scans correctly. Case Presentation: Non-physiological Iodine-131 (I-131) extra-thyroidal uptake detected on post-therapy or diagnostic I-131 scanning are not always interpreted a...

  5. Dosimetry study of [I-131] and [I-125]- meta-iodobenz guanidine in a simulating model for neuroblastoma metastasis.

    Science.gov (United States)

    Roa, W H; Yaremko, B; McEwan, A; Amanie, J; Yee, D; Cho, J; McQuarrie, S; Riauka, T; Sloboda, R; Wiebe, L; Loebenberg, R; Janicki, C

    2013-02-01

    The physical properties of I-131 may be suboptimal for the delivery of therapeutic radiation to bone marrow metastases, which are common in the natural history of neuroblastoma. In vitro and preliminary clinical studies have implied improved efficacy of I-125 relative to I-131 in certain clinical situations, although areas of uncertainty remain regarding intratumoral dosimetry. This prompted our study using human neuroblastoma multicellular spheroids as a model of metastasis. 3D dose calculations were made using voxel-based Medical Internal Radiation Dosimetry (MIRD) and dose-point-kernel (DPK) techniques. Dose distributions for I-131 and I-125 labeled mIBG were calculated for spheroids (metastases) of various sizes from 0.01 cm to 3 cm diameter, and the relative dose delivered to the tumors was compared for the same limiting dose to the bone marrow. Based on the same data, arguments were advanced based upon the principles of tumor control probability (TCP) to emphasize the potential theoretical utility of I-125 over I-131 in specific clinical situations. I-125-mIBG can deliver a higher and more uniform dose to tumors compared to I-131 mIBG without increasing the dose to the bone marrow. Depending on the tumor size and biological half-life, the relative dose to tumors of less than 1 mm diameter can increase several-fold. TCP calculations indicate that tumor control increases with increasing administered activity, and that I-125 is more effective than I-131 for tumor diameters of 0.01 cm or less. This study suggests that I-125-mIBG is dosimetrically superior to I-131-mIBG therapy for small bone marrow metastases from neuroblastoma. It is logical to consider adding I-125-mIBG to I-131-mIBG in multi-modality therapy as these two isotopes could be complementary in terms of their cumulative dosimetry. PMID:22974332

  6. Control system of liquid effluents generated in treatment with I-131

    International Nuclear Information System (INIS)

    In recent years, nuclear medicine has developed greatly in our country and around the world. Techniques for both medical diagnosis and therapy have increased the use of radiopharmaceuticals, notably the I-131. In Mexico there are around 150 nuclear medicine establishments authorized by the Comision Nacional de Seguridad Nuclear y Salvaguardias. Most of these establishments do not have an appropriate facility for the treatment of radioactive liquid effluents, to ensure compliance with the concentration limits established in the regulations. The Instituto Nacional de Investigaciones Nucleares (ININ) developed and implemented successfully, a control system of radioactive effluents (named SACEL) from a nuclear medicine facility. This system ensures an effective compliance with regulations and also better management and control of these radioactive effluents. Calculations and design of SACEL were made with respect to I-131, because is one of the most commonly used in radiotherapy and medical diagnostics, besides its half-life is greater in relation to other radionuclides. SACEL is comprised of four storage tanks and decay and a fifth tank for measuring the concentration of I-131 and later discharge to the drain; these tanks are connected to an automated system that controls the effluents passage. The calculation to determine the volume of the tanks was carried out according to the demand that has the hospital, to the maximum activity being poured in effluents and time required to decay. In this paper the design and installation of SACEL system, in addition to functioning as a facility that enables the Hospital meet the required standards is presented. Dose calculations performed with MCNPX and the methodology used in the calibration of the detection system is also presented. (Author)

  7. Unusual Fatal Effect of Radioiodine (I-131) Therapy : A Case Report

    International Nuclear Information System (INIS)

    The aim of radioiodine therapy following surgery for thyroid carcinoma is to ablate the remnant thyroid tissue in the neck by delivering a minimum dose of 300 gray to the residual thyroid tissue. Side-effects are usually minimal and transient, and use of rhTSH can reduce their incidence. In patients with functioning metastases, successive doses of radio iodine are administered until complete ablation of metastatic disease is achieved. A 54-year-old woman with diffuse pulmonary metastases from thyroid cancer died from a fatal sudden alveolar haemorrhage that occurred 3 weeks after radioiodine therapy. Post mortem biopsy of specimens taken from the sites of pulmonary metastasis revealed massive haemorrhage and apoptosis. It is known that in vitro, beta-irradiation can activate apoptosis pathways. This effect seems to depend on dose of radioiodine and time point. In humans, I-131 therapy can induce apoptosis in hyper-functioning thyroid tissue. This effect is dependent on iodine concentration which is dependent on NIS expression itself. A sudden wave of apoptosis occurring 3 weeks after radioiodine dose could be lethal. On the other hand in order to have favourable treatment response it is essential to have high I-131 uptake by pulmonary metastases. Although fatal effect of radioiodine therapy are rare, this particular case suggests that a high level of I-131 concentration in critical organs detected by post-therapy whole-body scan (WBS) should be an indication for imposing particular care in the management of such patients, and perhaps consideration for prolonged hospitalization and late discharge. (author)

  8. Low radiation dose to relatives after discharge of thyroid cancer patients treated with I-131

    Energy Technology Data Exchange (ETDEWEB)

    Remy, H.; Camps, E. [Pharmacy, Institut de Cancerologie Gustave Roussy, Villejuif (France); Ricard, M.; Lavielle, F.; Coulot, J. [Medical Physics, Institut de Cancerologie Gustave Roussy, Villejuif (France); Borget, I. [Health Economics, Institut de Cancerologie Gustave Roussy, Villejuif (France); Schhumberger, M. [Nuclear Medicine, Institut de Cancerologie Gustave Roussy, Villejuif (France); University Paris-sud, Bicetre (France)

    2012-07-01

    Patients treated with I-131 for thyroid carcinoma are potential source of radiation exposure for other individuals. In order to provide more reliable information to patients and relatives, this study evaluated the radiation dose received by family members after discharge from the hospital. Three main observations can be drawn. First, rhTSH (recombinant human Thyrotropin) stimulation leads to lower irradiation when mean rate is considered (cumulated irradiation divided by time contact) 1.4 {mu}Sv per hour compared to 1.6 {mu}Sv with withdrawal. However, this had no impact on the radiation dose received by relatives, because of a longer time spent close to the patient when rhTSH is used. Secondly, the mean cumulated radiation dose delivered to the relatives during the 7 days following discharge was similar with either rhTSH (58 {mu}Sv) or withdrawal patients (49.6 {mu}Sv). Thirdly, in euthyroid patients after rhTSH, the whole body retention of I-131 after three days of hospitalization is significantly lower than in hypothyroid patients after withdrawal. The hospital stay can be shortened when rhTSH is used

  9. Modeling High Energy (I-131) Pinhole Collimator for Small Animal Gamma Camera by Monte Carlo Simulation

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Young Jun; Kim, Kyeong Min; Kim, Jin Su; Park, Ji Ae; Lee, Young Sub; Yoo, A-ram; Kim, Jong Guk [Korea Institute of Radiologic and Medical Sciences, Seoul (Korea, Republic of); Lee, Hak Jae; Lee, Ki Sung [Korea University, Seoul (Korea, Republic of)

    2011-05-15

    In medical nuclear imaging, I-131 takes important role in not only the diagnostic image, but also the quantitative evaluation in nuclear medicine therapy. However, due to the relatively high energy peak of I-131[364 keV (82 %), 326 keV (0.27 %), 503 keV (0.36 %), 637 keV (7.18 %), 643 keV (0.22 %), 723 keV (1.77 %)], it is difficult to construct high resolution, high sensitivity preclinical gamma camera. Especially, 637 keV, 723 keV energy, penetration and scattering occur in relatively high possibility. In this manner, penetration and scattering of high energy gamma ray in collimator degrades image quality fatally. According to the characteristics, it is essential to design collimator which can minimize the degrading factor, and preserve the gamma ray for imaging at the same time. In this study, we designed and simulated the structure of pinhole collimator for a small animal high energy gamma camera by Monte Carlo simulation (GATE 6.0). In this model, the diameter, channel length of pinhole and the thickness of collimator are the main issue for determining the system sensitivity. Thus, in this study, we observed the difference in the number of photons on the scintillator which pass through the collimator that determined by those three factors

  10. Feasibility analysis of I-131 production in the Moroccan TRIGA research reactor

    International Nuclear Information System (INIS)

    Highlights: • A feasibility analysis for I-131 production at the Moroccan TRIGA MARK II research reactor was conducted. • Two production scenarios were discussed with several TeO2 target masses. • The MCNPX v2.7 computer code with its depletion capabilities was used. • A production activity of about 4.63 Ci per 80 MWh irradiation period is obtained. - Abstract: Since the commissioning of the Moroccan 2 MW TRIGA MARK II research reactor hosted by the Centre National de l’Energie des Sciences et des Techniques Nucléaires (CNESTEN), the latter institution has established a radioisotope production program to supply radiopharmaceuticals for use in nuclear medicine. This paper presents a feasibility analysis for I-131 production using two in-core irradiation positions within the Moroccan TRIGA MARK II research reactor. The MCNPX v2.7 code, with its depletion capabilities, was used for the evaluation of two different production scenarios using several masses of TeO2 target samples. The maximum achievable activities were found to be 3.90 Ci/week for scenario 1 and 4.63 Ci/week for scenario 2. Thermal analysis shows that safety limits of capsules used for these experiments were not violated

  11. Internal Dosimetry Of I-131 For Radiation Workers Based On Analysis Of The Human Urine And Liquid Scintillation Counting

    International Nuclear Information System (INIS)

    Internal dosimetry of I-131 for radiation workers based on analysis of the human urine, measuring radioactivity by the liquid scintillation system, and dose calculation by the specialized code has been firstly studied at the Nuclear Research Institute. Urine samples from the subjects internally contaminated with I-131 through respiratory ways were collected, chemically processed, measured beta radioactivities of I-131 by the liquid scintillation system of ALOKA-LSC-6100, and then thyroid doses and effective ones for whole-body were calculated by using the specialized code of LUDEP 2.0. Based on chemically separation procedure for I-131 in urine samples and the low background HPGe gamma spectrometer of Canberra for measuring radioactivity, efficiency for chemical separation was determined to be (86.1 ± 5.0)%. The experimental results for 9 subjects with urine samples to be collected during 4 operating courses of Dalat nuclear reactor with production of I-131 (from June to September, 2010) were shown that thyroid doses and effective ones for whole-body for each course of I-131 production were in ranges of from 0.11 to 13.00 mSv and from 0.01 to 0.71 mSv, respectively. Therefore, totally average doses per year for thyroid and whole-body were less than the correlative levels of permissible doses. Besides, the liquid scintillation method was also compared experimentally with the gamma spectrometry (measuring directly urine samples by the gamma spectrometer to be carried out at the Institute before) was shown that errors on dosimetric results between them were less than 12%. This was proved the dosimetry has had a confidence, and it could be applied for internal dosimetry for radiation workers contacting with unsealed sources of I-131 in radiation installations as well as for diagnostic and therapeutic patients in health ones. (author)

  12. A new method for the preparation of I131-labelled p-iodo-benzenesulphonic acid anhydride (pipsan)

    International Nuclear Information System (INIS)

    I131-labelled pipsan may be used, together with S35-labelled pipsan, in a double-isotope-derivation technique for the analytical determination of various steroids. The preparation of high-specific-activity I131-pipsan involves serious health hazards due to the γ-radiation of I131, and a shielded cell with remote-handling equipment has to be used. Earlier methods, in which I131 is introduced in diazo-benzenesulphonic acid, involve many steps with purification of the intermediary products and necessitate rather complicated equipment. By the introduction of I131 in diazo-benzene and by sulphonation of the labelled iodobenzene with oleum, labelled pipsan is obtained directly. This method has proved feasible for remote handling in a shielded cell. The procedure is based on recent Russian papers. Chemical aspects of the procedure are briefly discussed. Descriptions are given of some of the equipment used in the remote handling, e.g. : a micro steam-distillation apparatus for the preparation of iodobenzene, and a rotating Perspex pipetting station used for the addition of washing liquids, for air-propagation and for removal of supernatants. (author)

  13. Renal clearance and extraction parameters of ortho-iodohippurate (I-123) compared with OIH(I-131) and PAH

    International Nuclear Information System (INIS)

    0-[131I]iodohippurate [OIH(I-131)] has been used for many years in the estimation of effective renal plasma flow. This compound suffers from low photon yield and poor images when the quantity used is limited to stay within a reasonable radiation dose. To test the validity of substituting I-123 for I-131, a series of experiments was performed in a surgically prepared dog model. The extraction ratios and clearance values 0IH(I-123) prepared from radionuclidically pure I-123 were compared with those of commercial OIH(I-131) and PAH. The extraction ratios for OIH(I-123) and OIH(I-131) were 0.65 and 0.67, representing 0.86 and 0.88 that of PAH, respectively. The clearance values (cc/min/kg) for the I-123 and I-131 compounds were almost identical (P = 0.77). Therefore OIH(I-123) can be used to estimate effective renal plasma flow; moreover, because of the high yield within an acceptable radiation dose range, images of good quality can be produced

  14. Labelling of meta-iodobenzylguanidine with iodine-131 (I-131-MIBG) for adrenal gland diagnosis

    International Nuclear Information System (INIS)

    Labelling of meta-iodobenzylguanidine with iodine-131 (I-131 MIBG, for adrenal gland diagnosis has been studied. The MIBG was synthesized from the reaction of meta-iodobenzylamine hydrochloride with cyanamide and labelled with iodine-131 by isotope exchange method using copper(II) as a catalyst. The percentage of labelling was about 98%, with a specific activity of 1.5-2.0 mCi/mg. The radiochemical purity was found to be greater than 99%. Biodistribution studies were performed on mice, the results showed great affinity for the adrenal gland uptake with highest radioactivity after 1 day of injection. The stability of the product with 1% benzyl alcohol was 7 days upon storing at 40C

  15. Accuracy and pitfalls of I-131-β-iodomethylnorcholesterol (NP-59) scintigraphy

    International Nuclear Information System (INIS)

    This paper reports a rigorous assessment of I-131 β-iodomethylnorcholesterol (NP-59) adrenal scintigraphy performed in 108 consecutive cases (1982-1985) with correlative clinical, biochemical, radiographic, and pathologic data. Accuracy ranged from 71% in primary aldosteronism and 75% in euadrenal tumors to 100% in cases of Cushing syndrome and hyperandrogenism. More than in most nuclear medicine studies, the accuracy of NP-59 image interpretation requires the fulfillment of clear clinical, biochemical, and radiographic criteria, such as those the authors have defined. High image interpretation reproducibility was demonstrated by the exchange of 20 random cases, with another institution. Responses of 85 of 126 institutions to questionnaires revealed the high safety level of this radiopharmaceutical

  16. Fetal radiation dose estimates for I-131 sodium iodide in cases where conception occurs after administration

    Energy Technology Data Exchange (ETDEWEB)

    Sparks, R.B.; Stabin, M.G. [Oak Ridge Inst. for Science and Education, TN (United States)

    1999-01-01

    After administration of I-131 to the female patient, the possibility of radiation exposure of the embryo/fetus exists if the patient becomes pregnant while radioiodine remains in the body. Fetal radiation dose estimates for such cases were calculated. Doses were calculated for various maternal thyroid uptakes and time intervals between administration and conception, including euthyroid and hyperthyroid cases. The maximum fetal dose calculating was about 9.8E-03 mGy/MBq, which occurred with 100% maternal thyroid uptake and a 1 week interval between administration and conception. Placental crossover of the small amount of radioiodine remaining 90 days after conception was also considered. Such crossover could result in an additional fetal dose of 9.8E-05 mGy/MBq and a maximum fetal thyroid self dose of 3.5E-04 mGy/MBq.

  17. Medically-derived I-131: a potential tool for understanding the fate of wastewater nitrogen in aquatic systems

    Science.gov (United States)

    Rose, P. S.; Smith, J. P.; Aller, R. C.; Cochran, J. K.; Swanson, R. L.; Murthy, S. N.; Coffin, R. B.

    2010-12-01

    Iodine-131(t1/2 = 8 days) has been measured in Potomac River water and sediments in the vicinity of the Blue Plains Water Pollution Control Plant (WPCP), Washington, DC. The source of I-131 is medical, where it is commonly used to treat thyroid cancer and hyperthyroidism. Iodine is metabolized by patients and eliminated primarily in urine. While other medical radioisotopes may enter the environment via sewage effluent, the nature and quantity of treatments using I-131 cause it to account for much of the radioactivity in sewage effluent. Natural iodine in aquatic systems is biologically cycled similar to other nutrients, such as nitrogen. Iodine-131 concentrations measured in sewage effluent from Blue Plains WPCP and in the Potomac River suggest a relatively continuous discharge of this isotope. Dissolved I-131 shows a strong, positive correlation with δ15N values of nitrate in the river. The range of I-131 concentrations detected in surface waters is 0.18 ± 0.01 to 0.68 ± 0.02 Bq/L. Surface water δ15NO3 values ranged from 8.7 ± 0.3 to 33.4 ± 7.3 ‰ with NO3+NO2 concentrations between 0.38 ± 0.02 and 2.79 ± 0.13 mgN/L. Sediment profiles of particulate I-131 and δ15N indicate rapid mixing or sedimentation and in many cases remineralization of a heavy nitrogen source consistent with wastewater nitrogen. Iodine-131 concentrations in sediments ranged from 1.31 ± 0.8 to 117 ± 2 Bq/kg dry weight. Values of δ15N in sediments ranged from 4.7 ± 0.1 ‰ to 9.3 ± 0.1 ‰. We propose that I-131 coupled with δ15N can be an excellent tracer for the short-term fate of wastewater nitrogen in this system. However, the utility of I-131 as a tracer is not limited to use in the Potomac River. Other studies have documented the presence of I-131 in several aquatic systems and continuous discharges of this radioisotope in sewage effluent are likely to be widespread in urban environments.

  18. Radioimmunotheapy with [I-131]cG250 in patients with metastasized renal cell cancer : Dosimetric analysis and immunologic response

    NARCIS (Netherlands)

    Brouwers, AH; Buijs, WCAM; Mulders, PFA; de Mulder, PHM; van den Broek, WJM; Mala, C; Oosterwijk, E; Boerman, OC; Corstens, FHM; Oyen, WJG

    2005-01-01

    Purpose: A study was designed to define the therapeutic efficacy, safety, and toxicity of two sequential high-dose treatments of radioimmunotherapy with [I-131]cG250 in patients with metastasized renal cell carcinoma. Here, we report the dosimetric analysis and the relationship between the developme

  19. Implementation of iodine biokinetic model for interpreting I-131 contamination in breast milk after the Fukushima nuclear disaster

    Science.gov (United States)

    Tani, Kotaro; Kurihara, Osamu; Kim, Eunjoo; Yoshida, Satoshi; Sakai, Kazuo; Akashi, Makoto

    2015-07-01

    After the accident at the Fukushima Daiichi Nuclear Power Plant run by Tokyo Electric Power Company in 2011, breast milk samples obtained from volunteers living in Fukushima and neighboring prefectures were examined and small amounts of I-131 (2.2-36.3 Bq/kg) were detected in some samples. In this work, the I-131 concentrations in breast milk from nursing mothers in Ibaraki prefecture were calculated based on the iodine biokinetic model during lactation together with time-variable intake scenarios by inhalation of ambient air and ingestion of tap water, using the authors’ code. The calculated I-131 concentrations in breast milk generally agreed with those measured for the volunteers. Based on the results, thyroid equivalent doses to breast-fed infants were estimated for each place of residence of the volunteers on the assumption that these infants consumed 800 ml of breast milk every day, resulting in 10-11 mSv for Mito and Kasama cities and 1.1-1.8 mSv for Tsukuba and Moriya cities. It was suggested that breast milk consumption could be a major contributor to internal dose of breast-fed infants in areas with mild I-131 pollution; however, further studies considering personal behavior surveys would be necessary to estimate individual doses.

  20. Implications of mediastinal uptake of I-131 with regard to surgery in patients with differentiated thyroid carcinoma

    NARCIS (Netherlands)

    Haveman, JW; Phan, HTT; Links, TP; Jager, PL; Plukker, JTM

    2005-01-01

    BACKGROUND. Findings of mediastinal uptake of I-131 after surgical treatment for differentiated thyroid carcinoma (DTC) are common, especially in young patients. Given the frequency of false-positive findings, a protocol for diagnostic and their- apeutic strategies would be useful. With the goal of

  1. Quantitative uptake measurements of I-131 (364 keV) within the tomographic plane of a specially collimated SPECT system

    International Nuclear Information System (INIS)

    The use of SPECT for uptake measurements requires a linear relationship between the measured counts within a tomographic plane and its activity distribution. Many factors influence this relationship, and these include filter type and attenuation correction methods. However, for higher photon energy (I-131, 364 keV), photon penetration through the collimator or detector shielding may degrade, for example, the tomographic plane and slice thickness resolution and the ability to differentiate activity within a slice and between slices. A SPECT system (Picker International Dyna Camera), equipped with a specialized (low sensitivity) thick septa collimator for I-131 (364 keV) and 511 keV detector shielding is proposed for quantitative measurements. The influence of photon penetration was significantly reduced, with transverse plane and slice thickness resolution of 18 mm FWHM and 37 mm FWIM for a radius of rotation of 14 cm. Iodine collimators typically have FWTM 5-10 times the FWHM. A Jaszczak phantom was imaged with I-131, with two bar quadrants observed with diameters of 16 and 12.7 mm. The SPECT resolution data was equal to a low energy general purpose collimator. A multi-concentric ring (contrast) phantom was designed to quantitatively evaluate the SPECT system. A linear relationship was observed between the measured counts for a transverse plane and I-131 activity within the rings. Data suggest that with appropriate collimation and detector shielding SPECT systems may be used for quantitative measurements at higher photon energy

  2. Application of a medium-energy collimator for I-131 imaging after ablation treatment of differentiated thyroid cancer

    International Nuclear Information System (INIS)

    High-energy (HE) collimators are usually applied for I-131 imaging after ablation treatment of differentiated thyroid cancer (DTC). However, purchase of HE collimators has been avoided in many nuclear medicine departments because the HE collimators are more expensive than other collimators. In this study, we compared the I-131 imaging using HE- and medium-energy (ME) collimators, which is more versatile than HE collimators. To simulate DTC patients with extra-thyroid beds, a phantom of acrylic containers containing I-131 was used. To simulate patients with thyroid beds, four phantoms representing extra-thyroid beds were arranged around the phantom representing normal thyroid tissues. Patients administered 1.11 or 3.70 GBq NaI-131 were also evaluated. Whole-body imaging and SPECT imaging of the phantoms and patients performed using HE-general-purpose (HEGP) and ME-low-penetration (MELP) collimators, and full-width at half maximum (FWHM) and percent coefficient of variation (%CV) were measured. In the extra-thyroid beds, FWHM and %CV with MELP were negligibly different from those with HEGP in whole-body imaging. Although FWHM with MELP was a little different from that with HEGP in SPECT imaging, %CV with MELP was significantly higher than that with HEGP. In the thyroid beds, only an extra-thyroid bed including higher radioactivity was identified in whole-body imaging with both collimators. Although SPECT images with MELP could not clarify extra-thyroid beds with low radioactivity, HEGP could identify them. In patients, although some whole-body images with MELP could not detect extra-thyroid beds, whole-body imaging with HEGP and SPECT imaging with both collimators could detect them. Although HEGP is the best collimator for I-131 imaging, MELP is applicable for not only whole-body imaging but also SPECT imaging. (author)

  3. Risk from ionizing radiation to the clinical staff and incidental public in the course of therapy with I-131

    International Nuclear Information System (INIS)

    The aim of the study was to assess the risk to the personnel and neighbouring patients exposed to ionizing radiation during their stay at the Isotopic Therapy Clinic in Warsaw where therapeutic applications of I-131 are routinely performed. To this end, thermoluminescent dosimeters were deposited in various places throughout the Clinical ward and the absorbed doses were read after 125 days of the exposition. Additionally, exposure dose rates were determined at the skin surface over the thyroid gland at 0.5 and 1.0 m away from 71 patients treated with I-131 for hyperthyroidism or thyroid cancer (as a supplementary therapy after thyroidectomy) and the potential dose equivalents were calculated. From these values ''restriction times'', i.e., the amounts of time needed for the potential dose equivalents to decline below the limit recommended for occupational or public exposures to ionizing radiation were derived. The results indicate that - a) the probability to exceed the recommended annual dose limit by the personnel (50 mSv y-1) and neighbouring patients not subjected to radiotherapy (1 mSv y-1) during their exposition at the Isotopic Therapy Clinic to the I-131 treated patients is practically equal to zero; b) no restrictions in terms of limiting the duration of contact with the I-131-treated patients are necessary during the occupational exposures of the personnel of the Clinic; and c) the treated patients may incur some risk to the general public only when injected with high doses of I-131 and/or only within about 3 days upon the application of the radionuclide. (author)

  4. Estimation dose in organs of hyperthyroidism patients treated with I-131

    International Nuclear Information System (INIS)

    Full text: The absorbed dose in organs of hyperthyroidism patients, which received 370 MBq and 555 MBq of I-131 were estimated, using the MIRDOSE computational program and data of the ICRP-53 publication. The calculus were done considering an equal uptake to 45% and an effective half life of 5 days, these values are closed to the average values found in 17 studied patients. The thyroidal masses were previously determined by the physicians and varied between 40 g and 80 g The results showed that the dose in the thyroid, for an activity of 370 MBq, varied between 99 Gy and 49,5 Gy for the masses of 40 g and 80 g respectively. In the case of the administration of 555 MBq the patients had thyroidal masses between 60 g and 80 g and the doses varied between 99 Gy and 74,2 Gy, respectively. These values showed that the absorbed doses in thyroid are within limits expected for the hyperthyroidism therapy, which are of 506 Gy to 100 Gy. The 100 Gy dose would be exceeded, if the patients with thyroidal mass of 40 g had received a therapeutic dose of 555 MBq. The estimated media doses in others organs were relatively low, with inferior values of 0,1 Gy in kidneys, bone marrow and ovaries and of 0,19 Gy in stomach

  5. Empirical shielding design data for facilities administering I131 for thyroid carcinoma

    International Nuclear Information System (INIS)

    Retrospective review of the records for 434 post thyroidectomy patients receiving I131 therapy for thyroid carcinoma revealed approximately 75% of the patients were discharged within 48 hours and 90% within 72 hours. Criterion for discharge was an external radiation dose below 25 μSv/hr, measured at one metre anterior to the patient's neck. The time-averaged average dose rate at one metre anterior to the neck of a typical patient during the isolation period was 72 μSv/hr, with 90% of the patients below 82 μSv/hr. After correcting for the effects of patient size and scatter, the effective design dose rate from a patient in an isolation room treating two or three patients/week is 105 μSv.m2.hr-1, or 75 μSv.m2.hr-1 where only one patient is treated each week. Concrete is the most economical shielding material, with 190 mm filled concrete block walls and 150+mm concrete floors as the minimum recommended shielding for a radioiodine therapy suite. Additional shielding will be required if the suite adjoins (including areas immediately above and below) areas with a high occupancy factor. Copyright (1998) Australasian Physical and Engineering Sciences in Medicine

  6. Long-term efficacy of current thyroid prophylaxis and future perspectives on thyroid protection during I-131-metaiodobenzylguanidine treatment in children with neuroblastoma

    NARCIS (Netherlands)

    Clement, S. C.; van Rijn, R. R.; van Eck-Smit, B. L. E.; van Trotsenburg, A. S. P.; Caron, H. N.; Tytgat, G. A. M.; van Santen, H. M.

    2015-01-01

    Purpose Treatment with I-131-MIBG is associated with significant thyroid damage. This study was undertaken to investigate the long-term efficacy of current thyroid prophylaxis, to explore the relationship between thyroid dysfunction and thyroid volume after exposure to I-131-MIBG and to evaluate the

  7. Evaluation of absorbed dose in studies of renal function due to 123I/131I (hippuran) e 111In (DPTA)

    International Nuclear Information System (INIS)

    The absorbed dose of the kidneys during renal function studies of adult patients is estimated through biokinetics of radiopharmaceuticals containing the 123I/131I (hippuran) e 111In (DPTA). Using the methodology MIRD and representation Cristy-Eckerman for adult kidneys, it is shown that dosimetric contributions of organs of biokinetics 123I/131I (hippuran) e 111In (DPTA) are significant, in estimative of dose for renal function studies. Dosimetric contributions (body and whole bladder, kidneys excluding) are given by 11.90% (for 123I), 4.97% (for 131I) and 28.32% (for 111In). In all cases, the dosimetric contributions are mainly due to photons issued by the whole body

  8. Role of trophallaxis in the dispersal of radioactive I131 and of bacterial infections in the termite, Bifiditermes beesoni

    International Nuclear Information System (INIS)

    Dispersal and localisation of radioactive iodine (I131) through trophallaxis was studied in various organs of healthy or bacteria-infected pseudergates of Bifiditermes beesoni. The breakdown of the defence system by bacterial pathogens was also studied by means of I131. Individual groups of pseudergates of B. beesoni were infected by various bacterial pathogens, i.e. Thuricide-HP (commercial preparation of Bacillus thuringiensis), B. thuringiensis 11-toumanoffi, B. thuringiensis serotype 3a, 3b, Pseudomonas fluorescens and Serratia marcescens, respectively. Healthy pseudergates retained more radioactivity in their guts and less in their exoskeletons. However, bacteria-infected 'donor' and 'recipient' pseudergates and soldiers retained less radioactivity in their guts and more in their exoskeletons. The flow of radioactivity from gut towards exoskeleton or other parts of B. beesoni pseudergates occurred after destruction and breakdown of the inestinal defence system of the host. (orig.)

  9. Guide for the putting int practice the control of internal contamination due to I-131 in hospitals

    International Nuclear Information System (INIS)

    The generalized use of radioactive installations in different branches of the Economy and Medicine makes essential the existence of a radiological surveillance systems that guarantees that exposure are kept within the limits established. Nuclear medicine workers in hospitals that handle I-131 constitutes a professional group that can be internally contaminated the aim of this guide is to give the entity the general instructions and the necessary methodology to fulfill the control of the internal contamination by this radionuclide

  10. Significance of I-131 norcholesterol scintigraphy for diagnosis of adrenal dysfunction; Stellenwert der Nebennierenrindenszintigraphie bei der diagnostik adrenaler Funktionsstoerungen

    Energy Technology Data Exchange (ETDEWEB)

    Kampen, W.U. [Klinik fuer Nuklearmedizin, Universitaetsklinikum Schleswig-Holstein, Kiel (Germany)

    2003-03-01

    Scintigraphic imaging of adrenocortical function using I-131-norcholesterol (or Se-75-norcholesterol) should be used as a complementary method to morphological imaging procedures like CT-scanning or ultrasound in case of primary hyperaldosteronism or hypercortisolism or if an androgen-producing tumor is suspected. I-131-norcholesterol is especially useful for functional evaluation of equivocal adrenal masses found incidentally. However, due to a high radiation load, a strict indication is required. The technique of selective cathederization of the adrenal veins with consecutive serum hormone analysis is characterized by higher accuracy but is also technically demanding, invasive and carries the risk of severe vascular complications. (orig.) [German] Die Nebennierenrindenszintigraphie mit I-131-Norcholesterol (oder Se-75-Norcholesterol) ist bei der Diagnostik primaerer Formen von Hyperaldosteronismus oder Hypercortisolismus sowie bei Verdacht auf Androgen-produzierende Tumoren als funktionsorientiertes Verfahren komplementaer zur rein morphologischbildgebenden Diagnostik anzuwenden. Insbesondere bei der seitengetrennten Aktivitaetsabklaerung adrenaler Raumforderungen stellt die NNR-Szintigraphie ein hochsensitives und spezifisches Verfahren dar. Angesichts einer hohen Strahlenbelastung ist jedoch eine strenge Indikationsstellung zu fordern. Die Methode der seitengetrennten Hormonbestimmung in den adrenalen Venen zeigt eine hoehere Genauigkeit, ist aber im Vergleich zur Szintigraphie deutlich aufwendiger, invasiv und beinhaltet das Risiko schwerwiegender, vor allem vaskulaerer Komplikationen. (orig.)

  11. Long-term follow-up study of I-131 therapy for Graves' disease; Index associated with late-onset hypothyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Kusakabe, Kiyoko; Nakano, Keiko; Maki, Masako (Tokyo Women' s Medical Coll. (Japan)) (and others)

    1990-04-01

    We have studied the follow-up of thyroid function in the patients with late-onset hypothyroidism and euthyroidism after I-131 therapy of hyperthyroidism. Thirty three patients who did not need the thyroid treatment until ten years after I-131 therapy were classified as euthyroid group. And eleven patients who needed the thyroid supplement of thyroid hormone for late-onset hypothyroidism were classified as hypothyroid group. Patients in both groups who required only a single dose of I-131 for successful treatment of hyperthyroidism had similar age, gland size, 24 hour I-131 uptake, pretreatment serum T{sub 3} uptake level and T{sub 4} concentration, and I-131 treatment dose. Subclinical hypothyroidism occurred in 28.6% of euthyroid group and 66.7% of hypothyroid group four months after I-131 therapy. The levels of T{sub 3} were recovered to higher than normal range at 6 months in euthyroid group, while the levels of T{sub 3} were kept within the normal range in the seventy percent of hypothyroid group. Patients who were still lower in the level of T{sub 3} uptake than normal range at 6 months had a higher incidence of late-onset hypothyroidism. Our observation showed no significant difference in the course of follow-up studies after I-131 therapy between the patients with late-onset hypothyroidism and euthyroidism. (author).

  12. Rituximab for autoimmune blistering diseases: recent studies, new insights

    OpenAIRE

    Lunardon, Luisa; Payne, Aimee S.

    2012-01-01

    Rituximab, an anti-CD20 monoclonal antibody, has been successfully used off-label for treatment of autoimmune blistering diseases. We discuss rituximab mechanisms of action, host factors that may affect response to rituximab, and the efficacy and safety of rituximab in autoimmune blistering diseases, incorporating recent data on the use of rituximab in other autoimmune disease patients.

  13. Filter hurra: a method simple for delete artifacts of the collimator in picture planar with I-131; Filtro Hurra: un metodo sencillo para eliminar artefactos del colimador en imagen planar con I-131

    Energy Technology Data Exchange (ETDEWEB)

    Perez Garcia, H.; Barquero Sanz, R.; Cardenas Solano, A.

    2015-07-01

    This paper presents an analysis of the existing noise is performed on images taken by a gamma camera with high-energy collimator HE for I-131. Using the Fourier transform, dominant spatial frequencies shown in the picture next to white noise. It is demonstrated by these frequencies geometry They correspond to the spatial periodicity of the collimator itself. Finally, the use of a frequency filter that eliminates image artifacts that causes collimator, thus obtaining a cleaner image, in which to determine the FWHM and thus the size of the uptake is proposed. (Author)

  14. Diagnostic capabilities of I-131, TI-201, and Tc-99m-MIBI scintigraphy for metastatic differentiated thyroid carcinoma after total thyroidectomy.

    Directory of Open Access Journals (Sweden)

    Fujie,Shunji

    2005-06-01

    Full Text Available

    We investigated the diagnostic capabilities of I-131, Tl-201, and Tc-99m-MIBI (hexakis-2-methoxyisobutyl- isonitrile scintigraphy for thyroid cancer metastases after total thyroidectomy over the entire body and for every locus before and after thyroid bed ablation. After total thyroidectomy of thyroid cancer, 36 cases were subjected to I-131 treatment 64 times. They consisted of 17 men and 19 women with 31 papillary carcinomas and 5 follicular carcinomas. Their ages were 22--75(an average of 60.5+/-12.3 years. I-131 scintigraphy(I-131, Tl-201 scintigraphy(Tl-201, and Tc-99m- MIBI scintigraphy (Tc-99m-MIBI were performed. We defined the metastases as those cases in which serum thyroglobulin (Tgincreased significantly or in which we were able to prove the lesions on CT (computed tomography, MRI (magnetic resonance imaging or bone scintigram. Three radiology medical specialists visually evaluated each scintigram and calculated the sensitivity, specificity, and likelihood ratio. For whole-body sensitivity, both Tl-201 and Tc-99m-MIBI were high before ablation and I-131 was high after ablation. Before ablation, the negative likelihood ratio was less than 0.1 for Tl-201 and Tc-99m-MIBI, while the positive likelihood ratio was more than 10 for Tl-201. After ablation, the positive likelihood ratio for I-131, Tl-201, and Tc-99m-MIBI was more than 10. The sensitivity of the mediastinum was appropriate, except for I-131 before ablation, and the sensitivity of the lung before and after ablation was inferior for either tracer. The specificity of the cervix for I-131 before ablation was markedly deteriorated, but it increased after ablation.

  15. Fallout and drinking water contamination by I-131 and Cs-134, 137 in Japan, from the Fukushima Daiichi NPS accident

    Energy Technology Data Exchange (ETDEWEB)

    Kelecom, Alphonse; Miyashita, Erika; Kelecom, Patrick Vicent [Universidade Federal Fluminense (UFF), Niteroi, RJ (Brazil)

    2011-07-01

    The earthquake followed by a tsunami in Japan, on last March 11, seriously damaged four of the six reactors of the Fukushima Daiichi nuclear power station (NPS). Radioactive smokes and highly contaminated water were released for weeks to the environment. Since March 12, when the plant operator TEPCO and Japan's nuclear agency (NISA) confirmed the presence of radionuclides near the NPS, a giant environmental monitoring operation was set up, covering the entire Japanese territory. Daily thousands measurements are realized. We here analyze data released during 60 days on I-131 and Cs-134,137 radioactive concentrations in drinking water and fallout for 45 prefectures. Miyagi and Fukushima, that requires a separate study, are not considered here. Drinking water contamination by I-131 was observed in 13 prefectures, including Tokyo. The most impacted one was Tochigi (maximum of 110 Bq/l, March 24). This value turned water not drinkable for infants and babies. Cs-137 was detected in drinking water in 8 prefectures, with a maximum level of 18 Bq/l in Ibaraki. These levels do not affect potability of tap water. I-131 was observed in fallout in 27 prefectures, with level reaching 93 kBq/m2 in Ibaraki and 36 kBq/m{sup 2} in Tokyo on March 21 and 23 respectively. Fallout of Cs-137 was observed in 19 prefectures. The maximum deposition occurred again in Ibaraki (13kBq/m{sup 2}, March 21) and in Tokyo (5.3 kBq/m2, March 22). Since mid April, only trace contamination has been observed for both radionuclides in drinking water. Sporadically medium levels of Cs-137 are still observed in fallout. (author)

  16. A Quantitative Evaluation of Hepatic Uptake on I-131 Whole-Body Scintigraphy for Postablative Therapy of Thyroid Carcinoma.

    Science.gov (United States)

    Nakayama, Michihiro; Okizaki, Atsutaka; Sakaguchi, Miki; Ishitoya, Shunta; Uno, Takahiro; Sato, Junichi; Takahashi, Koji

    2015-07-01

    This study aimed to determine clinical association between quantitative hepatic uptake on postablative whole-body scan (WBS) with differentiated thyroid cancer (DTC) prognosis. We analyzed 541 scans of 216 DTC patients who were divided into 3 groups based on radioactive iodine (I-131) WBS uptake and clinical follow-up: group 1 (completion of ablation), group 2 (abnormal uptake in the cervical region), and group 3 (abnormal uptake with distant metastases). For each group, we calculated the ratio of I-131 WBS hepatic uptake (H) to cranial uptake as background (B); this ratio was defined as H/B. Furthermore, we made a distinction between group 1, as having completed radioactive iodine therapy (RIT) (CR), and group 2 and 3, as requiring subsequent RIT (RR). The average H/B scores were 1.34 (median, 1.36; range 1.00-2.1) for group 1; 1.89 (median, 1.75; range 1.41-4.20) for group 2; and 2.09 (median, 1.90; range 1.50-4.32) for group 3. Bonferroni multiple comparisons revealed significant differences in H/B among these groups. The H/B of group 1 was significantly smaller than that of other 2 groups (P < 0.0001). The precise cutoff value of H/B for therapeutic effect was ≤1.5. Moreover, 159 of 160 scans in the CR and 375 of 381 patients in the RR were correctly diagnosed using this cutoff value in the final outcome of RIT, yielding a sensitivity, specificity, positive predictive value, and negative predictive value of 99.4%, 98.4%, 99.7%, and 96.3%, respectively. Increased hepatic uptake of I-131 on WBS may predict disease-related progression. PMID:26181567

  17. A Quantitative Evaluation of Hepatic Uptake on I-131 Whole-Body Scintigraphy for Postablative Therapy of Thyroid Carcinoma.

    Science.gov (United States)

    Nakayama, Michihiro; Okizaki, Atsutaka; Sakaguchi, Miki; Ishitoya, Shunta; Uno, Takahiro; Sato, Junichi; Takahashi, Koji

    2015-07-01

    This study aimed to determine clinical association between quantitative hepatic uptake on postablative whole-body scan (WBS) with differentiated thyroid cancer (DTC) prognosis. We analyzed 541 scans of 216 DTC patients who were divided into 3 groups based on radioactive iodine (I-131) WBS uptake and clinical follow-up: group 1 (completion of ablation), group 2 (abnormal uptake in the cervical region), and group 3 (abnormal uptake with distant metastases). For each group, we calculated the ratio of I-131 WBS hepatic uptake (H) to cranial uptake as background (B); this ratio was defined as H/B. Furthermore, we made a distinction between group 1, as having completed radioactive iodine therapy (RIT) (CR), and group 2 and 3, as requiring subsequent RIT (RR). The average H/B scores were 1.34 (median, 1.36; range 1.00-2.1) for group 1; 1.89 (median, 1.75; range 1.41-4.20) for group 2; and 2.09 (median, 1.90; range 1.50-4.32) for group 3. Bonferroni multiple comparisons revealed significant differences in H/B among these groups. The H/B of group 1 was significantly smaller than that of other 2 groups (P < 0.0001). The precise cutoff value of H/B for therapeutic effect was ≤1.5. Moreover, 159 of 160 scans in the CR and 375 of 381 patients in the RR were correctly diagnosed using this cutoff value in the final outcome of RIT, yielding a sensitivity, specificity, positive predictive value, and negative predictive value of 99.4%, 98.4%, 99.7%, and 96.3%, respectively. Increased hepatic uptake of I-131 on WBS may predict disease-related progression.

  18. Our first experience in the application of I-131 MIBG in a patient with neuroblastoma (A case report)

    International Nuclear Information System (INIS)

    Full text: Neuroblastomas (NB) belong to a group of neuroendocrine tumors that are thought to arise from cells in the neural crest from the pelvis to neck, produce high levels of the urinary catecholamines vanillylmandelic acid (VMA) or homovanillic acid (HVA) in more than 90% of cases, and often metastasize to bones, bone marrow (BM), lymph nodes, and the liver. I-123 MIBG and I-131 MIBG are clinically important radiopharmaceuticals, which are routinely used for diagnostic imaging and treatment of NB. 90% percent of NB takes up the MIBG. If, however, the MIBG cannot successfully attach to a patient's tumor, it cannot be used to find or treat it. A 20-month-old girl presented with a 6-month history of a rapidly growing tumor mass 3.5 cm in diameter in the left orbital region. The first CT scan revealed a soft tissue tumor 22 x 28 mm, extending from the inferolateral wall of the left orbit and destroying the surrounding bone (os zygomaticus). CT scans of the chest and abdomen were negative. Histopathology showed high malignancy (G3) of NB (immunohistochemical reactions: NSE positive, CgA positive, SY positive, Ki-67 70% of tumor cells positive). First BM histological examination revealed no pathological findings. Urinary VMA and HVA levels were within the normal range. Tc-99m MDP scans showed increased uptake of radiopharmaceutical in the bones around the left orbital region but no evidence of skeletal metastases. 123I-MIBG studies revealed a hypermetabolic focus in the left orbital region, concordance with the CT and bone scans. The child was treated with preoperative chemotherapy, but without any results: the CT-scan performed four months later showed that the tumor had grown to 45 x 37 x 40 mm. The clinical test demonstrated the progress of the disease and the tumor at that stage was inoperable. Clinicians decided to change the chemotherapy regimen and a CT study carried out three months later showed that the tumor had decreased to 26 x 10 x 30 mm. The patient

  19. Vulvovaginal pyoderma gangrenosum secondary to rituximab therapy.

    Science.gov (United States)

    Dixit, Shreya; Selva-Nayagam, Priya; Hamann, Ian; Fischer, Gayle

    2015-01-01

    Rituximab is being used increasingly for the treatment of B-cell malignancies and nonmalignant conditions. Pyoderma gangrenosum is a rare neutrophilic dermatosis, which can be either idiopathic or associated with underlying systemic inflammatory conditions. We present a series of 4 patients who presented with ulcerative pyoderma gangrenosum in the vulvovaginal area after treatment with rituximab. PMID:24769650

  20. Study on the change of hepatic fibrosis indicators in serum before and after I-131 treatment in Graves' Patients

    International Nuclear Information System (INIS)

    Full text: Objective: To explore the change of hepatic fibrosis indicators, i.e., PC-III (type III procollagen), IV-C (type IV collagen), HA (hyaluronic acid), LN (laminin) levels in serum of Graves' patients before and after I-131 treatment. Methods: Control group were 40 healthy cases (female 25, male 15, aged 18-60 years) with normal serum levels of those indicators by medical examination in our hospital. Fifty-five Graves' patients (female 32, male 23, aged 17-58) were diagnosed by thyroid function indicators (TT3, TT4, FT3, FT4, TSH) tests, thyroid iodine intake and clinical symptoms and signs, with normal hepatic function indicators and without combined history of hepatic disease, cardiac disease, diabetes, and rheumatic disease. Three to six months after I-131 treatment these were completely recovered (back to normal thyroid function, shrunken thyroid gland volume from swelling, and disappeared clinical symptoms and signs). In both controls and Graves' patients, 2 ml venous blood was taken at early morning from each case with limosis respectively before and after I- 131 treatment. RIA method was adopted for detection of each serum indicator with reagents kit. Data were analyzed by t test in the SPSS statistical software pack. Results: 1. In Graves' patients, before treatment PC- III (type III procollagen) levels were statistically higher than that in controls (p0.05). 2. In Graves' patients, PC-III significantly decreased to a lower level after treatment than before (p05). 3. In Graves' patients, after treatment there is no significant difference of indicator levels when compared with controls (p>0.05). Conclusion: Graves' patients had certain degree of hyperplasia of hepatic connective tissue, and this pathogenesis recovered with healing of Graves' disease. PC-III positive rate and thyroid function indicator positive rate may be better in accordance with the disease process than IV-C, Ha and LN indicators. These data showed that of four serum hepatic

  1. Second malignancies in patients with differentiated thyroid carcinoma treated with low and medium activities of radioactive I-131

    Science.gov (United States)

    PICIU, DOINA; PESTEAN, CLAUDIU; BARBUS, ELENA; LARG, MARIA IULIA; PICIU, ANDRA

    2016-01-01

    Background and aim This study aimed at determining whether there is a risk regarding the development of second primary malignancies after patient exposure to the low and medium radioiodine activity used during the treatment of differentiated thyroid cancers (DTC). Methods Second primary malignancies that occurred after DTC were detected in 1,990 patients treated between 1970 and 2003. The mean long-term follow-up period was 182 months. Results Radioiodine I-131was administrated at a mean dose of 63.2 mCi. There were 93 patients with at least one second primary malignancy. The relative risk of development of second malignancy in DTC patients was increased (pDTC, but not to exposure to the low and medium activities of radioiodine administered as adjuvant therapy. PMID:27547058

  2. Reproductive function and biological dosimetry prospective study of young thyroid differentiated cancer patients treated with I-131

    International Nuclear Information System (INIS)

    Full text: The administration of I-131 in the management of differentiated thyroid cancer (DTC) is a well established practice. As the spermatogonia is highly sensitive to radiation, large doses of internal radiation could result in adverse effects on reproductive function such as oligo/azoospermia and infertility. During spermiogenesis, mammalian chromatin undergoes replacement of nuclear histones by protamines, which yields a DNA sixfold more highly condensed in spermatozoa than in mitotic chromosomes. The structure of this highly packaged chromatin shows a low binding capacity for several fluoro chromes and dyes such as chromo mycin A3 (CMA3). The aim of this study is to assess the correlation between reproductive function (endocrine and exocrine testicular function, and levels of CMA3 stainability) and biological dosimetry in a prospective study of 4 young DTC patients treated with I-131. In this context, a background level of CMA3 binding in mature human sperm was established. It revealed a variable accessibility of CMA3 to the DNA that is dependant on packaging quality and thus, indicative of protamine deficiency. The identification of altered stainability suggests DNA damage as well as epigenetic effects, which may be indicators of male infertility. Transient impairment of spermatogenesis associated with an increase in FSH, an altered spermiogram and even azoospermia was observed after the administration of cumulative activities. Overall, testosterone levels were preserved, except in one case, which presented a drastically diminished value associated with an increase in LH level. As peripheral blood lymphocytes and spermatogonia have equivalent radiosensitivity (interphase death) we hypothesize that the knowledge of DNA damage recovery in peripheral lymphocytes could correlate with spermatogonia recovery and with FSH evolution. Therefore, a prospective study on the decline of unstable chromosome aberrations is being conducted, considering the damage induced

  3. Reproductive function and biological dosimetry prospective study of young thyroid differentiated cancer patients treated with I-131

    International Nuclear Information System (INIS)

    The administration of I-131 in the management of differentiated thyroid cancer (DTC) is a well established practice. As the spermatogonia is highly sensitive to radiation, large doses of internal radiation could result in adverse effects on reproductive function such as oligo/azoospermia and infertility. During spermiogenesis, mammalian chromatin undergoes replacement of nuclear histones by protamines, which yields a DNA sixfold more highly condensed in spermatozoa than in mitotic chromosomes. The structure of this highly packaged chromatin shows a low binding capacity for several fluorochromes and dyes such as chromomycin A3 (CMA3). The aim of this study is to assess the correlation between reproductive function (endocrine and exocrine testicular function, and levels of CMA3 stainability) and biological dosimetry in a prospective study of 4 young DTC patients treated with I-131. In this context, a background level of CMA3 binding in mature human sperm was established. It revealed a variable accessibility of CMA3 to the DNA that is dependant on packaging quality and thus, indicative of protamine deficiency. The identification of altered stainability suggests DNA damage as well as epigenetic effects, which may be indicators of male infertility. Transient impairment of spermatogenesis associated with an increase in FSH, an altered spermiogram and even azoospermia was observed after the administration of cumulative activities. Overall, testosterone levels were preserved, except in one case, which presented a drastically diminished value associated with an increase in LH level. As peripheral blood lymphocytes and spermatogonia have equivalent radiosensitivity (interphase death) we hypothesize that the knowledge of DNA damage recovery in peripheral lymphocytes could correlate with spermatogonia recovery and with FSH evolution. (authors)

  4. Standisation of I-131 treatment of Graves` disease in Australian patients, with an intent to optimise radiation dose and treatment

    Energy Technology Data Exchange (ETDEWEB)

    Howarth, D.; Lan, L.; Allen, L.; Thomas, P. [John Hunter Hospital, Newcastle NSW (Australia). Department of Nuclear Medicine

    1998-06-01

    Full text: This study was part of an international multi-centre randomised outcome study under the auspices of the International Atomic Energy Agency, with the aim of standardising iodine-131 (I-131) therapy in Graves disease. Following Hunter Area Ethics Committee approval, patients were enrolled into the study and investigated by clinical assessment, biochemistry, immunology, thyroid ultrasound, technetium 99m thyroid scintigraphy and 24 hour I- 131 uptake measurement. Patients were randomised into two treatment groups: those receiving 60 Gy or 90 Gy thyroid doses of radioiodine. Outcome was determined clinically and biochemically. All patients tolerated radioiodine therapy well. Five patients had clinical exacerbation of thyrotoxicosis after radioiodine but only two required modification of therapy. At six months after radioiodine, 47% of patients remained hyperthyroid, 40 were euthyroid and 13% were hyperthyroid. Four of the hyperthyroid patients were re-treated with additional radioiodine. Significantly more patients who received a 90 Gy thyroid dose became hypothyroid compared to those who received 60 Gy, and significantly more patient who received 60 Gy remained hyperthyroid compared to those who received 90 Gy. Serial thyroid function tests demonstrated transient hypothyroidism in 47% of patients at 1-3 months after radioiodine treatment, most likely representing thyroid stunning. It is concluded that 90 Gy is an insufficient thyroid dose to render more than 53% of patients euthyroid or hypothyroid at 6 months after radioiodine therapy after such therapy a longer period may be required to achieve euthyroidism, during which most patients may require additional therapy with anti-thyroid medications

  5. Estimation of parameters biokinetics from the resolution of a model compartment for I-131. Application to a patient with thyroid carcinoma hemodialysis; Estimacion de parametros bioceniticos a partir de la resolucion de un modelo compartimental para I-131. Aplicacion a un paciente hemodializado con carcinoma de torioides

    Energy Technology Data Exchange (ETDEWEB)

    Garcia, R.; Jimenez Feltstrom, D.; Luis dimon, F. J.; Sanchez Carmona, G.; Herrador Cordoba, M.

    2013-07-01

    This work aims to define a biokinetic model for the I-131, and solve it for different conditions of the patient or person affected (normal, with cancer of the thyroid or hyperthyroid). Solve the model in the case of a patient treated with I-131 for ablation of thyroid remnants with undergoing renal insufficiency and hemodialysis . Get the parameters Biokinetic this model for different situations. (Author)

  6. Rate of thyroglossal duct remnant visualization after total thyroidectomy for differentiated thyroid carcinoma and its impact on clinical outcome of radioactive iodine (I-131) ablation

    International Nuclear Information System (INIS)

    The rate and impact of thyroglossal duct remnant (TGDR) visualization in patients with hypothyroidism after total thyroidectomy for differentiated thyroid carcinoma (DTC) have not yet been fully determined. The aim of this study was to assess the rate of TGDR visualization in post total thyroidectomy whole body scan (WBS) for DTC and to evaluate its impact on the outcome of I-131 ablation. A total of 60 consecutive DTC patients (51 papillary thyroid Ca., and 9 Follicular thyroid Ca.), underwent total thyroidectomy, followed by WBS (using I-131 in 28 patients and I-123 in 32 patients), neck ultrasound (US), thyroglobulin (Tg) and Tg anti-bodies (TgAb) assay after 40 days and subsequent I-131 ablation. At 6 months later follow-up I-131 WBS, neck U/S, Tg and TgAb were performed following suspension of L-thyroxine for 1-month (thyroid stimulating hormone [TSH] >30 μIU/ml) in 53 patients and following recombinant human TSH stimulation in seven patients. Of the studied 60 patients, 19/60 (31.7%) had a linear or focal radioactivity at the superior midline of the neck, suggesting TGDR (Group 1), and 41/60 (68.3%) had no uptake to suggest TGDR (Group 2). No significant difference regarding age, gender and histopathology between both groups. Neck US showed no evidence of thyroid tissue in the superior midline of the neck in both groups, and only a small or no residual thyroid tissue in patients of Group 1. There was a significant successful I-131 ablation rate among patients of group 1 compared to group 2 (79% in Group 1 vs. 41.5% in Group 2) (P = 0.007). Thyroglossal duct remnant visualization on WBS of hypothyroid subjects after total thyroidectomy suggests presence of only a small or no residual functioning thyroid tissue at the thyroid bed and can predict a good response to I-131 ablation

  7. Radioimmunotherapy using {sup 131}I-rituximab in patients with advanced stage B-cell non-Hodgkin's lymphoma: initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Bienert, Maren; Reisinger, Ingrid; Humplik, Beatrice I.; Reim, Christel; Kroessin, Thomas; Avril, Norbert; Munz, Dieter L. [Charite - Universitaetsmedizin Berlin, Clinic for Nuclear Medicine, Berlin (Germany); Srock, Stefanie; Pezzutto, Antonio [Charite - Universitaetsmedizin Berlin, Department of Haematology and Oncology, Berlin (Germany)

    2005-10-01

    The aim of this study was to evaluate the safety, toxicity and therapeutic response of non-myeloablative radioimmunotherapy using {sup 131}I-rituximab in previously heavily treated patients with B-cell non-Hodgkin's lymphoma (B-NHL). Nine patients with relapsed, refractory or transformed B-NHL received ten radioimmunotherapies. Patients had a median of 5 (range 2-7) prior standard therapies. Four patients had received prior high-dose chemotherapy followed by autologous stem cell transplantation, and eight had received prior rituximab therapy. Histopathology consisted of four mantle cell, one follicular and four diffuse large B-cell lymphomas. Rituximab, a monoclonal chimeric anti-CD20 antibody (IDEC-C2B8), was labelled with {sup 131}I using the Iodogen method. The administered activity (2,200{+-}600 MBq) was based on a dosimetrically calculated 45 cGy total-body radiation dose. All patients received an infusion of 2.5 mg/kg of rituximab prior to administration of the radiopharmaceutical. No acute adverse effects were observed after the administration of{sup 131}I-rituximab. Radioimmunotherapy was safe in our patient group and achieved one complete response ongoing at 14 months and two partial responses progressing at 12 and 13 months after treatment. One partial responder was re-treated with radioimmunotherapy and achieved an additional progression-free interval of 7 months. Four non-responders with bulky disease died 4.8{+-}2.0 months after therapy. Three patients had an elevated serum lactate dehydrogenase (LDH) level prior to radioimmunotherapy and none of the patients responded. Of two patients who received radioimmunotherapy as an additional treatment after salvage chemotherapy, one continues to be disease-free at 9 months and one relapsed at 5 months' follow-up. Reversible grade 3 or 4 haematological toxicity occurred in seven of nine patients. Median nadirs were 35 days for platelets, 44 days for leucocytes and 57 days for erythrocytes. (orig.)

  8. Comparison of internal dosimetry factors for three classes of adult computational phantoms with emphasis on I-131 in the thyroid

    Science.gov (United States)

    Lamart, Stephanie; Bouville, Andre; Simon, Steven L.; Eckerman, Keith F.; Melo, Dunstana; Lee, Choonsik

    2011-11-01

    The S values for 11 major target organs for I-131 in the thyroid were compared for three classes of adult computational human phantoms: stylized, voxel and hybrid phantoms. In addition, we compared specific absorbed fractions (SAFs) with the thyroid as a source region over a broader photon energy range than the x- and gamma-rays of I-131. The S and SAF values were calculated for the International Commission on Radiological Protection (ICRP) reference voxel phantoms and the University of Florida (UF) hybrid phantoms by using the Monte Carlo transport method, while the S and SAF values for the Oak Ridge National Laboratory (ORNL) stylized phantoms were obtained from earlier publications. Phantoms in our calculations were for adults of both genders. The 11 target organs and tissues that were selected for the comparison of S values are brain, breast, stomach wall, small intestine wall, colon wall, heart wall, pancreas, salivary glands, thyroid, lungs and active marrow for I-131 and thyroid as a source region. The comparisons showed, in general, an underestimation of S values reported for the stylized phantoms compared to the values based on the ICRP voxel and UF hybrid phantoms and relatively good agreement between the S values obtained for the ICRP and UF phantoms. Substantial differences were observed for some organs between the three types of phantoms. For example, the small intestine wall of ICRP male phantom and heart wall of ICRP female phantom showed up to eightfold and fourfold greater S values, respectively, compared to the reported values for the ORNL phantoms. UF male and female phantoms also showed significant differences compared to the ORNL phantom, 4.0-fold greater for the small intestine wall and 3.3-fold greater for the heart wall. In our method, we directly calculated the S values without using the SAFs as commonly done. Hence, we sought to confirm the differences observed in our S values by comparing the SAFs among the phantoms with the thyroid as a

  9. Rituximab-Induced Bronchiolitis Obliterans Organizing Pneumonia

    Directory of Open Access Journals (Sweden)

    Ahmet B. Ergin

    2012-01-01

    Full Text Available Rituximab-induced lung disease (R-ILD is a rare entity that should be considered in patients treated with rituximab who present with dyspnea, fever, and cough, but no clear evidence of infection. A variety of pathologic findings have been described in this setting. Bronchiolitis obliterans organizing pneumonia (BOOP is the most common clinicopathologic diagnosis, followed by interstitial pneumonitis, acute respiratory distress syndrome (ARDS, and hypersensitivity pneumonitis. Prompt diagnosis and treatment with corticosteroids are essential as discussed by Wagner et al. (2007. Here we present a case of an 82-year-old man who was treated with rituximab for recurrent marginal zone lymphoma. After the first infusion of rituximab, he reported fever, chills, and dyspnea. On computed tomography imaging, he was found to have bilateral patchy infiltrates, consistent with BOOP on biopsy. In our patient, BOOP was caused by single-agent rituximab, in the first week after the first infusion of rituximab. We reviewed the relevant literature to clarify the different presentations and characteristics of R-ILD and raise awareness of this relatively overlooked entity.

  10. TUMOR-LOCALIZATION WITH I-131-LABELED HUMAN-IGM MONOCLONAL-ANTIBODY 16.88 IN ADVANCED COLORECTAL-CANCER PATIENTS

    NARCIS (Netherlands)

    BOVEN, E; Haisma, Hidde; BRIL, H; MARTENS, HJM; VANLINGEN, A; DENHOLLANDER, W; KESSEL, MAP; DEJAGER, RL; ROOS, JC

    1991-01-01

    Human IgM monoclonal antibody 16.88 recognised an intracellular antigen strongly expressed in colorectal cancer tissue in 51% of our patients. Tumour localisation was carried out with 185 MBq I-131-16.88 (8 mg) in 20 of these patients with advanced disease. In 16 patients (80%) immunoscintigraphy wa

  11. Radiation exposure from liquid discharges from I-131 therapy rooms into the piping system of a hospital building

    International Nuclear Information System (INIS)

    Over 80% of the activity from patients undergoing radioiodine therapy for thyroid cancer is eliminated during the first three days. In our I-131 therapy unit, the number of hospitalized patients has increased from less than 200 in 2004 to more than 300 in 2006. The total amount of radio activity used is about 1,800 GBq per year, and the estimated amount excreted is calculated to be about 1,500 GBq. This results in significant volume of contaminated liquid discharges into the piping system. In this study, we monitored external dose rates in non-radiation use areas adjacent to pipeline connections in the building to ensure that the dose to non-occupational workers who reside in offices below the unit does not exceed 1 mSv per year. Exposure rates in areas adjacent to the pipeline junction connections were measured periodically from April 2006 to February 2007 five floors below the therapy unit. The measurements were made inside the wall at contact with the junction, outside the wall and in hallways at 1 meter from the wall, using a GM detector or an ionization chamber. The results were recorded in μSv/h and the dose received was estimated for members of the public. Significant increases in dose rates were detected in three floors below the unit. They were 20--30, 10--30 and 5--15 μSv/h at contact with the pipeline connections, 9--15, 10--15 and 3--5 μSv/h outside the wall, and 3--6, 4--6 and 2--5 μSv/h in hallways on floors 1, 2 and 3 respectively. After appropriate wall shielding has been provided, dose rate outside the wall was reduced to 1.4 μSv/h, and to 0.5.3 μSv/h in hallways. By using an occupancy factor 1/4 for hallways, the calculated dose now meets the public dose limits of 1 mSv per year. Therapeutic application of I-131 for the treatment of thyroid cancer generates a significant amount of contaminated liquid waste into the sewers. These wastes originate mainly from toilets, showers, wash basins and floor drains. Although waste discharges can be

  12. Preoperative F-18-FDG PET for the detection of metastatic cervical lymph nodes in recurrent papillary thyroid carcinoma patients with negative I-131 whole body scans

    Energy Technology Data Exchange (ETDEWEB)

    Byun, Byung Hyun; Urn, Sang Moo; Cheon, Gi Jeong; Choi, Chang Woon; Lee, Byeong Cheol; Lee, Guk Haeng; Lee, Yong Sik; Shim, Youn Sang [Korea Institute of Radiological and Medical Sciences, Seoul (Korea, Republic of)

    2007-07-01

    We evaluated the diagnostic performance of FDG-PET for the detection of metastatic cervical lymph nodes in recurrent papillary thyroid carcinoma patients with negative I-131 scan. All patients had total thyroidectomy and following I-131 ablation therapy. In the follow-up period, FDG-PET showed suspected cervical lymph nodes metastases and neck dissection was performed within 3 months after FDG-PET. It had shown for all patients the negative I-131 scan within 3 months before FDG-PET or negative I-131 scan during the period of cervical lymph nodes metastases suspected on the basis of FDG-PET, CT, or ultrasonography until the latest FDG-PET. Preoperative FDG-PET results were compared with the pathologic findings of lymph nodes specimens of 19 papillary thyroid carcinoma patients. Serum Tg, TSH, and Tg antibody levels at the time of latest I-131 scan were reviewed. The size of lymph node was measured by preoperative CT or ultrasonography. In 45 cervical lymph node groups dissected, 31 lymph node groups revealed metastasis. The sensitivity and specificity of FDG-PET for metastasis were 74.2% (23 of 31) and 50.0% (7 of 14), respectively. Except for patients with elevated Tg antibody levels, all patients showed the elevated serum Tg levels than normal limits at the TSH of =30uIU/ml. 8 lesions without suspected metastatic findings on FDG-PET revealed metastasis (false negative), and none of them exceeded 8mm in size (4 to 8mm, median= 6mm). On the other hand, 23 true positive lesions on FDG-PET were variable in size (6 to 17mm, median=9mm). FDG-PET is suitable for the detection of metastatic cervical lymph nodes in patients with recurrent papillary thyroid carcinoma. However, false positive or false negative should be considered according to the size of lymph node.

  13. Quantitation of imaging with I-131-F(ab')/sub 2/ fragments of monoclonal antibody in patients

    International Nuclear Information System (INIS)

    Iodine-131 labeled F(ab')/sub 2/ fragments of monoclonal antibody (IgG/sub 2a/ immunoglobulin with specificity for a cell surface antigen of colon carcinoma) have been used for quantitative imaging of tumor in 27 patients. Activity of I-131 F(ab')/sub 2/ fragments localized in tumor and in liver was quantitated using a modification of the method of Thomas SR, employing computer-acquired conjugate views (i.e. 180 opposed) to eliminate need for tumor or organ depth and tissue attenuation. The method was validated with an abdominal imaging phantom showing accuracy of +/- 10%. Quantitation indicates that activity reaches a peak in tumor at 48-72 hours and the ratio of activity in hepatic metastases to activity in liver peaks at approximately 72 hours. Mean activity in tumor was less than 0.01% of the administered dose per gram of tumor at any imaging time from 24 to 168 hours, while mean activity in surrounding liver was less than .002% of administered dose per gram of liver at any imaging time. Liver activity decreased monotonically with time, showing no peak activity. This non-invasive method of quantitating the distribution of F(ab')/sub 2/ fragments of monoclonal antibody in patients has proven accurate by comparison with phantom simulation. This type of quantitation is necessary for evaluating optimal imaging time, comparing relative utility of various antibodies and has use for therapeutic applications of monoclonal antibody fragments

  14. Rituximab induced hypoglycemia in non-Hodgkin's lymphoma

    OpenAIRE

    Lali V; Geetha N.; Hussain Badrudeen M; Pandey Manoj

    2006-01-01

    Abstract Background Hypoglycemia is a vary rare toxicity of rituximab. The exact mechanism of rituximab induced hypoglycemia is not clear. Case presentation A 50 year old female presented with a left tonsillar non Hodgkin's lymphoma and was started on R-CHOP chemotherapy. Twenty four hours after the first rituximab infusion, she developed hypoglycemia which was managed by IV glucose infusion. Conclusion Hypoglycemia following rituximab administration is rare. Possibilities of hypoglycemia sho...

  15. Acquired hemophilia a successfully treated with rituximab.

    Science.gov (United States)

    D'Arena, Giovanni; Grandone, Elvira; Di Minno, Matteo Nicola Dario; Musto, Pellegrino; Di Minno, Giovanni

    2015-01-01

    Acquired hemophilia A (AHA) is a rare bleeding disorder due to the development of specific autoantibodies against factor VIII. The anti-CD20 monoclonal antibody Rituximab has been proven to be effective in obtaining a long-term suppression of inhibitors of AHA, besides other immunosuppressive standard treatments. Here we describe a case of idiopathic AHA in a 60-year old man successfully treated with rituximab. He showed a complete clinical response with a normalization of clotting parameters after 5 weekly courses of rituximab given at a dose of 375 mg/sqm., but after stopping rituximab, an initial worsening of coagulation parameters induced the addition of 3 further courses. At present, the patient is in complete clinical and hematological remission after 200 days. This case confirms that Rituximab may be a safe and useful tool to treat AHA and, a prolonged administration can overcome the initial resistance. However, the precise position of this drug in the therapeutic strategy (first or second-line, alone or in combination with other drugs) remains to be established and warrants further investigation. PMID:25745551

  16. Acquired Hemophilia A successfully treated with rituximab

    Directory of Open Access Journals (Sweden)

    Giovanni D'Arena

    2015-02-01

    Full Text Available Acquired hemophilia A (AHA is a rare bleeding disorder due to the development of specific autoantibodies against factor VIII. The anti-CD20 monoclonal antibody Rituximab has been proven to be effective in  obtaining a long-term suppression of inhibitors of AHA,  besides other immunosuppressive standard treatments. Here we describe a case of idiopathic AHA in a 60-year old man successfully treated with rituximab. He showed a complete clinical response with  a normalization of clotting  parameters after 5 weekly courses of rituximab given at a dose of 375 mg/sqm. , but after stopping rituximab, an initial worsening of coagulation  parameters  induced the addition of 3 further courses. At present, the patient is in complete clinical and hematological remission after 200 days.  This case confirms that Rituximab may be a safe and useful tool to treat AHA and, a prolonged administration can overcome the initial resistance. However, the precise position of this drug in the therapeutic strategy (first or second-line, alone or in combination with other drugs remains to be established and warrants further investigation.

  17. Clinical Significance of Diffuse Intrathoracic Uptake on Post-Therapy I-131 Scans in Thyroid Cancer Patients

    International Nuclear Information System (INIS)

    The purpose of this study was to identify the frequency and possible cause of diffuse intrathoracic uptake on post-therapy I-131 scans in thyroid cancer patients. We retrospectively reviewed 781 post-therapy scans of 755 thyroid cancer patients who underwent total thyroidectomy and radioactive iodine therapy between January and December 2010. Diffuse intrathoracic uptake on post-therapy scans was examined, and clinical patient characteristics including sex, age, regimen for thyroid-stimulating hormone (TSH) stimulation (thyroid hormone withdrawal or recombinant human TSH injection), TSH, thyroglobulin (Tg) and anti-thyroglobulin antibody (anti-Tg Ab) levels, therapeutic dose of radioactive iodine therapy and prior history of radioactive iodine therapy were recorded.Scan findings were correlated with chest CT, chest radiographs, laboratory tests and/or clinical status. Diffuse intrathoracic uptake without evidence of pathologic condition was categorized as indeterminate. The association between clinical characteristics and intrathoracic uptake were analyzed for negative intrathoracic uptake and indeterminate uptake groups. Diffuse intrathoracic uptake on post-therapy scans was demonstrated in 39 out of 755 (5.2 %) patients, among which 3 were confirmed as lung metastasis. The 14 patients that showed high Tg or anti-Tg Ab levels were considered to be at risk of having undetected micrometastasis on other imaging modalities. The remaining 22 were indeterminate (2.9 %). Upon comparison of negative intrathoracic uptake and indeterminate uptake groups, TSH stimulation by thyroid hormone withdrawal was shown to be significantly correlated with diffuse intrathoracic uptake (p <0.05). The frequency of diffuse intrathoracic uptake on post-therapy scans was 5.2 % and could be seen in thyroid cancer patients with underlying lung metastasis as well as those without definite pathologic condition. In the latter, there was a higher frequency for diffusely increased intrathoracic

  18. Clinical Significance of Diffuse Intrathoracic Uptake on Post-Therapy I-131 Scans in Thyroid Cancer Patients

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Hyun Su; Kim, Sung Hoon; Park, Sonya Youngju; Park, Hye Lim; Seo, Ye Young; Choi, Woo Hee [The Catholic Univ. of Korea, Suwon (Korea, Republic of)

    2014-03-15

    The purpose of this study was to identify the frequency and possible cause of diffuse intrathoracic uptake on post-therapy I-131 scans in thyroid cancer patients. We retrospectively reviewed 781 post-therapy scans of 755 thyroid cancer patients who underwent total thyroidectomy and radioactive iodine therapy between January and December 2010. Diffuse intrathoracic uptake on post-therapy scans was examined, and clinical patient characteristics including sex, age, regimen for thyroid-stimulating hormone (TSH) stimulation (thyroid hormone withdrawal or recombinant human TSH injection), TSH, thyroglobulin (Tg) and anti-thyroglobulin antibody (anti-Tg Ab) levels, therapeutic dose of radioactive iodine therapy and prior history of radioactive iodine therapy were recorded.Scan findings were correlated with chest CT, chest radiographs, laboratory tests and/or clinical status. Diffuse intrathoracic uptake without evidence of pathologic condition was categorized as indeterminate. The association between clinical characteristics and intrathoracic uptake were analyzed for negative intrathoracic uptake and indeterminate uptake groups. Diffuse intrathoracic uptake on post-therapy scans was demonstrated in 39 out of 755 (5.2 %) patients, among which 3 were confirmed as lung metastasis. The 14 patients that showed high Tg or anti-Tg Ab levels were considered to be at risk of having undetected micrometastasis on other imaging modalities. The remaining 22 were indeterminate (2.9 %). Upon comparison of negative intrathoracic uptake and indeterminate uptake groups, TSH stimulation by thyroid hormone withdrawal was shown to be significantly correlated with diffuse intrathoracic uptake (p <0.05). The frequency of diffuse intrathoracic uptake on post-therapy scans was 5.2 % and could be seen in thyroid cancer patients with underlying lung metastasis as well as those without definite pathologic condition. In the latter, there was a higher frequency for diffusely increased intrathoracic

  19. Rituximab induced hypoglycemia in non-Hodgkin's lymphoma

    Directory of Open Access Journals (Sweden)

    Lali V

    2006-12-01

    Full Text Available Abstract Background Hypoglycemia is a vary rare toxicity of rituximab. The exact mechanism of rituximab induced hypoglycemia is not clear. Case presentation A 50 year old female presented with a left tonsillar non Hodgkin's lymphoma and was started on R-CHOP chemotherapy. Twenty four hours after the first rituximab infusion, she developed hypoglycemia which was managed by IV glucose infusion. Conclusion Hypoglycemia following rituximab administration is rare. Possibilities of hypoglycemia should be kept in mind in patients developing symptoms like fatigue, restlessness, and sweating while on rituximab therapy.

  20. Rituximab Administration and Reactivation of HBV

    Directory of Open Access Journals (Sweden)

    Yutaka Tsutsumi

    2010-01-01

    Full Text Available Rituximab is a drug used for the treatment of B-cell non-Hodgkin's lymphoma, and its range of use has expanded to the treatment of collagen diseases such as idiopathic thrombocytopenic purpura and rheumatoid arthritis. One serious complication of rituximab use is the reactivation of dormant hepatitis B virus, and prevention of this phenomenon has become an urgent issue. This paper provides a general outline of the problem through an analysis of patient cases that we and other groups have experienced to date.

  1. A simple low-cost of liquid I-131 dispenser for routine radiopharmaceutical dispensing at nuclear medicine department, Institut Kanser Negara

    Energy Technology Data Exchange (ETDEWEB)

    Said, M. A.; Suhaimi, N. E. F. [Fakulti Sains dan Teknologi, Universiti Kebangsaan Malaysia, 43600 UKM, Bangi Selangor (Malaysia); Ashhar, Z. N., E-mail: aminhpj@gmail.com [Institut Kanser Negara, No 4, Jalan P7, Presint 7, 62250 Putrajaya (Malaysia); Zainon, R. [Advanced Medical & Dental Institute, Universiti Sains Malaysia, Bertam, 13200, Kepala Batas, Pulau Pinang (Malaysia)

    2016-01-22

    In routine radiopharmaceutical Iodine-131 ({sup 131}I) dispensing, the amount of radiation dose received by the personnel depends on the distance between the personnel and the source, the time spent manipulating the source and the amount of shielding used to reduce the dose rate from the source. The novel iRAD-I131 dispenser using recycle {sup 131}I liquid lead pot will lead into low cost production, less maintenance and low dose received by the personnel that prepared the {sup 131}I. The new fabricated of low cost {sup 131}I dispenser was tested and the dose received by personnel were evaluated. The body of lead material is made from 2.5 cm lead shielded coated with epoxy paint to absorb the radiation dose up to 7.4 GBq of {sup 131} I. The lead pot was supported with two stainless steel rod. The Optically Stimulated Luminescence (OSL) nanodot was used in this study to measure the dose rate at both extremities for every personnel who prepared the {sup 131}I. Each OSL nanodot was attached at the fingertip. Three different personnel (experienced between one to ten years above in preparing the radiopharmaceuticals) were participated in this study. The average equivalent dose at right and left hand were 122.694 ± 121.637 µSv/GBq and 77.281 ± 62.146 µSv/GBq respectively. This study found that the dose exposure received using iRAD-I131 was less up to seven times compared to the conventional method. The comparison of experimental data using iRAD-I131 and established radiopharmaceutical dispenser was also discussed. The innovation of {sup 131}I dispenser is highly recommended in a small radiopharmaceutical facility with limited budget. The novel iRAD-I131 enables implementation of higher output liquid dispensing with low radiation dose to the personnel.

  2. Comparison of effective I-131 half-life between thyroid hormone withdrawal and recombinant human thyroid-stimulating hormone for thyroid cancer: a retrospective study

    International Nuclear Information System (INIS)

    Preparation for postoperative radioiodine ablation for differentiated thyroid carcinoma is performed by either thyroid hormone withdrawal or recombinant human thyroid-stimulating hormone (rhTSH) administration. There is little information on the impact of the method of preparation with respect to whole-body effective I-131 half-life and its potential clinical implications in the Australian setting. A retrospective study was performed on patients admitted for adjuvant radioiodine ablation for non-metastatic differentiated thyroid carcinoma at the Royal Adelaide Hospital over a 4½-year period from 2009. Dose rate measurements were analysed for 19 rhTSH and 31 thyroid hormone withdrawal patients. The mean effective I-131 half-lives were 11.51 and 13.29 h for the rhTSH and thyroid hormone withdrawal groups, respectively, with no statistically significant difference between the two groups (P = 0.761). This result differs from previously published data where withdrawal periods were typically longer, resulting in slower renal clearance and longer half-lives for withdrawal patients. Our study did not demonstrate a significant difference in whole-body effective half-life of I-131 between the two methods of preparation for radioiodine ablation. This suggests that putative advantages of rhTSH over withdrawal in terms of whole-body radiation dose, duration of hospital admission and quality of life may be sensitive to duration of withdrawal.

  3. I-131 for Remnant Ablation in Differentiated Thyroid Cancer After Thyroidectomy: A Meta-Analysis of Randomized Controlled Evidence.

    Science.gov (United States)

    Shengguang, Yan; Ji-Eun, Choi; Lijuan, He Li

    2016-01-01

    BACKGROUND The aim of this study was to compare the success rate of various levels of I-131 activity for use in remnant ablation in low-risk differentiated thyroid cancer. MATERIAL AND METHODS We identified eligible studies in 5 electronic databases up to December 2014 and the reference lists of original studies and review articles were hand searched for additional articles on this topic. Summary relative risks with their 95% confidence intervals were calculated with a random-effects model. Heterogeneity was assessed using I2 statistics. RESULTS Fourteen randomized clinical trials met the eligibility criteria. The data suggest that the pooled successful ablation rate is 5% lower (95% CI, 1-9% lower) when using 30 mCi compared with 100 mCi (test for heterogeneity, p=0.468, I2=0.0%). In stratified analysis, ablation success rates using 30 mCi are similar to 100 mCi in Asia (SRRs=0.91; 95%CI=0.72-1.14). However, the results favor 100 mCi in Europe (SRRs=0.95; 95%CI=0.91-0.99). Ablation success rates using 30 mCi are similar to 100 mCi in patients who underwent TT/NTT (total thyroidectomy/near total thyroidectomy) (SRRs=0.96; 95%CI=0.92-1.00) and TT/STT (SRRs=0.98; 95%CI=0.73-1.31). However, the result favor 100 mCi in patients who underwent ST/HT (subtotal thyroidectomy/ hemithyroidectomy) (SRRs=0.80; 95%CI=0.65-0.99). There was no publication bias in the present meta-analysis. CONCLUSIONS High radioiodine activity is better than low activity in terms of successful ablation rate in low-risk differentiated thyroid cancer, but the advantage of high activity seems to only exist in patients who underwent hemithyroidectomy/subtotal thyroidectomy, but not lymph node involvement, preparation before ablation, and definition of successful ablation. PMID:27406262

  4. The prevalence of thyroid tissue along the thyroglossal tract on SPECT/CT following I131 ablation therapy after total thyroidectomy for thyroid cancer

    International Nuclear Information System (INIS)

    Full text of publication follows. Aim: the aims of this study are first to determine the prevalence of thyroid tissue along the thyroglossal tract on SPECT/CT and secondly to assess the contribution of this tissue to total neck I-131 activity in patients treated with I-131 ablation therapy after total thyroidectomy for thyroid cancer. Materials and methods: a total of 63 consecutive patients with well differentiated thyroid cancer treated with total thyroidectomy underwent whole body planar imaging and SPECT/CT of the neck 48 hours following ablative I-131 therapy. On SPECT/CT, thyroglossal tract thyroid tissue was defined as radioiodine activity in the anterior neck, superior to the thyroid bed in close proximity to the midline without evidence of localisation to lymph nodes. On planar imaging, thyroglossal tract thyroid tissue was defined as linear radioiodine activity in the midline of the neck superior to the thyroid bed. SPECT/CT and planar images were classified by two independent reviewers as positive, negative or equivocal with interobserver agreement quantified using a Kappa score. Disagreement was resolved using a third reviewer. Quantitation of thyroglossal tract thyroid tissue and total neck I-131 activity was performed using region of interest analysis on planar imaging following localisation on SPECT/CT. Results: thyroglossal tract thyroid tissue was present in 31/63 (49%; 95% CI: 37-61%) patients on SPECT/CT. In these 31 patients, thyroglossal tract thyroid tissue contributed to an average of 49% of total neck activity. Interobserver agreement was substantial on SPECT/CT (Kappa = 0.76; 95% CI: 0.61-0.91) and fair on planar imaging (Kappa = 0.31; 95% CI: 0.15-0.47). Conclusion: thyroid tissue along the thyroglossal tract was present in one half of patients in our study population and can contribute to a significant amount of total neck I-131 activity. Given the high prevalence of thyroglossal tract thyroid tissue, our results suggest that total neck

  5. Prospective randomised trial for the evaluation of the efficacy of low vs. high dose I-131 for post operative remnant ablation in differentiated thyroid cancer

    International Nuclear Information System (INIS)

    This study was performed under the auspices of IAEA project (i) to evaluate the efficacy of low (50 mCi) vs. high (100 mCi) dose I-131 for post operative remnant ablation in differentiated thyroid cancer and (ii) to search for factors associated with successful ablation. There were 138 cases of either papillary or follicular type without evidence of any metastasis. All patient had undergone at least subtotal thyroidectomy. Seventy-five were randomised to be treated with high dose and 63 with low dose I-131. Pretreatment total body scan and 24 hour-neck uptake were performed using 1 mCi of I-131, together with serum T4, TSH, Tg and antiTg. The criteria for successful ablation were absence of discrete thyroid bed activity in total body scan done using 3 mCi of I-131, 48-72 hour-neck uptake of less than 0.2% and serum Tg of less than 10 ng/ml. in the follow up done after 6-8 months of therapy. All patient characteristics were not significantly different between the two randomized groups. The overall successful ablation of the two groups was 76.8% (106/138). The success rate of therapy for each group is presented. High dose (100 mCi) I-131 is more efficient than low dose (50 mCi) for remnant ablation, even in cases with low neck uptake i.e. less than 10%. Logistic regression analysis confirmed the significant influence of ablative dose on the outcome with 4 times more chance of success using the high dose rather than the low dose. Baseline serum T4 and TSH were also associated with successful ablation with 1.4 times more chance of success with each 1 unit (mg/dl) of T4 decrease and 1.2 times with 10 units (mU/ml) of TSH increase. This might be, at least partly, due to good correlation between T4, TSH and the remnant mass

  6. The usefulness of I-131 MIBG scintigraphy in assessing the staging of neuroectodermal tumors in children - Our experience

    International Nuclear Information System (INIS)

    Full text: Neuroendodermal tumors include pheochromocytoma, paraganglioma, medullary thyroid cancer and neuroblastoma. These malignant tumors derive from the primitive neural crest, which develops to sympathic nervous system. The tumors consist of cells that are capable of incorporating the amine precursors such as I-131 MIBG. The most common malignant tumor in childhood is neuroblastoma. The tested group included patients with neuroblastoma and one with pheochromocytoma treated in the Department of Oncology at the Paediatric University Hospital in Bialystok. There were 8 patients between the ages of 2 and 13. They have all undergone standard whole body scanning with a tomographic Nucline X-Ring camera made by Mediso, fitted with high-energy all purpose parallel hole collimator, a scan speed 5cm/ min and static images of 250,000 counts or 10 min per image. The study was performed 24-48 h after I-131 MIBG injection of 35 MBq activity. The results were obtained by antero-posterior and posterio-anterior projections (a whole body scan) and, if necessary, additional static images of chest and abdomen, skull, pelvis, and lower limbs. Clinical Characteristics of the Group: M.E. 12-year-old child with a right suprarenal tumor with morrow metastases. HP-neuroblastoma. The child was treated with a preoperative chemotherapy, operated and given postoperative chemotherapy (palliative therapy). The MIBG scintigraphy showed hypermetabolic focus in the pelvis and in the left vertex bone. Clinical test pointed to the progress of the disease. M.J. 6-year-old child with infiltrative retroperitoneal on both sides of celiac trunk with a metastases to mediastinum and bone marrow. HP-neuroblastoma. The first MIBG scintigraphy performed after Tsishidy operative procedure was negative. The second MIBG scintigraphy, one year later showed metastases to thigh bone, spine, and sacroiliac joint. Clinically proven progress of the disease. G.G. 2-year-old child with facial skeleton tumor and

  7. Software for dosimetry hypothyroid patients treated with I131 pick up and using probe gamma camera; Software para la dosimetria de pacientes hipertiroideos tratados con 131I utilizando sonda de captacion y gammacamara

    Energy Technology Data Exchange (ETDEWEB)

    Jimenez Felstrom, D.; Luis simon, J.; Reyes Garcia, R.; Derecho Torres, P.; Herrador Cordoba, M.

    2015-07-01

    In this communication the process recently implemented in our hospital for pre and post treatment of patients treated with I-131 in benign diseases of the thyroid gland internal dosimetry is described. We have developed a proprietary software that facilitates the process of dosimetry. Through scans Planar or pictures Spect be determines the mass of the gland thyroid. In function of the mass, is calculated by Monte Carlo the media power absorbed by disintegration of the I-131 in said gland endocrine. (Author)

  8. Rituximab in treatment of idiopathic glomerulopathy

    Directory of Open Access Journals (Sweden)

    Kamel El-Reshaid

    2012-01-01

    Full Text Available The aim of our study was to assess the role of rituximab (Mabthera in the treatment of patients with corticosteroid-resistant and calcineurin-inhibitors ± cellcept refractory idiopathic nephrotic syndrome (INS. A total of 83 patients who had required the previous treatment for a minimum of two years were included in the study. Our protocol included the use of rituximab in four-weekly slow infusions. Five patients were excluded as they could not tolerate rituximab infusion for allergic reaction. As expected, none of the patients had a decline in the total circulating lymphocyte counts yet all had achieved decline of their initially normal CD20 to < 0.5% one month after infusion. The decline persisted for eight to ten months later. In the minimal change disease (MCD group, 31 of the 32 patients had complete remission (CR and were off any immunosuppressive therapy and one of the previous non-responders (NR did not respond. Excluding two patients who had required retreatment, the others remained in CR (17 up to 28 months and six up to 36 months. Treatment with rituximab resulted in amelioration of NS in 17 of the 18 patients with focal segmental glomerulosclerosis (FSGS, while only one patient remained NR. Although renal function remained stable, proteinuria reappeared by eight to 12 months. Retreatment with rituximab resulted in a similar response with stable kidney function. In the 28 patients with membranous glomerulopathy (MG, 24 had achieved CR. Two patients failed to respond and two had partial remission. By 12 months, all patients relapsed. The response was within one month following treatment in patient with MCD, but was gradual within three months in FSGS and MG. Relapsers in all groups responded in a similar pattern to repeat dosing with the drug subsequently. Our prospective study represents an adequate number of patients with biopsy-proven subgroups of INS in both children and adults with long-term follow-up of treatment with rituximab

  9. Multiple model testing using Chernobyl fallout data of I-131 in forage and milk and Cs-137 in forage, milk, beef and grain. Pt. 1

    International Nuclear Information System (INIS)

    Comprehensive measurements of I-131 and Cs-137 in the environment after the Chernobyl accident provided a unique opportunity for the collection of environmental transfer data sets. These come from 13 locations in the northern hemisphere which experienced levels of contamination that spanned approximately three orders of magnitude. Data have been compiled for radionuclide concentrations in air, rain, pasture vegetation, milk, beef and grain. In addition background information has been collated for factors such as prevailing meteorological conditions, location description, and local agricultural practices. Participants were asked to predict radionuclide concentrations in forage, milk, beef and grain from radionuclide concentrations in air, the daily amounts of precipitation and other pertinent information. This was a blind test in that the locations to which the input data referred were not revealed to the participants until after they had submitted their predictions. Twenty-three models were involved in the study. This report compares observations and predictions for deposition, time- integrated concentrations in forage, milk, beef and grain, to help assess understanding of individual processes, time-dependent concentrations in forage, milk and beef. In general, predictions of time-integrated concentration of I-131 and Cs-137 in forage, milk (normalized for forage) and beef are within a factor of 10 of the observations. About 50% of the predictions of I-131 and Cs-137 in forage and just over 30% of the predictions of those nuclides in milk (normalized for forage) fall within a factor of 2 of the observations. Documentation of the measurements, models, methods of analysis and model results is presented in the appendices. (au) (75 refs.)

  10. Doses to the hand during the administration of radiolabeled antibodies containing Y-90, Tc-99m, I-131, and Lu-177

    International Nuclear Information System (INIS)

    Exposure of the hands of medical personnel administering radiolabeled antibodies (RABs) was evaluated on the basis of (a) observing and photo-documenting administration techniques, and (b) experimental data on doses to thermoluminescent dosimeters (TLDs) on fingers of phantom hands holding syringes, and on syringes, with radionuclides in the syringes in each case. Actual exposure data for I-131 and Lu-177 were obtained in field studies. Variations in handling and administration techniques were identified. Dose rates measured using TLDs on the surface of loaded syringes were adjusted for differences in electronic stopping power, absorption coefficients, and attenuation between dosimeters and tissue to estimate dose-to-skin averaged over 1 cm2 at 7 mg cm-2 depth for Y-90, Tc-99m, I-131, and Lu-177. Dose rate coefficients to the skin, if in contact with the syringe wall, were 89, 1.9, 3.8, and 0.41 microSv s-1 per 37 MBq (1 mCi) for Y-90, Tc-99m, I-131, and Lu-177, respectively. For dose reduction, when using Y-90 the importance was clearly indicated of (a) avoiding direct contact with syringes containing RABs, if practical, and (b) using a beta-particle shield on the syringe. In using a syringe for injection, doses can best be approximated for the geometry studied by (a) wearing a finger dosimeter on the middle finger, toward the outside of the hand, on the hand operating the plunger, and (b) wearing finger dosimeters on the inner (palm) side of the finger on the hand that supports the syringe for energetic beta-particle emitters, such as Y-90 and Re-188

  11. Long-Term Quality of Life and Pregnancy Outcomes of Differentiated Thyroid Cancer Survivors Treated by Total Thyroidectomy and I(131) during Adolescence and Young Adulthood.

    Science.gov (United States)

    Metallo, Melanie; Groza, Lelia; Brunaud, Laurent; Klein, Marc; Weryha, Georges; Feigerlova, Eva

    2016-01-01

    Introduction. Differentiated thyroid cancer (DTC) is rare and confers good prognosis. Long-term health related quality of life (HRQoL) and pregnancy outcomes are not well known in subjects treated during adolescence and young adulthood. Methods. Cross-sectional analysis of HRQoL and global self-esteem, using SF-36 and ISP-25 surveys, and of pregnancy outcomes in female survivors of DTC treated by total thyroidectomy and I(131) before age of 25 years. Results. Forty-five of 61 patients (74%) responded to the survey. Cumulative I(131) activity was ≤3.85 GBq in 18 subjects and >3.85 GBq in 27 subjects. Mean time from diagnosis was 7.6 ± 5.2 years for the group ≤ 3.85 GBq versus 16.9 ± 11.6 years for the group > 3.85 GBq (P self-esteem was observed. Thirty pregnancies after I(131) were noted in patients from the group > 3.85 GBq and 10 in patients from the group ≤ 3.85 GBq. Frequency of miscarriages was of 17% (group > 3.85 GBq) and 10% (group ≤ 3.85 GBq) with 9 and 24 live births, respectively. No congenital malformations or first year mortality was noted. Conclusion. Long-term HRQoL, global self-esteem, and pregnancy outcomes are not affected in young female survivors of DTC. PMID:26977147

  12. I131 therapy induces persistent radiation-dose dependent increases in glycophorin a locus somatic mutations in bone marrow stem cells

    International Nuclear Information System (INIS)

    Patients with thyroid diseases treated with I131 receive known sub-acute marrow exposures to ionizing radiation of ∼2 to >200 cGy. Time-series sampling of peripheral blood from these patients, assayed for the frequency of erythrocytes expressing glycophorin A (GPA) allele-loss variant phenotypes, demonstrates the induction, accumulation, and long-term persistence of radiation-induced in vivo somatic mutations at this locus in erythroid marrow progenitor cells. Initial dosimetry and assay data from 5 patients yielded a linear GPA dose response of ∼6.5 induced variants/106 cells/Gy which is 1/3 to 1/4 of that previously observed for Hiroshima A-bomb survivors and individuals exposed at the Chernobyl nuclear reactor and Goiania Cs137 source accidents who predominantly received external exposures to ionizing radiation. The lower slope of the dose response observed in the I131 treated patients may reflect a reduced biological effectiveness of this exposure due to differences in the energy spectra of the γ radiation, internal versus external exposure, and/or protracted versus acute dose rate effects. Ongoing studies of I131 treated patients are designed to define the shape of the low dose response and limit of sensitivity of the GPA assay; parameters that are required for the application of the assay as a quantitative cumulative radiation biodosimeter in medical, occupational, and accidental exposure settings. This biodosimetric analysis of patients receiving very similar marrow exposures will also permit an assessment of the inter-individual variability in biological response to ionizing radiation

  13. Long-Term Quality of Life and Pregnancy Outcomes of Differentiated Thyroid Cancer Survivors Treated by Total Thyroidectomy and I131 during Adolescence and Young Adulthood

    OpenAIRE

    Metallo, Melanie; Groza, Lelia; Brunaud, Laurent; Klein, Marc; Weryha, Georges; Feigerlova, Eva

    2016-01-01

    Introduction. Differentiated thyroid cancer (DTC) is rare and confers good prognosis. Long-term health related quality of life (HRQoL) and pregnancy outcomes are not well known in subjects treated during adolescence and young adulthood. Methods. Cross-sectional analysis of HRQoL and global self-esteem, using SF-36 and ISP-25 surveys, and of pregnancy outcomes in female survivors of DTC treated by total thyroidectomy and I131 before age of 25 years. Results. Forty-five of 61 patients (74%) res...

  14. Successful Desensitization of a Patient with Rituximab Hypersensitivity

    Directory of Open Access Journals (Sweden)

    Pinar Ataca

    2015-01-01

    Full Text Available Rituximab is a monoclonal antibody which targets CD20 in B cells that is used for the treatment of CD20 positive oncologic and hematologic malignancies. Rituximab causes hypersensitivity reactions during infusions. The delay of treatment or loss of a highly efficient drug can be prevented by rapid drug desensitization method in patients who are allergic to rituximab. We report a low grade B cell non-Hodgkin lymphoma patient with rituximab hypersensitivity successfully treated with rapid drug desensitization. In experienced centers, drug desensitization is a novel modality to break through in case of hypersensitivity that should be considered.

  15. Estimation of ingestion dose due to I-131 in the initial month by using food-monitoring data after the Fukushima nuclear disaster in Japan

    International Nuclear Information System (INIS)

    The committed equivalent dose to the thyroid caused by I-131 and the effective dose caused by I-131, Cs-134 and Cs-137 due to ingestion immediately after the accidental releases following the Fukushima nuclear disaster in March 2011 were estimated retrospectively by using measured food data. A food monitoring dataset provided by the Ministry of Health, Labour and Welfare (MHLW) up to April 18, 2011 (N=1,752) was used for this study. Information on food consumption by 99 food categories was made available by using the original data of the Japanese National Food Consumption Survey, which was conducted in 2009 (N=9,942). Food concentration every 4 days and food consumption in each food category was randomly picked up (N=100,000). The levels of radioactive iodine and cesium were summed for one month and then converted to equivalent doses to the thyroid and effective doses. These doses in the first month after the Fukushima nuclear power plant accident were evaluated by using the food monitoring dataset provided by the MHLW. Assuming that food was randomly extracted from monitored food samples and food restrictions were fully implemented, the 90%tile of the equivalent doses to the thyroid and the effective doses in 1- to 6-year-old children were estimated to be around 1 mSv and 0.07 mSv, respectively. Several different methods should be considered to reduce limitations of this estimation. (author)

  16. The standardization methods of radioactive sources (125I, 131I, 99mTc, and 18F) for calibrating nuclear medicine equipment in Indonesia

    Science.gov (United States)

    Wurdiyanto, G.; Candra, H.

    2016-03-01

    The standardization of radioactive sources (125I, 131I, 99mTc and 18F) to calibrate the nuclear medicine equipment had been carried out in PTKMR-BATAN. This is necessary because the radioactive sources used in the field of nuclear medicine has a very short half-life in other that to obtain a quality measurement results require special treatment. Besides that, the use of nuclear medicine techniques in Indonesia develop rapidly. All the radioactive sources were prepared by gravimetric methods. Standardization of 125I has been carried out by photon- photon coincidence methods, while the others have been carried out by gamma spectrometry methods. The standar sources are used to calibrate a Capintec CRC-7BT radionuclide calibrator. The results shows that calibration factor for Capintec CRC-7BT dose calibrator is 1,03; 1,02; 1,06; and 1,04 for 125I, 131I, 99mTc and 18F respectively, by about 5 to 6% of the expanded uncertainties.

  17. Long-Term Quality of Life and Pregnancy Outcomes of Differentiated Thyroid Cancer Survivors Treated by Total Thyroidectomy and I131 during Adolescence and Young Adulthood

    Directory of Open Access Journals (Sweden)

    Melanie Metallo

    2016-01-01

    Full Text Available Introduction. Differentiated thyroid cancer (DTC is rare and confers good prognosis. Long-term health related quality of life (HRQoL and pregnancy outcomes are not well known in subjects treated during adolescence and young adulthood. Methods. Cross-sectional analysis of HRQoL and global self-esteem, using SF-36 and ISP-25 surveys, and of pregnancy outcomes in female survivors of DTC treated by total thyroidectomy and I131 before age of 25 years. Results. Forty-five of 61 patients (74% responded to the survey. Cumulative I131 activity was ≤3.85 GBq in 18 subjects and >3.85 GBq in 27 subjects. Mean time from diagnosis was 7.6 ± 5.2 years for the group ≤ 3.85 GBq versus 16.9 ± 11.6 years for the group > 3.85 GBq (P 3.85 GBq and 10 in patients from the group ≤ 3.85 GBq. Frequency of miscarriages was of 17% (group > 3.85 GBq and 10% (group ≤ 3.85 GBq with 9 and 24 live births, respectively. No congenital malformations or first year mortality was noted. Conclusion. Long-term HRQoL, global self-esteem, and pregnancy outcomes are not affected in young female survivors of DTC.

  18. Normalization of lymphocyte count after high ablative dose of I-131 in a patient with chronic lymphoid leukemia and secondary papillary carcinoma of the thyroid: case report; Normalizacao da contagem de linfocitos apos dose ablativa de I-131 em um paciente com leucemia linfoide cronica e carcinoma papilifero da tireoide: relato de caso

    Energy Technology Data Exchange (ETDEWEB)

    Thom, Anneliese Rosmarie Gertrud Fischer; Hamerschlak, Nelson; Osawa, Akemi; Santos, Fabio Pires de Souza; Pasqualin, Denise da Cunha; Wagner, Jairo; Yamaga, Lilian Yuri Itaya; Cunha, Marcelo Livorsi da; Campos Neto, Guilherme de Carvalho; Funari, Marcelo Buarque de Gusmao, E-mail: afthom@einstein.br [Hospital Israelita Albert Einstein, Sao Paulo, SP (Brazil); Teles, Veronica Goes [Sociedade Brasileira de Diabetes, Sao Paulo, SP (Brazil)

    2014-07-01

    The authors report the case of a 70-year-old male patient with chronic lymphoid leukemia who presented subsequently a papillary carcinoma of the thyroid with metastases to regional lymph nodes. The patient was treated with surgical thyroidectomy with regional and cervical lymph node excision and radioiodine therapy (I-131). The protocolar control scintigraphy 4 days after the radioactive dose showed I-131 uptake in both axillae and even in the inguinal regions. PET/CT showed faint FDG-F-18 uptake in one lymph node of the left axilla. An ultrasound guided fine needle biopsy of this lymph node identified by I-131 SPECT/CT and FDG-F-18 PET/CT revealed lymphoma cells and was negative for thyroid tissue and thyroglobulin content. The sequential blood counts done routinely after radiation treatment showed a marked fall until return to normal values of leucocytes and lymphocytes (absolute and relative), which were still normal in the last control 19 months after the radioiodine administration. Chest computed tomography showed a decrease in size of axillary and paraaortic lymph nodes. By immunohistochemistry, cells of the lymphoid B lineage decreased from 52% before radioiodine therapy to 5% after the procedure. The authors speculate about a possible sodium iodide symporter expression by the cells of this lymphoma, similar to some other non-thyroid tumors, such as breast cancer cells. (author)

  19. Detection for residual thyroid tissue and metastatic lesion after total thyroidectomy in patients with differentiated thyroid cancer: comparison between Tc-99m pertechnetate scan and high dose I-131 therapy scan

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Joo Ryung; Ahn, Byeong Cheol; Jeong, Shin Young; Lee, Fae Tae; Lee, Kyu Bo [Kyungpook National University Medical School, Daegu (Korea, Republic of)

    2003-04-01

    To evaluate diagnostic sensitivity of nuclear imaging in the detection of residual thyroid tissue and metastatic lesion, we have compared neck scintigrams with Tc-99m pertechnetate (Tc-99m scan) and high dose I-131 iodide (I-131 scan) in patients with differentiated thyroid cancer. One hundred thirty-five thyroidectomized patients for differentiated thyroid cancer were enrolled in this study. Twenty-three had a previous history of radioiodine therapy. Planar and pin-hole images of anterior neck with Tc-99m were acquired at 20 minutes after injection, followed by I-131 scan three days after high-dose radioiodine therapy with 7 days interval. Patients were asked to discontinue thyroid hormone replacement more than 4 weeks. All subjects were in hypothyroid state. Seventy out of 135 patients (51.9%) showed concordant findings between Tc-99m and I-131 scan. Tc-99m scan did not show any uptake in thyroid bed in 11 of 112 patients without previous history of radioiodine therapy, but 9 of them showed bed uptake in I-131 scan. Tc-99m scan showed no bed uptake in all of the 23 patients with previous history of radioiodine therapy, in contrast 14 of them (60.9%) showed bed uptake in I-131 scan. These results suggest that Tc-99m scan has poor detectability for residual thyroid tissue or metastatic lesion in thyroidectomized differentiated thyroid cancer patients, compared to high dose I-131 therapy scan. Tc-99m scan could not detect any remnant tissue or metastatic lesion in patients with previous history of radioiodine treatment, especially.

  20. Update on the use of rituximab for intractable rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    R John Looney

    2009-07-01

    Full Text Available R John LooneyUniversity of Rochester, Rochester, New York, USAAbstract: It has been 3 years since rituximab, a mouse x human chimeric anti-CD20 monoclonal antibody that selectively depleted B cells, was approved by the FDA for the treatment of moderate to severe rheumatoid arthritis (RA with an inadequate response to anti-TNF therapies. Since approval rituximab has become a part of standard treatment, and additional data have become available on long-term efficacy and safety both from clinical trials and from post-marketing surveillance. In open long-term follow-up from clinical trials, patients treated with multiple courses of rituximab continued to respond in terms of signs and symptoms, and damage assessed radiographically was significantly inhibited. Moreover, the rate of serious infectious events was not increased as the number of courses increased. However, because of case reports of progressive multifocal leukoencephalopathy in patients treated with rituximab for non-malignant conditions, a black box warning has been added. Studies on the immunologic correlates of response to rituximab treatment including B cell subsets in peripheral blood and synovial biopsies are providing clues into how rituximab works for autoimmune disease. However, at this time we are not able to explain why some patients do not respond and cannot predict who will respond. Future challenges for the further development of rituximab for intractable RA will be discussed.Keywords: rheumatoid arthritis, rituximab, B cells, immunocompetency

  1. Ibrutinib and rituximab induced rapid response in refractory Richter syndrome

    OpenAIRE

    Lamar, Zanetta; Kennedy, LeAnne; Kennedy, Brooke; Lynch, Mary; Goad, Amanda; Hurd, David; McIver, Zachariah

    2015-01-01

    Key Clinical Message We report a 53-year-old man diagnosed with Richter syndrome. He was heavily pretreated and was refractory to prior therapy. He received rituximab and ibrutinib, and achieved a significant response after 1 month of therapy. Our case illustrates the importance of investigation of rituximab and ibrutinib in Richter’s syndrome.

  2. Rituximab Desensitization in Pediatric Patients: Results of a Case Series

    Science.gov (United States)

    Lee, Joyce P.; Platt, Craig D.

    2016-01-01

    Rituximab is a monoclonal antibody (mAb) primarily used to treat oncologic and autoinflammatory conditions. Although hypersensitivity reactions (HSRs) and desensitization protocols to mAbs have been well described in adults, the experience in the pediatric population is very limited. We sought to determine the safety and efficacy of desensitization to rituximab in the pediatric population at our institution. We retrospectively reviewed the experience with HSRs and desensitization to rituximab during a 5-year period in our tertiary care pediatric center, including reaction evaluation, premedication regimens, and desensitization procedures and protocols. A total of 17 desensitizations to rituximab were performed in three patients. A 14-year-old patient underwent successful desensitization to rituximab using a published adult protocol without incident. Two younger patients (ages 7 years and 23 months) experienced significant reactions during initial desensitization attempts. Therefore, we designed a modified desensitization protocol to rituximab, with particular attention to the rate of infusion as mg/kg/h. This new patient weight-based protocol was successfully used in a total of 13 desensitizations in these two patients. Desensitization to rituximab was a safe and effective procedure in our pediatric population. We present a new patient weight-based desensitization protocol for pediatric patients who develop HSRs to rituximab, with particular usefulness for younger pediatric patients and potential utility in pediatric patients with HSRs to other mAbs.

  3. A Case of Chronic Conjunctivitis following Rituximab Therapy

    Directory of Open Access Journals (Sweden)

    Marnelli A. Bautista

    2009-01-01

    Full Text Available The activity of the anti-CD20 monoclonal antibody, rituximab in B-cell non-Hodgkin's lymphoma, with relatively minimal toxicity has been well established. Adverse effects such as low-grade fever, urticaria, bronchospasm, sporadic tachycardia, and hypotension have been described. However, only a single case of rituximab-related, transient conjunctivitis has been documented in literature. We report an occurrence of chronic, bilateral conjunctivitis in an 88-year-old female diagnosed with stage IV, non-Hodgkin's lymphoma (NHL, who was maintained on rituximab for 12 months. In contrast to the previously described case, our patient developed severe conjunctival inflammation approximately three to four weeks following rituximab induction. Resolution of conjunctivitis occurred within two months after cessation of rituximab treatment.

  4. B Cell Depletion: Rituximab in Glomerular Disease and Transplantation

    Directory of Open Access Journals (Sweden)

    S. Marinaki

    2013-12-01

    Full Text Available B cells play a central role in the pathogenesis of many autoimmune diseases. Selective targeting can be achieved with the use of the monoclonal antibody rituximab. In addition to being a drug for non-Hodgkin's lymphoma, rituximab is also an FDA-approved treatment for refractory rheumatoid arthritis and, since recently, ANCA vasculitis. It has shown efficacy in many autoimmune diseases. This review will discuss current evidence and the rationale of the use of rituximab in glomerular diseases, including randomized controlled trials. The focus will be on the use of rituximab in idiopathic membranous nephropathy, systemic lupus erythematosus and ANCA-associated vasculitis. The emerging role of rituximab in renal transplantation, where it seems to be important for the desensitization protocols for highly sensitized patients as well as for the preconditioning of ABO-incompatible recipients and the treatment of antibody-mediated rejection, will also be addressed.

  5. Rituximab in B-Lineage Adult Acute Lymphoblastic Leukemia.

    Science.gov (United States)

    Maury, Sébastien; Chevret, Sylvie; Thomas, Xavier; Heim, Dominik; Leguay, Thibaut; Huguet, Françoise; Chevallier, Patrice; Hunault, Mathilde; Boissel, Nicolas; Escoffre-Barbe, Martine; Hess, Urs; Vey, Norbert; Pignon, Jean-Michel; Braun, Thorsten; Marolleau, Jean-Pierre; Cahn, Jean-Yves; Chalandon, Yves; Lhéritier, Véronique; Beldjord, Kheira; Béné, Marie C; Ifrah, Norbert; Dombret, Hervé

    2016-09-15

    Background Treatment with rituximab has improved the outcome for patients with non-Hodgkin's lymphoma. Patients with B-lineage acute lymphoblastic leukemia (ALL) may also have the CD20 antigen, which is targeted by rituximab. Although single-group studies suggest that adding rituximab to chemotherapy could improve the outcome in such patients, this hypothesis has not been tested in a randomized trial. Methods We randomly assigned adults (18 to 59 years of age) with CD20-positive, Philadelphia chromosome (Ph)-negative ALL to receive chemotherapy with or without rituximab, with event-free survival as the primary end point. Rituximab was given during all treatment phases, for a total of 16 to 18 infusions. Results From May 2006 through April 2014, a total of 209 patients were enrolled: 105 in the rituximab group and 104 in the control group. After a median follow-up of 30 months, event-free survival was longer in the rituximab group than in the control group (hazard ratio, 0.66; 95% confidence interval [CI], 0.45 to 0.98; P=0.04); the estimated 2-year event-free survival rates were 65% (95% CI, 56 to 75) and 52% (95% CI, 43 to 63), respectively. Treatment with rituximab remained associated with longer event-free survival in a multivariate analysis. The overall incidence rate of severe adverse events did not differ significantly between the two groups, but fewer allergic reactions to asparaginase were observed in the rituximab group. Conclusions Adding rituximab to the ALL chemotherapy protocol improved the outcome for younger adults with CD20-positive, Ph-negative ALL. (Funded by the Regional Clinical Research Office, Paris, and others; ClinicalTrials.gov number, NCT00327678 .). PMID:27626518

  6. Preparation & in vitro evaluation of 90 Y-DOTA-rituximab

    Directory of Open Access Journals (Sweden)

    Mythili Kameswaran

    2016-01-01

    Full Text Available Background & objectives: Radioimmunotherapy is extensively being used for the treatment of non-Hodgkin′s lymphoma (NHL. Use of rituximab, a chimeric anti-CD20 antibody directed against the CD20 antigen in combination with suitable beta emitters is expected to result in good treatment response by its cross-fire and bystander effects. The present work involves the conjugation of p-isothiocyanatobenzyl DOTA (p-SCN-Bn-DOTA to rituximab, its radiolabelling with [90] Y and in vitro and in vivo evaluation to determine its potential as a radioimmunotherapeutic agent. Methods: Rituximab was conjugated with p-SCN-Bn-DOTA at 1:1 antibody: DOTA molar ratio. The number of DOTA molecules linked to one molecule of rituximab was determined by radioassay and spectroscopic assay. Radiolabelling of rituximab with 90 Y was carried out and its in vitro stability was evaluated. In vitro cell binding studies were carried out in Raji cells expressing CD20 antigen. Biodistribution studies were carried out in normal Swiss mice. Results: Using both radioassay and spectroscopic method, it was determined that about five molecules of DOTA were linked to rituximab. Radiolabelling of the rituximab conjugate with [90] Y and subsequent purification on PD-10 column gave a product with radiochemical purity (RCP > 98 per cent which was retained at > 90 per cent up to 72 h when stored at 37°C. In vitro cell binding experiments of 90 Y-DOTA-rituximab with Raji cells exhibited specific binding of 20.7 ± 0.1 per cent with [90] Y-DOTA-rituximab which reduced to 15.5 ± 0.2 per cent when incubated with cold rituximab. The equilibrium constant K d for 90 Y-DOTA-Rituximab was determined to be 3.38 nM. Radiolabelled antibody showed clearance via hepatobiliary and renal routes and activity in tibia was found to be quite low indicating in vivo stability of [90] Y-DOTA-rituximab. Interpretation & conclusions: p-SCN-Bn-DOTA was conjugated with rituximab and radiolabelling with 90 Y was

  7. The first programme of assesment of occupational exposure due to intake of I-131 in the practice of nuclear medicine in Venezuela

    International Nuclear Information System (INIS)

    The amount of medical procedures on the Single Photon Emission Computerized Tomography (SPECT) and Positron Emission Tomography Computerized (PET/CT) practices has increased dramatically in Venezuela. Unfortunately, Venezuela lacks assessment experience on occupational exposure due to intakes of radionuclide in nuclear medicine practices. The Venezuelan Scientific Investigations Institute (IVIC) in cooperation with the Colombia National University-Sede Medellin are developing the methodology to implement in Venezuela the evaluation of the occupational exposure due to the intakes of Iodine-131 in concordance with Safety Standards Series No RS-G-1.2 (IAEA). For this task, we selected four institutions as reference. The first institution is a business company dedicated to fractioning I-131 doses; the other three institutions are health institutions which perform various diagnostic examinations involving intravenous administration of radiopharmaceutical. In a three month period, every 15 days, seven technicians working in these institutions were individually monitored according to the recommendation of the ICRP 78. Two types of measurements were made: Direct measurements in the thyroid using a NaI(TI) crystal and indirect measurements of urine samples collected for 24 hours. The Committed Effective Dose E(50) and Committed Equivalent Dose H(50) of workers was estimated running the AIDE code developed in the Region. The doses were compared with the following reference: levels: Investigation levels (ILj), recording level (RLj) and derived levels (DILj) established for this program according to Safety Guide No RS-G-1.2. Finally based on these results, we should take a decision on the methodology for a national programme for assessment of occupational exposures due to intakes of I-131 in nuclear medicine practice. (author)

  8. I-131 Treatment of Graves' Disease in an Unsuspected First Trimester Pregnancy; the Potential for Adverse Effects on the Fetus and a Review of the Current Guidelines for Pregnancy Screening

    Directory of Open Access Journals (Sweden)

    Barrett Mark

    2010-03-01

    Full Text Available Graves' disease is a thyroid-specific autoimmune disorder in which the body makes antibodies to the thyroid-stimulating hormone receptor leading to hyperthyroidism. Therapeutic options for the treatment of Graves' disease include medication, radioactive iodine ablation, and surgery. Radioactive iodine is absolutely contraindicated in pregnancy as exposure to I-131 to the fetal thyroid can result in fetal hypothyroidism and cretinism. Here we describe a case of a female patient with recurrent Graves' disease, who inadvertently received I-131 therapy when she was estimated to be eight days pregnant. This was despite the obtaining of a negative history of pregnancy and a negative urine pregnancy test less than 24 hours prior to ablation. At birth, the infant was found to have neonatal Graves' disease. The neonatal Graves' disease resolved spontaneously. It was suspected that the fetal thyroid did not trap any I-131 as it does not concentrate iodine until 10 weeks of gestation.

  9. The effect of combination therapy with doxorubicin and I-131 in multidrug resistance (MDR) gene expressing cancer cells by transduced shRNA for mdr1 mRNA and sodium Iodine symporter (NIS) genes

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Sohn Joo; Lee, Yong Jin; Lee, You La; Lee, Sang Woo; Yoo, Jeong Soo; Ahn, Byeong Cheol; Lee, Jae Tae [School of Medicine, Kyungpook National University, Daegu (Korea, Republic of)

    2007-07-01

    Transduction of shMDR for mdr1 gene and NIS gene into MDR cancer cells expressing MDR can improve therapeutic effect of anticancer treatment. We have established stable cell lines expressing both shMDR and NIS gene using mammalian expression vector from human colon cancer cells having MDR characteristics. In this study, we have evaluated effects of combined therapy with doxorubicin and I-131 in xenograft model of MDR human colon cancer cells transduced with shMDR and NIS genes. We prepared adenoviruses containing shMDR (Ad-shMDR) or NIS (Ad-NIS) gene and finally established stable cell lines expressing both shMDR and NIS gene. Two days after transfection, inhibition of P-gp function by shMDR was assessed by a change of Tc-99m MIBI uptake, and functional activity of induced NIS expression was also assessed by a change of I-125 uptake. Doxorubicin and I-131 cytotoxicity was measured in Ad-shMDR transfected or non-transfected cell lines. Tc-99m MlBl and I-131 images was obtained effect in Ad-shMDR/NIS-cotransfected tumor xenograft. Dual therapy using doxorubicin and I-131 was measured effect in injected tumor xenograft by shMDR and NIS gene expressing stable cells. After transfection, uptake of Tc-99m MIBI and I-125 increased up to {approx}1.5-fold and approximately 25-fold compared to control. Ad-shMDR/NIS-cotransfected HCT15 cell showed enhanced cytotoxicity by doxorubicin and I-131 compared to control. Tc-99m MIBI and I-131 images demonstrated that in Ad-shMDR/NIS-cotransfected tumor xenograft were 2 and 10 times higher than that in non-intratumoral injected tumor xenograft. Therapy with I-131, or both doxorubicin and I-131 were revealed enhanced tumor regression than control group. Suppression of mdr1 gene expression and enhanced iodine uptake can be produced by shMDR and NIS gene transfection. Dual therapy with doxorubicin and radioiodine followed by transfection of shMDR/NIS gene can be effectively used in MDR expressing cancer cell.

  10. The evaluation and optimal use of rituximab in lymphoid malignancies

    Directory of Open Access Journals (Sweden)

    Smolewski P

    2012-01-01

    Full Text Available Tadeusz Robak1, Pawel Robak2, Piotr Smolewski21Department of Hematology, 2Experimental Hematology, Medical University of Łódź, Łódź, PolandAbstract: Rituximab is an IgG1, chimeric monoclonal antibody (mAb containing murine light- and heavy-chain variable-region sequences and human constant-region sequences. Rituximab targets the CD20 molecule expressed on normal and malignant B-lymphocytes. At present, rituximab is the most important mAb of clinical value in patients with B-cell lymphoid malignancies. Since approval in 1997, rituximab has become widely used in chronic lymphocytic leukemia (CLL, follicular lymphoma (FL, mantle cell lymphoma (MCL, and diffused large B-cell lymphoma (DLBCL when combined with chemotherapy. Currently, rituximab is commonly combined with first-line chemotherapy for FL and should be offered as maintenance therapy to all appropriate patients with this disease. Randomized Phase III trials demonstrated the superiority of rituximab added to CHOP chemotherapy against CHOP chemotherapy alone in patients with DLBCL. Rituximab alone has limited activity in MCL but can be used in MCL in combination with chemotherapy, despite the benefits not being as impressive as when used against other lymphoma entities. In addition, for the less frequent B-cell lymphomas, small series show considerable activity for most of these entities. Fludarabine and rituximab combination therapies in CLL yielded promising results in several studies. Two large Phase III randomized trials demonstrated the superiority of chemoimmunotherapy with rituximab compared with chemotherapy alone in previously untreated and refractory/relapsed patients with CLL. Therefore, it can be concluded that rituximab, with only few exceptions, can generally be accepted as a standard component of anti B-cell non-Hodgkin's lymphoma therapies. In this review, the pharmacology, mode of action, pharmacokinetics, and current place in the therapy of B-cell lymphoid

  11. Treatment of orbital inflammation with rituximab in Wegener's granulomatosis

    DEFF Research Database (Denmark)

    Baslund, Bo; Wiencke, Anne Katrine; Rasmussen, Niels;

    2012-01-01

    inflammation. All patients were treated with 1000 mg of rituximab administered twice with an interval of 14 days between the infusions. Six months after therapy, a physical examination and a control computerised tomography (CT) scan was performed. RESULTS: All patients had orbital inflammation demonstrated......OBJECTIVES: To study the efficacy of rituximab therapy for the treatment of orbital inflammation in patients with Wegener's granulomatosis (WG). METHODS: Ten WG patients with orbital inflammation were included in this case-series. None had symptoms suggestive of extra-orbital disease activity...... the size of the orbital mass was unchanged in eight patients. CONCLUSIONS: Rituximab therapy has positive effects on symptoms, visual acuity and/or granuloma size in some WG patients with orbital inflammation. Treatment with rituximab should be considered in WG patients with this serious manifestation...

  12. Prolonged Remission in Neuromyelitis Optica Following Cessation of Rituximab Treatment.

    Science.gov (United States)

    Weinfurtner, Kelley; Graves, Jennifer; Ness, Jayne; Krupp, Lauren; Milazzo, Maria; Waubant, Emmanuelle

    2015-09-01

    Neuromyelitis optica is an autoimmune disease characterized by acute episodes of transverse myelitis and optic neuritis. Several small, open-label studies suggest rituximab, a monoclonal antibody against CD20, prevents relapses in neuromyelitis optica; however, there is little consensus on timing or duration of treatment. Here we report four patients with severe relapsing neuromyelitis optica who were stabilized on rituximab and, after discontinuing treatment, continued to experience prolonged remission of their disease. Remission ranged from 4.5 to 10.5 years total, including 3 to 9 years off all therapies. The patients had sustained clinical responses despite normal B-lymphocyte levels and, in at least 2 patients, continued seropositivity for aquaporin-4 antibodies. These cases suggest that rituximab may induce prolonged remission in certain neuromyelitis optica patients, and they highlight the need for further elucidation of rituximab's mechanism in neuromyelitis optica.

  13. Rituximab: An emerging therapeutic agent for kidney transplantation

    Directory of Open Access Journals (Sweden)

    Joseph Kahwaji

    2009-10-01

    Full Text Available Joseph Kahwaji, Chris Tong, Stanley C Jordan, Ashley A VoComprehensive Transplant Center, Transplant immunology Laboratory, HLA Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA, USAAbstract: Rituximab (anti-CD20, anti-B-cell is now emerging as an important drug for modification of B-cell and antibody responses in solid-organ transplant recipients. Its uses are varied and range from facilitating desensitization and ABO blood group-incompatible transplantation to the treatment of antibody-mediated rejection (AMR, post-transplant lymphoproliferative disorder (PTLD, and recurrent glomerular diseases in the renal allograft. Despite these uses, prospective randomized trials are lacking. Only case reports exist in regards to its use in de novo and recurrent diseases in the renal allograft. Recent reports suggests that the addition of rituximab to intravenous immunoglobulin (IVIG may have significant benefits for desensitization and treatment of AMR and chronic rejection. Current dosing recommendations are based on data from United States Food and Drug Administration-approved indications for treatment of B-cell lymphomas and rheumatoid arthritis. From the initial reported experience in solid organ transplant recipients, the drug is well tolerated and not associated with increased infectious risks. However, close monitoring for viral infections is recommended with rituximab use. The occurrence of progressive multifocal leukoencephalopathy (PML has been reported with rituximab use. However, this is rare and not reported in the renal transplant population. Here we will review current information regarding the effectiveness of rituximab as an agent for desensitization of highly human leukocyte antigen-sensitized and ABO-incompatible transplant recipients and its use in treatment of AMR. In addition, the post-transplant use of rituximab for treatment of PTLD and for recurrent and de novo glomerulonephritis in the allograft will be discussed. In

  14. A practical guideline for the release of patients treated by I-131 based on Monte Carlo dose calculations for family members

    International Nuclear Information System (INIS)

    We recently published effective doses per time-integrated activity (mSv MBq−1 s−1) for paediatric and adult family members exposed to an adult patient released from hospital following I-131 therapy. In the present study, we intend to provide medical physicists with a methodology to estimate family member effective dose in daily clinical practice because the duration of post-radiation precautions for the patient–family member exposure scenario has not been explicitly delineated based on the effective dose. Four different exposure scenarios are considered in this study including (1) a patient and a family member standing face to face, (2) a patient and a family member lying side by side, (3) an adult female patient holding a newborn child to her chest and (4) a one-year-old child standing on the lap of an adult female patient following her I-131 therapy. The results of this study suggest that an adult female hyperthyroidism (HT) patient who was administered with 740 MBq should keep a distance of 100 cm from a 15-year-old child for six days and the same distance from other adults for seven days. The HT female patient should avoid holding a newborn against her chest for at least 16 days following hospital discharge, and a female patient treated with 5550 MBq for differentiated thyroid cancer should not hold her newborn child for at least 15 days following hospital discharge. This study also gives dose coefficients allowing one to predict age-specific effective doses to family members given the measured dose rate (mSv h−1) of the patient. In conclusion, effective dose-based patient release criteria with a modified NRC two-component model provide a site medical physicist with less restrictive and age-specific radiation precaution guidance as they fully consider a patient’s iodine biokinetics and photon attenuation within both the patient and the exposed family members. (note)

  15. Comparative evaluation of early and late whole body scan images post-therapy with I131 in patients with differentiated thyroid cancer

    International Nuclear Information System (INIS)

    Aim: In order to reduce the period of time between the therapy with I131 and the acquisition of images for Whole Body Scan (WBS), the aim of this investigation is the comparison of WBS images acquired early (4th-6th days) and late (10th-15th days). Materials and Methods: 15 patients whit the diagnosis of Differentiated Thyroid Carcinoma (Follicular and Papillary) were included in the study. All of them received a therapeutic dose of Iodine 131 of 100 mCi. WBS images were obtained in one early control -4th - 6th day- and after 10-15 days post-therapy -late control-, using an SPECT system General Electric Starcam 3200 AC/T. The WB images were acquired in 512x128 matrix for anterior and posterior views. Their evaluation was performed blind and independently by 3 Nuclear Medicine Physicians, classifying the cases according a checklist 'with changes or without changes'. The signification of the results was evaluated by McNemar non parametric Test, using a significance level alfa=0.05. Results: 60% of patients showed some change between early and late controls. The change consisted of important descending or complete disappearance of I131 uptake focus in late control comparing with early evaluation. In the 33.3% of cases (44% of focus) is possible to observe total disappearance of focus described early. In 4 patients there were extra thyroidal metastasis, they didn't present reduction in their intensity of uptake and in one case the focus increased the uptake. Likewise, there was possible to determine the frequency of observation for the uptaking of Iodine 131 in normal sites. Conclusion: The changes observed between early and late evaluations an unacceptable loss of information which support the idea in order to evaluate with WBS images to the patient early (4th-6th day). This change is very appreciated in order to reduce the period between the therapy and control and it's a favourable support for the aim of this investigation

  16. The combination of ANT2 shRNA and hNIS radioiodine gene therapy increases CTL cytotoxic activity through the phenotypic modulation of cancer cells: combination treatment with ANT2 shRNA and I-131

    International Nuclear Information System (INIS)

    It is important to simultaneously induce strong cell death and antitumor immunity in cancer patients for successful cancer treatment. Here, we investigated the cytotoxic and phenotypic modulation effects of the combination of ANT2 shRNA and human sodium iodide symporter (hNIS) radioiodine gene therapy in vitro and in vivo and visualized the antitumor effects in an immunocompromised mouse colon cancer model. A mouse colon cancer cell line co-expressing hNIS and the luciferase gene (CT26/hNIS-Fluc, named CT26/NF) was established. CT26/NF cells and tumor-bearing mice were treated with HBSS, scramble, ANT2 shRNA, I-131, and ANT2 shRNA + I-131. The apoptotic rates (%) and MHC class I and Fas gene expression levels were determined in treated CT26/NF cells using flow cytometry. Concurrently, the level of caspase-3 activation was determined in treated cells in vitro. For in vivo therapy, tumor-bearing mice were treated with scramble, ANT2 shRNA, I-131, and the combination therapy, and the anti-tumor effects were monitored using bioluminescence. The killing activity of cytotoxic T cells (CTLs) was measured with a lactate dehydrogenase (LDH) assay. For the in vitro experiments, the combination of ANT2 shRNA and I-131 resulted in a higher apoptotic cell death rate compared with ANT2 shRNA or I-131 alone, and the levels of MHC class I and Fas-expressing cancer cells were highest in the cells receiving combination treatment, while single treatment modestly increased the level of MHC class I and Fas gene expression. The combination of ANT2 shRNA and I-131 resulted in a higher caspase-3 activation than single treatments. Interestingly, in vivo combination treatment led to increased gene expression of MHC class I and Fas than the respective mono-therapies; furthermore, bioluminescence showed increased antitumor effects after combination treatment than monotherapies. The LDH assay revealed that the CTL killing activity against CT26/NF cells was most effective after combination

  17. The Effects of the Factors Related to the Patient and the Disease on the Performance of Ablation Therapy in Patients with Differentiated Thyroid Cancer who have Received I-131 Ablation Therapy

    Directory of Open Access Journals (Sweden)

    Tarık Şengöz

    2012-12-01

    Full Text Available Objective: To investigate whether the factors related to the patient and the disease have any effect on the success of ablation therapy in patients with differentiated thyroid cancer who have received I-131 ablation therapy. Material and Methods: All the patients with differentiated thyroid cancer were referred for I-131 ablation therapy after thyroidectomy between July 2007 and September 2009. The patients had at least six months of follow-up. Age, gender, type of tumor, presence of capsule invasion, size of tumor, number of the tumors, localization of the tumor, invasion of thyroid capsule, lymph/vessel invasion, presence of metastatic lymph nodes, type of surgery, preablation values of thyroglobulin (Tg, AntiTg, TSH, surveys for the evaluation of metastatic disease, (thyroid and bone scintigraphy, neck and abdominal ultrasonography, chest and brain computerized tomography, administered dose, postablation I-131 whole body scan (WBS and diagnostic I-131 WBS, neck USG, values of Tg and AntiTg at the 6th month were recorded. The presence of residual thyroid activity on the 6th month diagnostic I-131 WBS image was accepted as the criterion for ablation success. Results: 191 patients with differentiated thyroid cancer were assessed in this study. The overall success rate of the first ablation therapy was 74.3%. The success rate of the ablation therapy was 66% and 75% in metastatic group and non-metastatic group, respectively. Except the significant correlation between the number of pathologic lymph nodes and the success of ablation (p=0.025, there was no other significant correlation between the patient/disease related factors and the success of ablation therapy. Conclusion: Significant correlation between the number of the pathologic lymph nodes and the ablation therapy performance can also be due to statistical error because of the limited sample size. There was no significant correlation between other patient/disease related prognostic factors

  18. Rituximab for the treatment of rheumatoid arthritis: an update

    Directory of Open Access Journals (Sweden)

    Mok CC

    2013-12-01

    Full Text Available Chi Chiu MokDepartment of Medicine, Tuen Mun Hospital, Hong Kong, Special Administrative Region of the People's Republic of ChinaAbstract: Rituximab is a chimeric monoclonal antibody that targets the CD20 molecule expressed on the surface of B cells. It was first used in the treatment of non-Hodgkin's lymphoma and later approved for the treatment of rheumatoid arthritis (RA that does not respond adequately to disease-modifying antirheumatic drugs, including the anti-tumor-necrosis-factor (TNF biologics. Sustained efficacy in RA can be achieved by repeated courses of rituximab. However, the optimal dose and retreatment schedule of rituximab in RA remains to be established. Seropositivity, complete B cell depletion shortly after treatment, and previous failure to no more than one anti-TNF agent are three factors associated with greater clinical benefits to rituximab. Infusion reaction to the first dose of rituximab occurs in approximately 25% of RA patients, and the incidence reduces with subsequent exposure. Immunogenicity to the chimeric compound occurs in 11% of RA patients, but this does not correlate with its efficacy in B cell depletion. Extended observation of randomized controlled trials in RA does not reveal a significant increase in the incidence of serious infections related to rituximab compared to placebo groups, and the infection rate remains static over time. Repeated treatment with rituximab is associated with hypogammaglobulinemia, which may increase the risk of serious, but rarely opportunistic, infections. Reactivation of occult hepatitis B infection has been reported in RA patients receiving rituximab, but no increase in the incidence of tuberculosis was observed. Screening for baseline serum immunoglobulin G level and hepatitis B status (including occult infection is important, especially in Asian countries where hepatitis B infection is prevalent. The rare but fatal progressive multifocal leukoencephalopathy linked to the use

  19. Diagnostic Value of I-131 NP-59 SPECT/CT Scintigraphy in Patients with Subclinical or Atypical Features of Primary Aldosteronism

    Directory of Open Access Journals (Sweden)

    Yi-Chun Chen

    2011-01-01

    Full Text Available Accumulating evidence has shown the adverse effect of long-term hyperaldosteronism on cardiovascular morbidity that is independent of blood pressure. However, the diagnosis of primary aldosteronism (PA remains a challenge for patients who present with subtle or atypical features or have chronic kidney disease (CKD. SPECT/CT has proven valuable in the diagnosis of a number of conditions. The aim of this study was to determine the usefulness of I-131 NP-59 SPECT/CT in patients with atypical presentations of PA and in those with CKD. The records of 15 patients with PA were retrospectively analyzed. NP-59 SPECT/CT was able to identify adrenal lesion(s in CKD patients with suspected PA. Patients using NP-59 SPECT/CT imaging, compared with those not performing this procedure, significantly featured nearly normal serum potassium levels, normal aldosterone-renin ratio, and smaller adrenal size on CT and pathological examination and tended to feature stage 1 hypertension and non-suppressed plasma renin activity. These findings show that noninvasive NP-59 SPECT/CT is a useful tool for diagnosis in patients with subclinical or atypical features of PA and those with CKD.

  20. Perfusion pulmonary radio-isotope scan using MA I131 and separate spirographic measurement of each lung. Trial of interpretation in discrepant results

    International Nuclear Information System (INIS)

    The comparison of the results of perfusion pulmonary radio-isotope scanning, using MA I131 and separate bronchospirometry of each lung, in 42 patients with chronic lung disease, showed definite discrepancy in more than 50% of cases. The discrepancies noted are due to the procedure of radioisotope scanning itself, which correspond to the static recording of fixation of macroaggregates blocked in the pulmonary pre-capillaries. They are injected at rest under stable thermodynamic conditions and, instantaneously and preferentially, pass towards the side with the least pressure, i.e. the healthy side. On several occasions, as in this case, a slight increase in arterial pressure in the main mulmonary artery of the deficient lung was noted. This balance may explain the relative failure of scintiscanning as shown by lesser uptake in the diseased lung. Separate bronchospirometry, on the other hand, remains a more dynamic investigation which may be continued under hemodynamic conditions which are subject to variations. It also permits, by a quantitatively precise oxygen consumption, assessment without any error of the relative perfusion of each lung. In conclusion, in functional assessment and, even more, in the diagnosis of operability, lung perfusion scanning does not give information as precise as separate bronchospirometry

  1. Fibrinogen labelling with I-131

    Energy Technology Data Exchange (ETDEWEB)

    Seminario, C.; Capillo, T.; Montanez, J. (Instituto Peruano de Energia Nuclear, Lima)

    1983-05-01

    Of the different techniques of labelling liophylized human fibrinogen, the technique of mono-chloride with modified iodine was selected. The labelling of the molecule was performed in alkali media of buffalo glycine in which the solution of stable iodine will react as well as on a later stage will the radioactive isotope. The labelling processes which were undertaken with different activities had an efficiency of over 40%; when purification with resins amberlite was carried through, in none of the cases were the impurities over 5%. Daily controls till the seventh day showed that the average values of radiochemical purity decrease were lower than 1%. The specific activity as well as the concentration of I/sup 131/, the fibrinogen and other characteristics come up to the norms of the pharmacopoeia which are applied.

  2. Rituximab in patients with CIDP: A report of 13 cases and review of the literature

    OpenAIRE

    Benedetti, Luana; Briani, Chiara; Franciotta, Diego; Fazio, Raffaella; Paolasso, Ilaria; Comi, Cristoforo; Luigetti, Marco; Sabatelli, Mario; Giannini, Fabio; Mancardi, Giovanni Luigi; Schenone, Angelo; Nobile-Orazio, Eduardo; Cocito, Dario

    2010-01-01

    Abstract Background: A few case reports have shown controversial results of rituximab efficacy in patients with CIDP. Objective: To analyze the efficacy of rituximab in a large CIDP cohort. Methods: A retrospective, observational and multicenter study on the use of rituximab in CIDP. We treated 13 Italian CIDP patients with rituximab after the partial or complete lack of efficacy of conventional therapies. Eight patients had co-occurring haematological diseases. Patients ...

  3. Cytomegalovirus enterocolitis in a patient with diffuse large B-cell lymphoma after chemotherapy with rituximab

    Institute of Scientific and Technical Information of China (English)

    Jason Seewoodhary

    2006-01-01

    Rituximab has been associated with the development of cytomegalovirus enterocolitis in immunosuppressed patients. A 51-year-old patient with diffuse large B-cell lymphoma who received a conditioning chemotherapy regimen (RCVP and RICE) consisting of rituximab before bone marrow transplantation went on to develop cytomegalovirus enterocolitis. This supports evidence from previously described cases that rituximab may be associated with cytomegalovirus enterocolitis.

  4. Rituximab and biosimilars – equivalence and reciprocity

    Science.gov (United States)

    Qureshi, Zaina P; Magwood, Jametta S; Singh, Sarveshwari; Bennett, Charles L

    2014-01-01

    Cancer is a debilitating disease affecting millions of people daily. Over the years, cancer treatment has advanced in leaps and bounds. Antibodies are important breakthrough therapeutic agents for cancer. These agents, proteins produced by B lymphocytes of the immune system in response to antigens, bind to receptors on cell surfaces so that the antigen–antibody complexes can be recognized and destroyed by phagocytes. While each B cell synthesizes only one kind of antibody, an entire population of different types of B cells and their respective antibodies are produced in response to various antigens to which the organism had been exposed. However, to be useful clinically, substantial amounts of a single antibody must be generated from a single ancestral B cell. These antibodies produced by a specific population of B cells are the monoclonal antibodies that have become the cornerstone of treatment for cancer and many immunologic illnesses. The purpose of this report is to provide an overview of the clinical development of biosimilars in clinical oncology, focusing on rituximab and like biosimilars. PMID:24829884

  5. Severe Primary Raynaud's Disease Treated with Rituximab

    Science.gov (United States)

    Almoallim, Hani

    2016-01-01

    Raynaud's phenomenon refers to reversible spasms of the peripheral arterioles that can be primary Raynaud's phenomenon (PRP) or secondary Raynaud's phenomenon (SRP) to underlying connective tissue disease, both of which are characterized by a triphasic color response triggered by cold exposure or stress. PRP is typically a benign disease, whereas SRP may progress into digital ulcers and/or gangrene. Here, we report a case of a 55-year-old female diagnosed with PRP 7 years ago. Treatment with first-line agents, including calcium channel blocker, aspirin, and phosphodiesterase inhibitor, did not control her symptoms, which progressed to digital ulceration and gangrene. There were no symptoms of underlying autoimmune disease or malignancy, and autoimmune, serology, and immunology test results were normal; a biopsy of her left little finger was negative for vasculitis. Development to critical digital ischemia necessitated treatment with intravenous iloprost and heparin infusion followed by angioplasty, which led to a partial improvement. Due to persistent symptoms, rituximab therapy was initiated and two cycles induced a complete resolution of symptoms. PMID:27651971

  6. A new and simple test for the exocrinic function of the pancreas: Analysis of the urine after oral application of a I-131 labeled triglyceride

    International Nuclear Information System (INIS)

    Aim: A simple non-invasive test for the exocrine function of the pancreas would be attractive to diagnose various diseases of this organ. 1,2-dipalmitoyl-3-[(15-p-[I-131]-iodophenyl)pentadecan-1-oyl]rac-glycerol (MIPPAG) has been evaluated for this purpose. Materials and Methods: After oral administration, IPPA is released from the triglyceride by the action of pancreatic lipases followed by intestinal absorption and subsequent metabolism. Radioiodinated phenylpropenoic acid as the final metabolite of IPPA is then conjugated and excreted into the urine. We investigated 7 normal volunteers, 13 patients without signs of pancreatic disease and 23 patients with pancreatic insufficiency (PI). About 1 MBq Iodine-131-MIPPAG were administered orally with subsequent urine collection for two 24 h periods. Blood samples were withdrawn after 1, 3, 6, and 24 hours. TLC analysis was performed on the serum lipid extracts. As a reference method for PI measurement of the elastase concentration in the feces was used. Results: Healthy subjects excreted 44.9% (SD: 7.5%) of the administered dose in the first 24 h and after 48 h this value cumulated to 61.9 % (SD: 8.1%) whereas patients with PI excreted 27.5% (SD: 15.4%) and 35.0% (SD: 18.7%), respectively. These values were statistically highly significant (p<0.00001) compared to normals. The TLC's showed two major peaks which corresponded to the standards iodine benzoic acid (IBA) and tripalmitin (TP). The IBA/TP ratio increased with time. The sensitivity and specificity of this new test was 78.3% and 100%, respectively. Sensitivity of the elastase test was only 54%. Conclusion: MIPPAG showed the expected physiologic behavior and a pancreatic insufficiency might be diagnosed by a simple urine analysis after oral application of this new tracer

  7. Improving testing for hepatitis B before treatment with rituximab

    Science.gov (United States)

    Jopson, Laura; Ng, Sarah; Lowery, Matthew; Harwood, Jayne; Waugh, Sheila; Valappil, Manoj; McPherson, Stuart

    2016-01-01

    Aims/Objectives/Background Individuals with current or previous infection with the hepatitis B virus (HBV) can experience viral reactivation when treated with immunosuppression. Rituximab, an anti-CD20 antibody used to treat many diseases, has potent immunosuppressant effects with a high risk of causing HBV reactivation. Reactivation can range from elevated liver enzymes to acute severe hepatitis with liver failure and a significant mortality risk. HBV screening and appropriate use of prophylactic antiviral therapy can prevent reactivation. This work describes the introduction of a local policy for HBV testing in patients before rituximab treatment and assesses its impact. Methods and Results A baseline review (before policy introduction) of 90 patients showed that only 21 (23%) had hepatitis B surface antigen (HBsAg) and 17 (19%) had hepatitis B core antibody (anti-HBcAb) tested before receiving rituximab. Following introduction of the policy (on the basis of international guidelines), improved laboratory reporting protocols and targeted education sessions, two further reviews of HBV testing rates among patients being initiated onto rituximab were performed. There was a marked increase in pre-rituximab testing for HBsAg from 23 to 79% and for anti-HBcAb from 19 to 78%. Throughout the study period, a total of one (0.8%) HBsAg-positive and six (4.7%) anti-HBcAb-positive patients were identified. Conclusions This work clearly indicates that simple strategies can markedly improve appropriate HBV screening. In our cohort, 6% (of whom only 43% had recognized HBV risk factors) required antiviral prophylaxis, which emphasizes the importance of universal screening before rituximab. Reinforcement of the guidelines and ongoing education is needed to further increase testing rates. PMID:27388147

  8. I-131 Treatment of Graves' Disease in an Unsuspected First Trimester Pregnancy; the Potential for Adverse Effects on the Fetus and a Review of the Current Guidelines for Pregnancy Screening

    OpenAIRE

    Barrett Mark; DeSimone Shane; Tran Phuong; Bachrach Bert

    2010-01-01

    Graves' disease is a thyroid-specific autoimmune disorder in which the body makes antibodies to the thyroid-stimulating hormone receptor leading to hyperthyroidism. Therapeutic options for the treatment of Graves' disease include medication, radioactive iodine ablation, and surgery. Radioactive iodine is absolutely contraindicated in pregnancy as exposure to I-131 to the fetal thyroid can result in fetal hypothyroidism and cretinism. Here we describe a case of a female patient with recurrent...

  9. Rituximab in combination with multiagent chemotherapy for pediatric follicular lymphoma.

    Science.gov (United States)

    Kumar, Riten; Galardy, Paul J; Dogan, Ahmet; Rodriguez, Vilmarie; Khan, Shakila P

    2011-08-01

    Given the rarity of follicular lymphoma (FL) in children, there is limited data on which to base treatment recommendations. Herein, we report our institutional experience of using rituximab with multiagent chemotherapy for pediatric FL. Six pediatric patients were diagnosed with FL from 2000 to 2009. All patients received rituximab in combination with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) for varying durations. Five of the six patients remain in remission with a median follow-up of 31 months. Larger randomized trials are indicated to establish the efficacy of this regimen for pediatric FL patients. PMID:21462303

  10. Rituximab as a possible cause of posterior reversible encephalopathy syndrome

    Directory of Open Access Journals (Sweden)

    Ahmed Imran Siddiqi

    2011-09-01

    Full Text Available A 66-year-old woman presented with new onset generalisedtonic-clonic seizures following her first dose ofchemotherapy comprising Rituximab, Cyclophosphamide,Hydroxydaunorubicin, Oncovin and Prednisolone (R-CHOP10 days earlier for non-Hodgkin’s lymphoma. On admission,computed tomography (CT scan of the cranium showed noabnormality. The CT was repeated within 48 hours as thepatient developed status epilepticus and papilledema; therepeat scan showed characteristics of posterior reversibleencephalopathy syndrome (PRES. Association of rituximabwith this condition was suspected as there was norecurrence of PRES after receiving two more cycles of CHOPwithout rituximab. Contrary to previously published casereports, this patient had a delayed clinical presentation.

  11. RITUXIMAB: NEW POTENTIALITIES OF THERAPY FOR RHEUMATOID ARTHRITIS

    Directory of Open Access Journals (Sweden)

    D E Karateev

    2008-01-01

    Full Text Available Some patients with rheumatoid arthritis (RA are unresponsive or intolerant to both synthetic first-line anti-inflammatory drugs (FLAID and tumor necrosis factor (TNF а inhibitors already included into all the treatment standards . Along with the conventional methods for overcoming drug resistance - switching to another FLAID or another TNF а blocker, the use of biologicals with another mechanism of action rather than suppression of TNF а gives a good account of itself. Prominent among these agents is the anti-B-cell drug rituximab. The new possibilities of the therapy, which open up the use of rituximab in patients with RA, are discussed.

  12. Research demystifies the interaction between Rituximab and its target

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    @@ As the first US FDA-approved monclonal antibody drug for the treatment of B-cell lymphomas and later on for the treatment of autoimmune diseases, Rituximab has been widely sold under the trade name of Rituxan ever since 1997 with an average sales volume over US$ 2 billion each year in the US.However, the recognition mechanism between Rituximab and its target CD20, an antigen expressed on the surface of mature B-cells, remained unclear. Now, an important step toward decoding the longstanding problem is achieved by scientists at the CAS Shanghai Institutes for Biological Sciences(SIBS) and their collaborators from the Second Military Medical University.

  13. Hepatitis B virus reactivation with a rituximab-containing regimen

    Institute of Scientific and Technical Information of China (English)

    Yutaka; Tsutsumi; Yoshiya; Yamamoto; Shinichi; Ito; Hiroyuki; Ohigashi; Souichi; Shiratori; Hirohito; Naruse; Takanori; Teshima

    2015-01-01

    Rituximab is currently used not only in the treatment of B-cell lymphoma but also for various other diseases, including autoimmune diseases, post-transplant graft vs host disease, and rejection following kidney transplants. Due to rituximab’s widespread use, great progress has been made regarding research into complications that arise from its use, one of the most serious being the reactivation of hepatitis B virus(HBV), and efforts continue to establish guidelines for preventive treatment against this occurrence. This report discusses preventive measures against rituximab-induced HBV reactivation and future objectives.

  14. Preparation & in vitro evaluation of 90Y-DOTA-rituximab

    OpenAIRE

    Mythili Kameswaran; Usha Pandey; Ashutosh Dash; Grace Samuel; Meera Venkatesh

    2016-01-01

    Background & objectives: Radioimmunotherapy is extensively being used for the treatment of non-Hodgkin′s lymphoma (NHL). Use of rituximab, a chimeric anti-CD20 antibody directed against the CD20 antigen in combination with suitable beta emitters is expected to result in good treatment response by its cross-fire and bystander effects. The present work involves the conjugation of p-isothiocyanatobenzyl DOTA (p-SCN-Bn-DOTA) to rituximab, its radiolabelling with [90] Y and in vitro and in vivo ev...

  15. A retrospective study on the transition of radiation dose rate and iodine distribution in patients with I-131-treated well-differentiated thyroid cancer to improve bed control shorten isolation periods

    International Nuclear Information System (INIS)

    The objective of this study was to evaluate for how long patients should be isolated after I-131 treatment for thyroid cancer according to the guidelines issued by the Japanese Ministry of Welfare. We reviewed 92 therapies performed in 76 patients who were administered I-131 at our hospital from July 2007 to September 2009. Fifty-six patients were given 2220 or 2960 MBq I-131 at the first therapy, and 29 patients underwent 36 repeated therapies using 2960, 3700, 5550 or 7400 MBq I-131. We surveyed radioactivity for a 1 cm dose equivalent rate at 1 m intervals at 30 and 48 h after administration of I-131, obtained planar scintigrams at 48 h, and surveyed radioactivity repeatedly until it fell to under 30 μSv/h. The radioactivity was under 30 μSv/h at 30 h in 51 out of 92 cases (55%). Among the remaining 41 (45%) cases, 27 (29%) and 32 (35%) cases showed decreased radioactivity under 30 μSv/h at 48 and 72 h, respectively, and it remained higher than 30 μSv/h at 72 h in another 9 cases (10%). In 5 (38%) of the 13 cases with bone metastasis, the radioactivity remained over 30 μSv/h after 72 h, and scintigrams showed strong accumulation in bone metastases. Among the 27 cases demonstrating below 30 μSv/h at 48 h, 26 showed radioactivity being below 50 μSv/h at 30 h, while it was above 50 μSv/h at 30 h in all 14 cases which demonstrated above 30 μSv/h at 48 h. We compared the radioactivity levels of 27 cases under 30 μSv/h at 48 h and 14 cases over 30 μSv/h at 48 h using a cutoff value of under 50 μSv/h at 30 h to release patient at 48 h, the positive predictive value and negative predictive value were 100 and 93%, respectively, and radioactivity was found to differ significantly (P<0.001). To predict external radiation levels at 48 h, it is helpful to consider external radiation levels at 30 h after treatment. Consideration of intracellular uptake in thyroid cancer, especially in cases of bone metastases, digestive tract function, and renal function, is

  16. Rituximab-Based Treatment, HCV Replication, and Hepatic Flares

    Directory of Open Access Journals (Sweden)

    Evangelista Sagnelli

    2012-01-01

    Full Text Available Rituximab, a chimeric mouse-human monoclonal antibody directed to the CD20 antigen expressed on pre-B lymphocytes and mature lymphocytes, causes a profound B-cell depletion. Due to its peculiar characteristics, this drug has been used to treat oncohaematological diseases, B cell-related autoimmune diseases, rheumatoid arthritis, and, more recently, HCV-associated mixed cryoglobulinaemic vasculitis. Rituximab-based treatment, however, may induce an increased replication of several viruses such as hepatitis B virus, cytomegalovirus, varicella-zoster virus, echovirus, and parvovirus B19. Recent data suggest that rituximab-based chemotherapy induces an increase in HCV expression in hepatic cells, which may become a target for a cell-mediated immune reaction after the withdrawal of treatment and the restoration of the immune control. Only a few small studies have investigated the occurrence of HCV reactivation and an associated hepatic flare in patients with oncohaematological diseases receiving R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone. These studies suggest that the hepatic flares are frequently asymptomatic, but life-threatening liver failure occurs in nearly 10% of cases.

  17. Rituximab therapy in steroid-resistant severe hypothyroid Grave's ophthalmopathy

    OpenAIRE

    Aditi Pandit; Abhay Gundgurthi; Sandeep Kharb; Karninder S Brar; Garg, M. K.

    2013-01-01

    Association of Grave′s ophthalmopathy with hyperthyroidism is well known, and it has also been reported in euthyroid or hypothyroid autoimmune thyroiditis, which rarely requires treatment. Here, we report a case of bilaterally symmetrical severe corticosteroid-resistant hypothyroid Grave′s ophthalmopathy successfully treated with rituximab.

  18. Rituximab treatment in rheumatoid arthritis: how does it work?

    NARCIS (Netherlands)

    M.J.H. Boumans; P.P. Tak

    2009-01-01

    Treatment with the chimerical monoclonal antibody rituximab results in CD20-directed B cell depletion. Although this depletion is almost complete in the peripheral blood of nearly all patients with rheumatoid arthritis, a proportion of patients does not exhibit a clinical response. The paper by Nako

  19. Failure of CHOP with rituximab for lymphomatoid granulomatosis

    NARCIS (Netherlands)

    Oosting-Lenstra, S. F.; Kooy, M. van Marwijk

    2007-01-01

    We present a 66-year-old male patient with pulmonary lymphomatoid granulomatosis. The patient had progressive disease after three courses of CHOP and rituximab and, therefore, treatment with interferon-alpha 2b 5 x 10(6) IE three times a week was started. This resulted in stable disease for five mon

  20. Rituximab in the treatment of non-Hodgkin’s lymphoma

    Directory of Open Access Journals (Sweden)

    Beate Hauptrock

    2008-09-01

    Full Text Available Beate Hauptrock, Georg HessHematology/Oncology, Johannes Gutenberg-University, Mainz, GermanyAbstract: Besides traditional cytostatic drugs the introduction of monoclonal antibodies has substantially influenced current treatment concepts of non-Hodgkin’s lymphoma (NHL.  Rituximab, a monoclonal anti-CD20 chimeric antibody, now has been widely evaluated in the various B-cell lymphatic neoplasms. Large phase III studies helped to prove the value of this drug in follicular lymphoma as part of induction or relapse treatment as well as maintenance treatment. The addition of rituximab to the well established CHOP regimens has increased achievable cure rates in diffuse large cell lymphoma, and this combination is now accepted worldwide as standard of care. Although conflicting results are available, rituximab is widely used for the treatment of mantle cell lymphoma. For the less frequent lymphoma entities phase 2 studies show a considerable efficiency for most of these B-NHL variants. Current research focuses on combined chemoimmunotherapy approaches, optimization of dosing regimens, and combination with novel agents.Keywords: non-Hodgkin’s lymphoma, rituximab, monoclonal-antibody, targeted therapy

  1. Rituximab (MabThera) til behandling af aktiv reumatoid artritis

    DEFF Research Database (Denmark)

    El Fassi, Daniel; Nielsen, Claus Henrik; Bendtzen, Klaus

    2006-01-01

    Rituximab (RTX) is a murine/human monoclonal antibody to CD20, a protein expressed almost exclusively on human B-lymphocytes. RTX induces rapid and marked B-cell depletion with beneficial clinical effects in 1/3 to 1/2 of rheumatoid arthritis patients. Treatment is given as two iv. infusions with...

  2. Rituximab for the treatment of patients with chronic lymphocytic leukemia

    Directory of Open Access Journals (Sweden)

    M Gentile

    2010-03-01

    Full Text Available M Gentile, E Vigna, C Mazzone, E Lucia, AG Recchia, L Morabito2, MG Bisconte, C Gentile, F Morabito1UOC di Ematologia, Azienda Ospedaliera di Cosenza, Italy; 2Servicio de Hematología y Hemoterapia, Hospital Universitario de Canarias, La Laguna, Tenerife, SpainAbstract: Chronic lymphocytic leukemia (CLL is a lymphoproliferative disorder that originates from antigen-experienced B lymphocytes that do not die and hence accumulate due to external survival signals or undergo apoptosis and are replenished by proliferating precursors. These neoplastic lymphocytes exhibit a characteristic immunophenotype of CD5+/CD19+/CD20+/HLA-DR+/CD23+/sIgdim. Thus, the CD20 antigen has been an appealing target for therapy. The introduction of the monoclonal antibody rituximab (anti-CD20 enabled an outstanding advance in CLL treatment. The introduction of this monoclonal antibody into chemotherapy regimens has dramatically improved complete response rates and progression-free survival in patients with both untreated and relapsed CLL. Although only preliminary data from phase III confirmatory trials have been reported, the FCR regimen, which combines fludarabine and cyclophosphamide with rituximab, is currently the most effective treatment regimen for CLL patients, and has also been demonstrated to significantly improve overall survival . The success of rituximab and the identification of other CLL lymphocyte surface antigens have spurred the development of a multitude of monoclonal antibodies targeting distinct proteins and epitopes in an attempt to target CLL cells more effectively.Keywords: rituximab, chronic lymphocytic leukemia, chemotherapy

  3. Rituximab maintenance for 2 years in patients with high tumour burden follicular lymphoma responding to rituximab plus chemotherapy (PRIMA): a phase 3, randomised controlled trial

    DEFF Research Database (Denmark)

    Salles, Gilles; Seymour, John Francis; Offner, Fritz;

    2011-01-01

    Patients with follicular lymphoma can have long survival times, but disease progression typically occurs 3-5 years after initial treatment. We assessed the potential benefit of 2 years of rituximab maintenance after first-line treatment in patients with follicular lymphoma receiving a rituximab p...

  4. Organ S values and effective doses for family members exposed to adult patients following I-131 treatment: A Monte Carlo simulation study

    Energy Technology Data Exchange (ETDEWEB)

    Han, Eun Young [Department of Radiation Oncology, University of Arkansas Medical Sciences, Little Rock, Arkansas 72205 (United States); Lee, Choonsik [Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Bethesda, Maryland 20852 (United States); Mcguire, Lynn; Brown, Tracy L. Y. [Department of Radiology, Division of Nuclear Medicine, University of Arkansas Medical Sciences, Little Rock, Arkansas 72205 (United States); Bolch, Wesley E. [J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida 32611 (United States)

    2013-08-15

    Purpose: To calculate organ S values (mGy/Bq-s) and effective doses per time-integrated activity (mSv/Bq-s) for pediatric and adult family members exposed to an adult male or female patient treated with I-131 using a series of hybrid computational phantoms coupled with a Monte Carlo radiation transport technique.Methods: A series of pediatric and adult hybrid computational phantoms were employed in the study. Three different exposure scenarios were considered: (1) standing face-to-face exposures between an adult patient and pediatric or adult family phantoms at five different separation distances; (2) an adult female patient holding her newborn child, and (3) a 1-yr-old child standing on the lap of an adult female patient. For the adult patient model, two different thyroid-related diseases were considered: hyperthyroidism and differentiated thyroid cancer (DTC) with corresponding internal distributions of {sup 131}I. A general purpose Monte Carlo code, MCNPX v2.7, was used to perform the Monte Carlo radiation transport.Results: The S values show a strong dependency on age and organ location within the family phantoms at short distances. The S values and effective dose per time-integrated activity from the adult female patient phantom are relatively high at shorter distances and to younger family phantoms. At a distance of 1 m, effective doses per time-integrated activity are lower than those values based on the NRC (Nuclear Regulatory Commission) by a factor of 2 for both adult male and female patient phantoms. The S values to target organs from the hyperthyroid-patient source distribution strongly depend on the height of the exposed family phantom, so that their values rapidly decrease with decreasing height of the family phantom. Active marrow of the 10-yr-old phantom shows the highest S values among family phantoms for the DTC-patient source distribution. In the exposure scenario of mother and baby, S values and effective doses per time-integrated activity to

  5. Tumour targeting and radiation dose of radioimmunotherapy with {sup 90}Y-rituximab in CD20+ B-cell lymphoma as predicted by {sup 89}Zr-rituximab immuno-PET: impact of preloading with unlabelled rituximab

    Energy Technology Data Exchange (ETDEWEB)

    Muylle, Kristoff [Vrije Universiteit Brussel, MIMA Research Group, Brussels (Belgium); Universite Libre de Bruxelles, Department of Nuclear Medicine, Jules Bordet Institute, Brussels (Belgium); Flamen, Patrick; Guiot, Thomas; Ghanem, Ghanem; Meuleman, Nathalie; Bourgeois, Pierre; Vanderlinden, Bruno; Vaes, Melanie; Bron, Dominique [Universite Libre de Bruxelles, Jules Bordet Institute, Brussels (Belgium); Vugts, Danielle J.; Dongen, Guus A.M.S. van [VU University Medical Centre, Amsterdam (Netherlands); Everaert, Hendrik [Vrije Universiteit Brussel, UZ Brussel, Brussels (Belgium); Vrije Universiteit Brussel, MIMA Research Group, Brussels (Belgium)

    2015-07-15

    To compare using immuno-PET/CT the distribution of {sup 89}Zr-labelled rituximab without and with a preload of unlabelled rituximab to assess the impact of preloading with unlabelled rituximab on tumour targeting and radiation dose of subsequent radioimmunotherapy with {sup 90}Y-labelled rituximab in CD20+ B-cell lymphoma. Five patients with CD20+ B-cell lymphoma and progressive disease were prospectively enrolled. All patients underwent three study phases: initial dosimetric phase with baseline {sup 89}Zr-rituximab PET/CT imaging without a cold preload, followed 3 weeks later by a second dosimetric phase with administration of a standard preload (250 mg/m{sup 2}) of unlabelled rituximab followed by injection of {sup 89}Zr-rituximab, and a therapeutic phase 1 week later with administration of unlabelled rituximab followed by {sup 90}Y-rituximab. PET/CT imaging and tracer uptake by organs and lesions were assessed. With a cold rituximab preload, the calculated whole-body dose of {sup 90}Y-rituximab was similar (mean 0.87 mSv/MBq, range 0.82-0.99 mSv/MBq) in all patients. Without a preload, an increase in whole-body dose of 59 % and 87 % was noted in two patients with preserved circulating CD20+ B cells. This increase in radiation dose was primarily due to a 12.4-fold to 15-fold higher dose to the spleen without a preload. No significant change in whole-body dose was noted in the three other patients with B-cell depletion. Without a preload, consistently higher tumour uptake was noticed in patients with B-cell depletion. Administration of the standard preload of unlabelled rituximab impairs radioconjugate tumour targeting in the majority of patients eligible for radioimmunotherapy, that is patients previously treated with rituximab-containing therapeutic regimens. This common practice may need to be reconsidered and further evaluated as the rationale for this high preload has its origin in the ''prerituximab era''. (orig.)

  6. Comparison of 18F-FDG PET/CT, 99mTc-methy-isobutyl-isonitrile(MIBI) scan and radioiodine diagnostic whole body scan with I-131 post-therapeutic whole body scan in papillary thyroid carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Chung Ho; Park, Young Ha; Yoo, Ie Ryung; Kim, Sung Hoon; Chung, Soo Kyo [The Catholic University of Korea, Seoul (Korea, Republic of)

    2007-07-01

    To evaluate the usefulness of 18F-FDG PET/CT and 99mTc-MIBI scan in the detection of remnant thyroid tissue, recurrence or metastasis before high dose I-131 ablation therapy. Twenty-four patients (20 female, 4 male, age=52.913.2), who received 99mTc-MIBI scan, radioiodine diagnostic whole body scan (WBS) and 18F-FDG PET/CT within a week before high dose I-131 ablation therapy from May 2004 to September 2007 were retrospectively reviewed. All patients thyroid stimulating hormone, thyroglobulin (Tg) and anti-thyroglobulin level were checked before administering I-123 or I-131 for diagnostic WBS. TSH level were higher than 30 mIU/L in all patients. The radioiodine diagnostic WBS, 99mTc-MIBI scan and 18F-FDG PET/CT were compared with the post-therapeutic WBS obtain 7 days after administration of I-131 (=150 mCi). Post-therapeutic WBS of 4 patients showed distant metastases, commonly in lung, all 4 were positive on 18F-FDG PET/CT, 1 on 99mTc-MIBI scan, but none of them were detectable on radioiodine diagnostic WBS. 7 patients with cervical or supraclavicular lymph node metastases on post-therapeutic WBS, 5 were positive on 18F-FDG PET/CT, 4 on radioiodine diagnostic WBS, and 3 on 99mTc-MIBI scan. 9 patients with remnant thyroid tissue only in thyroid bed, 7 were positive on radioiodine diagnostic WBS, 5 on 18F-FDG PET/CT and 3 on 99mTc-MIBI scan. One case with high Tg level (>10ng/mI) was positive only on post-therapeutic WBS scan. 3 patients with high Tg level, all of diagnostic scans and post-therapeutic scan were negative. Compared to the post-therapeutic WBS with radioiodine diagnostic WBS, 99mTc-MIBI scan, 18F-FDG PET/CT, none of the studies were perfectly matched with post-therapeutic WBS, but can compensate each other. 18F-FDG PET/CT might be helpful, when lymph node or lung metastasis is suspected. Further evaluation with larger population is necessary.

  7. Rituximab Efficacy during a Refractory Polyarteritis Nodosa Flare

    Directory of Open Access Journals (Sweden)

    Emmanuel Ribeiro

    2009-01-01

    Full Text Available Polyarteritis nodosa (PAN is a systemic vasculitis whose severe forms are treated with glucocorticoids and cyclophosphamide. Refractory patients are exposed to many complications, notably accelerated atherosclerosis. We report a case report of 71-year-old man followed for polyarteritis nodosa refractory to glucocorticoids and cyclosphosphamide. Systemic vasculitis relapses are followed to accelerated atherosclerosis: severe ischemic lesions led to amputation of lower limbs. Remission of refractory PAN is obtained with rituximab. Disappearance of biological inflammatory is allowed to regression of ischemic lesions in upper limbs. In this situation, we recommend a systematic vascular work-up for patients suffered from refractory vasculitis. On the other hand, therapeutic trials are needed to determine the real efficacy and place of rituximab in the treatment of polyarteritis nodosa.

  8. Post-transplant lymphoproliferative disorder treated with rituximab: case report

    Institute of Scientific and Technical Information of China (English)

    MENG Hai-tao; LI Ying; LIU Jian-hua; XU Gai-xiang; TENG Xiao-dong

    2007-01-01

    @@ Post-transplant lymphoproliferative disorder (PTLD), a rare disease, is characterized by an abnormal proliferation of lymphoid cells after solid organ transplantation.1 This complication is usually caused by the immunosuppressive therapy following transplantation.Though the techniques of early detection and diagnosis of the disease are well established, treatment is not so straightforward and poses a real challenge. At this time,options include anti-viral therapy, cytotoxic chemotherapy, cellular immunotherapy, and reduction of immunosuppression. But the effects of these therapies are not satisfying. Rituximab, a chimeric monoclonal anti-CD20 antibody used for the treatment of B cell lymphoma with a good effect, is rarely, especially in combination with chemotherapy, used for PTLD. In this report, we describe a case of PTLD treated with rituximab and chemotherapy resulting in complete remission.

  9. Rituximab for the treatment of rheumatoid arthritis: an update

    OpenAIRE

    Mok CC

    2013-01-01

    Chi Chiu MokDepartment of Medicine, Tuen Mun Hospital, Hong Kong, Special Administrative Region of the People's Republic of ChinaAbstract: Rituximab is a chimeric monoclonal antibody that targets the CD20 molecule expressed on the surface of B cells. It was first used in the treatment of non-Hodgkin's lymphoma and later approved for the treatment of rheumatoid arthritis (RA) that does not respond adequately to disease-modifying antirheumatic drugs, including the anti-tumor-nec...

  10. Is rituximab effective for induction of remission in lupus nephritis?

    Directory of Open Access Journals (Sweden)

    Macarena Mac-Namara

    2014-08-01

    Full Text Available La combinación de ciclofosfamida y corticoides constituye el tratamiento estándar en pacientes con nefritis lúpica con indicación de terapia inmunosupresora mayor. Sin embargo, se asocia a importantes efectos adversos, por lo que existe interés en otros inmunosupresores como rituximab. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 19 bases de datos, identificamos 5 revisiones sistemáticas que en conjunto incluyen 24 estudios. Realizamos una síntesis mediante tablas de resumen de los resultados utilizando el método GRADE y concluimos que existe incertidumbre sobre la eficacia de rituximab en nefritis lúpica porque la certeza de la evidencia es muy baja, se asocia a efectos adversos importantes, y tiene alto costo. Rituximab no debiera utilizarse fuera de un estudio clínico, o sólo en casos en que otras alternativas han fracasado si es que no existen limitaciones de recursos.

  11. Intensified chemotherapy with ACVBP plus rituximab versus standard CHOP plus rituximab for the treatment of diffuse large B-cell lymphoma (LNH03-2B): an open-label randomised phase 3 trial

    OpenAIRE

    Récher, Christian; Coiffier, Bertrand; Haioun, Corinne; Molina, Thierry Jo; Fermé, Christophe; Casasnovas, Olivier; Thièblement, Catherine; Bosly, André; LAURENT, GUY; Morschhauser, Franck; Ghesquières, Hervé; Jardin, Fabrice; Bologna, Serge; Fruchart, Christophe; Corront, Bernadette

    2011-01-01

    Background The outcome of diff use large B-cell lymphoma has been substantially improved by the addition of the anti-CD20 monoclonal antibody rituximab to chemotherapy regimens. We aimed to assess, in patients aged 18–59 years, the potential survival benefi t provided by a dose-intensive immunochemotherapy regimen plus rituximab compared with standard treatment plus rituximab. Methods We did an open-label randomised trial comparing dose-intensive rituximab, doxorubicin, cyclo phosphamide, ...

  12. A single dose of rituximab does not deplete B cells in secondary lymphoid organs but alters phenotype and function

    NARCIS (Netherlands)

    Kamburova, E.G.; Koenen, H.J.P.M.; Borgman, K.J.; Berge, I.J. Ten; Joosten, I.; Hilbrands, L.B.

    2013-01-01

    A single dose of the anti-CD20 monoclonal antibody rituximab induces a nearly complete B cell depletion in peripheral blood, but not in secondary lymphoid organs. Modulation of this remaining B cell population due to rituximab treatment may contribute to the therapeutic effects of rituximab. To asse

  13. Successful pregnancy after rituximab in a women with recurrent in vitro fertilisation failures and anti-phospholipid antibody positive.

    LENUS (Irish Health Repository)

    Ng, C T

    2012-02-01

    We report a case of successful pregnancy after rituximab in a patient with a history of in vitro fertilisation (IVF) failures and positive anti-cardiolipin antibody (ACA). Following a course of rituximab, her ACA became negative and she successfully conceived with IVF treatment. This is the first case in literature describing the use of rituximab therapy in this clinical scenario.

  14. Tc-99m-labeled Rituximab for Imaging B Lymphocyte Infiltration in Inflammatory Autoimmune Disease Patients

    NARCIS (Netherlands)

    Malviya, G.; Anzola, K. L.; Podesta, E.; Lagana, B.; Del Mastro, C.; Dierckx, R. A.; Scopinaro, F.; Signore, A.

    2012-01-01

    The rationale of the present study was to radiolabel rituximab with 99m-technetium and to image B lymphocytes infiltration in the affected tissues of patients with chronic inflammatory autoimmune diseases, in particular, the candidates to be treated with unlabelled rituximab, in order to provide a r

  15. Updated consensus statement on the use of rituximab in patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Buch, Maya H; Smolen, Josef S; Betteridge, Neil;

    2011-01-01

    Since initial approval for the treatment of rheumatoid arthritis (RA), rituximab has been evaluated in clinical trials involving various populations with RA. Information has also been gathered from registries. This report therefore updates the 2007 consensus document on the use of rituximab...

  16. In vitro effects of rituximab on the proliferation, activation and differentiation of human B cells.

    NARCIS (Netherlands)

    Kamburova, E.G.; Koenen, H.J.P.M.; Boon, L.; Hilbrands, L.B.; Joosten, I.

    2012-01-01

    Rituximab is a chimeric anti-CD20 monoclonal antibody (mAb) used in B-cell malignancies, various autoimmune disorders and organ transplantation. Although administration of a single dose of rituximab results in full B-cell depletion in peripheral blood, there remains a residual B-cell population in s

  17. Micro-costing study of rituximab subcutaneous injection versus intravenous infusion in dutch setting

    NARCIS (Netherlands)

    Mihajlović, J.; Bax, P.; Van Breugel, E.; Blommestein, H.M.; Hoogendoorn, M.; Hospes, W.; Postma, M.J.

    2015-01-01

    Background: Rituximab for subcutaneous (SC) administration has recently been approved for use in common forms of diffuse large B-cell lymphoma (DLBCL). This form of rituximab is supplied in ready-to-use vials that do not require individual dose adjustment. It is expected that SC-injection will short

  18. T cells in tumors and blood predict outcome in follicular lymphoma treated with rituximab

    DEFF Research Database (Denmark)

    Wahlin, Björn Engelbrekt; Sundström, Christer; Holte, Harald;

    2011-01-01

    T cells influence outcome in follicular lymphoma, but their contributions seem to be modified by therapy. Their impact in patients receiving rituximab without chemotherapy is unknown.......T cells influence outcome in follicular lymphoma, but their contributions seem to be modified by therapy. Their impact in patients receiving rituximab without chemotherapy is unknown....

  19. Humoral responses after influenza vaccination are severely reduced in patients with rheumatoid arthritis treated with rituximab

    NARCIS (Netherlands)

    Van Assen, Sander; Holvast, Albert; Benne, Cornelis A.; Posthumus, Marcel D.; Van Leeuwen, Miek A.; Voskuyl, Alexandre E.; Blom, Marlies; Risselada, Anke P.; De Haan, Aalzen; Westra, Johanna; Kallenberg, Cornelis; Bijl, Marc

    2010-01-01

    Objective. For patients with rheumatoid arthritis (RA), yearly influenza vaccination is recommended. However, its efficacy in patients treated with rituximab is unknown. The objectives of this study were to investigate the efficacy of influenza vaccination in RA patients treated with rituximab and t

  20. Updated consensus statement on the use of rituximab in patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Buch, Maya H; Smolen, Josef S; Betteridge, Neil;

    2011-01-01

    Since initial approval for the treatment of rheumatoid arthritis (RA), rituximab has been evaluated in clinical trials involving various populations with RA. Information has also been gathered from registries. This report therefore updates the 2007 consensus document on the use of rituximab in th...

  1. Rituximab for subcutaneous delivery: Clinical management principles from a nursing perspective.

    Science.gov (United States)

    Carlson, Julia; Cox, Keith; Bedwell, Kylie; Ku, Mathew

    2015-12-01

    Nurses play an integral role in administering treatments to patients with non-Hodgkin's lymphomas. Intravenous (IV) rituximab was approved by the Australian Therapeutic Goods Administration in 1998, and a novel subcutaneous (SC) formulation was approved in 2014. Fixed-dose SC rituximab is highly concentrated; co-formulation with a fully human recombinant vorhyaluronidase alfa enzyme helps overcome the physiological barriers of the SC space, facilitating drug dispersion. Despite a different pharmacokinetic profile to the IV preparation, SC rituximab demonstrates a comparable efficacy/safety profile. Most frequently occurring rituximab-related adverse events include neutropenia, nausea and constipation, and administration-related reactions are more frequent with the SC preparation. Compared with IV, SC delivery reduces treatment times and nurse workload, and patients report greater comfort and convenience. This article sets out nursing considerations for optimal administration of SC rituximab, including premedication, drug handling/preparation, injection technique, after-care and management of adverse events, particularly administration-related reactions.

  2. Rituximab-induced interstitial lung disease in a patient with follicular lymphoma: A rare case report

    Directory of Open Access Journals (Sweden)

    Suhas Aagre

    2015-01-01

    Full Text Available Rituximab is a chimeric monoclonal antibody that targets CD-20 antigen expressed in more than 90% of all B cell non-Hodgkin's lymphoma (NHL. We report a case of 33-year-old female without any comorbidities, newly diagnosed with stage IIIB follicular lymphoma treated with rituximab-based chemotherapy. Patient developed exertional dyspnea and dry cough after the fourth cycle of rituximab-based chemotherapy. Diagnostic high-resolution computed tomography (HRCT of the lungs revealed bilateral patchy ground glass opacities suggestive of interstitial lung disease (ILD. It was managed successfully with supplemental oxygen and corticosteroids with discontinuation of the Rituximab. Extensive review of the literature did not reveal ample of material on rituximab-induced ILD (RTX-ILD.

  3. Randomised Phase I/II trial assessing the safety and efficacy of radiolabelled anti-carcinoembryonic antigen I131 KAb201 antibodies given intra-arterially or intravenously in patients with unresectable pancreatic adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Bosonnet Lorraine

    2009-02-01

    Full Text Available Abstract Background Advanced pancreatic cancer has a poor prognosis, and the current standard of care (gemcitabine based chemotherapy provides a small survival advantage. However the drawback is the accompanying systemic toxicity, which targeted treatments may overcome. This study aimed to evaluate the safety and tolerability of KAb201, an anti-carcinoembryonic antigen monoclonal antibody, labelled with I131 in pancreatic cancer (ISRCTN 16857581. Methods Patients with histological/cytological proven inoperable adenocarcinoma of the head of pancreas were randomised to receive KAb 201 via either the intra-arterial or intravenous delivery route. The dose limiting toxicities within each group were determined. Patients were assessed for safety and efficacy and followed up until death. Results Between February 2003 and July 2005, 25 patients were enrolled. Nineteen patients were randomised, 9 to the intravenous and 10 to the intra-arterial arms. In the intra-arterial arm, dose limiting toxicity was seen in 2/6 (33% patients at 50 mCi whereas in the intravenous arm, dose limiting toxicity was noted in 1/6 patients at 50 mCi, but did not occur at 75 mCi (0/3. The overall response rate was 6% (1/18. Median overall survival was 5.2 months (95% confidence interval = 3.3 to 9 months, with no significant difference between the intravenous and intra-arterial arms (log rank test p = 0.79. One patient was still alive at the time of this analysis. Conclusion Dose limiting toxicity for KAb201 with I131 by the intra-arterial route was 50 mCi, while dose limiting toxicity was not reached in the intravenous arm.

  4. Rituximab Administration in Third Trimester of Pregnancy Suppresses Neonatal B-Cell Development

    Directory of Open Access Journals (Sweden)

    D. T. Klink

    2008-01-01

    Full Text Available We describe the effect on the neonate of administration of rituximab to a woman with idiopathic thrombocytopenic purpura (ITP. Rituximab, an anti-CD20 antibody, was given weekly for 4 weeks to a woman with ITP in her third trimester of pregnancy. One month after the last rituximab administration a healthy girl was born. She had normal growth and development during the first six months. At birth, B-lymphocytes were not detectable. Rituximab levels in mother and neonate were 24000 and 6700 ng/mL, respectively. Only 7 cases of rituximab administration during pregnancy were described. No adverse events are described for fetus and neonate. We demonstrate that rituximab passes the placenta and inhibits neonatal B-lymphocyte development. However, after 6 months B-lymphocyte levels normalized and vaccination titres after 10 months were adequate. No infection-related complications occurred. Rituximab administration during pregnancy appears to be safe for the child but further studies are warranted.

  5. Study On The Preparation Of 90Y-DTPA-Rituximab For Non-Hodgkin Lymphoma Treatment

    International Nuclear Information System (INIS)

    Yttrium is one of the most useful radionuclides for radioimmunotherapeutic applications, especially labelling with monoclonal antibodies. Rituximab was bound to the DTPA chelating agent using Hnatowich methods. Cyclic anhydride DTPA (cDTPAa, 0.1 mg/ml) was dissolved in chloroform and was degassed under a stream of nitrogen for 30 minutes. Rituximab solution in 0.05 M bicarbonate buffer was immediately added and mixed for one minute at room temperature. The antibody Rituximab at different concentration (5 mg/ml and 10 mg/ml) was coupled with the cDTPAa, at molar ratios (cDTPAa : Rituximab) of 1:1, 3:1, 5:1, 10:1 and 20:1. The conjugation of DTPA-Rituximab mixture was labelled with Y-90, then using Sephadex G25 in order to determine coupling efficiency. Coupling efficiency at a 3:1 mole ratio was 70%. After purification, the conjugation DTPA-Rituximab was labeled with Y-90 in 0.5 M acetate buffer, pH 5, at room temperature. The labeling yield was about 99%. The radiochemical purity of 90Y-DTPA-Rituximab was more than 98 % which determined by ITLC in 0.1 M acetate at pH 6 as mobile phase. The radiopharmaceuticals have been test for sterility, apyrogenicity and biodistribution. This is a potential radiopharmaceutical for clinical application in therapeutic Non Hodgkin Lymphoma treatments. (author)

  6. Rituximab in a child with autoimmune thrombotic thrombocytopenic purpura refractory to plasma exchange.

    Science.gov (United States)

    Narayanan, Parameswaran; Jayaraman, Aparna; Rustagi, Rashi S; Mahadevan, S; Parameswaran, Sreejith

    2012-07-01

    A nine-year-old girl presented with headache, purpura and mild left hemiparesis. Laboratory evaluation revealed thrombotic microangiopathy with ADAMTS13 deficiency, with auto-antibodies to ADAMTS13. She was treated with plasma exchange and steroids, following which she improved transiently, relapsing within 2 months. The relapse was refractory to conventional therapy and rituximab was tried. She had good response to rituximab and has been in remission for the past 12 months. Rituximab may be a promising option for children with acquired TTP refractory to plasma exchange and steroids.

  7. Crescendo response to rituximab in oral pemphigus vulgaris: a case with 7-year follow-up.

    Science.gov (United States)

    Greenblatt, D T; Benton, E C; Groves, R W; Setterfield, J F

    2016-07-01

    Pemphigus vulgaris (PV) is an autoimmune blistering disease affecting the skin and mucous membranes. Rituximab, a CD20 chimeric monoclonal antibody, has efficacy in PV management. We report a case of severe oral PV that showed a progressive response to repeated courses of rituximab, culminating in a rapid response within 4 weeks following severe relapse 4 years after initial therapy. It demonstrates the progressively shorter time to achieve partial or complete remission following rituximab infusions, combined with minimal adjuvant therapy over a 7-year follow-up period.

  8. Rituximab therapy reduces organ-specific T cell responses and ameliorates experimental autoimmune encephalomyelitis.

    Directory of Open Access Journals (Sweden)

    Nancy L Monson

    Full Text Available Recent clinical trials have established B cell depletion by the anti-CD20 chimeric antibody Rituximab as a beneficial therapy for patients with relapsing-remitting multiple sclerosis (MS. The impact of Rituximab on T cell responses remains largely unexplored. In the experimental autoimmune encephalomyelitis (EAE model of MS in mice that express human CD20, Rituximab administration rapidly depleted peripheral B cells and strongly reduced EAE severity. B cell depletion was also associated with diminished Delayed Type Hypersensitivity (DTH and a reduction in T cell proliferation and IL-17 production during recall immune response experiments. While Rituximab is not considered a broad immunosuppressant, our results indicate a role for B cells as a therapeutic cellular target in regulating encephalitogenic T cell responses in specific tissues.

  9. Rituximab chimeric anti-CD20 monoclonal antibody treatment for adult refractory idiopathic thrombocytopenic purpura

    DEFF Research Database (Denmark)

    Braendstrup, Peter; Bjerrum, Ole W; Nielsen, Ove J;

    2005-01-01

    . Recent studies have shown that rituximab, a chimeric anti-CD20 monoclonal antibody, is useful in the treatment of these patients, with overall response rates of about 50%. Most published reports have included a small number patients including case reports. The present study reports the results...... of a retrospective Danish multicenter study of rituximab in the treatment of adult patients with refractory ITP. Thirty-five patients (median age 52 years, range 17-82 years, 17 males) were included. One patient had immune thrombocytopenia and neutropenia. All patients had received prednisolone (Pred). Next to Pred...... of rituximab. The large majority of patients also received Pred and, in some cases, other concomitant immunosuppressive treatment during part of their rituximab treatment. A complete response (CR) was defined as a rise in the platelet count > 100 x 10(9)/L, a partial response (PR) as a rise in the platelet...

  10. Rituximab versus cyclophosphamide in ANCA-associated renal vasculitis : 2-year results of a randomised trial

    NARCIS (Netherlands)

    Jones, Rachel B.; Furuta, Shunsuke; Tervaert, Jan Willem Cohen; Hauser, Thomas; Luqmani, Raashid; Morgan, Matthew D.; Peh, Chen Au; Savage, Caroline O.; Segelmark, Marten; Tesar, Vladimir; van Paassen, Pieter; Walsh, Michael; Westman, Kerstin; Jayne, David R. W.; Stegeman, C. A.

    2015-01-01

    Objectives The RITUXVAS trial reported similar remission induction rates and safety between rituximab and cyclophosphamide based regimens for antineutrophil cytoplasm antibody (ANCA)-associated vasculitis at 12months; however, immunosuppression maintenance requirements and longer-term outcomes after

  11. Treatment of Graves' disease with rituximab specifically reduces the production of thyroid stimulating autoantibodies

    DEFF Research Database (Denmark)

    El Fassi, Daniel; Banga, J Paul; Gilbert, Jacqueline A;

    2008-01-01

    Treatment of Graves' disease (GD) with the B-lymphocyte depleting agent rituximab in addition to standard methimazole-therapy prolongs remission. Paradoxically, it does not mediate a reduction in thyrotropin receptor antibody (TRAb) levels over that of methimazole monotherapy. Using a bioassay...... involving Chinese hamster ovary cells transfected with the human thyrotropin receptor, we found that the stimulatory capacity of TRAbs was reduced markedly, by 66+/-22%, upon treatment with rituximab and methimazole for 21 days (p... methimazole alone (p=0.04 between groups). The overall levels of TRAbs decreased by around 15% in both groups. Within one year of follow-up, rituximab therapy mediated specific decreases in thyroid-peroxidase antibody- and IgM levels, whereas IgG levels were unaffected. The data indicate that rituximab...

  12. Induction treatment of previously undiagnosed ANCA-associated vasculitis in a renal transplant patient with Rituximab

    Science.gov (United States)

    Graham-Brown, M. P. M.; Aljayyousi, R.; Baines, R. J.; Burton, J. O.; Brunskill, N. J.; Furness, P.; Topham, P.

    2016-01-01

    We report the case of a 40-year-old female transplant patient with undiagnosed ANCA-associated vasculitis (AAV) and renal allograft dysfunction who achieved disease remission with restoration of transplant function following induction therapy with rituximab. There are currently no trial data looking at the use of rituximab for induction of remission of renal transplant patients with AAV. Although recurrence of AAV following renal transplantation is rare, such patients have invariably had multiple previous exposures to induction and maintenance immunosuppressive regimens, often limiting treatment options post-transplantation. In this case, rituximab was well tolerated with no side effects, and was successful in salvaging transplant function. Optimal treatment regimens for relapsed AAV in the transplant population are not known, and clinical trials are needed to evaluate the efficacy and safety of rituximab at inducing and maintaining disease remission in relapsed AAV following transplantation. PMID:27699052

  13. Early-Onset Neutropenia Induced by Rituximab in a Patient with Lupus Nephritis and Hemolytic Anemia

    OpenAIRE

    Mariangelí Arroyo-Ávila; Fred-Jiménez, Ruth M.; Vilá, Luis M.

    2015-01-01

    Rituximab is an anti-CD20 monoclonal antibody that has been used to treat several complications of systemic lupus erythematosus (SLE) including nephritis, cerebritis, and hematological disorders. Neutropenia is among the adverse events associated with rituximab; this usually occurs several weeks after therapy. However, early-onset neutropenia has been reported only in a few cases. Herein, we describe a 36-year-old Hispanic SLE woman who developed severe early-onset neutropenia (0.3 × 109/L) a...

  14. Rituximab in treatment-resistant CIDP with antibodies against paranodal proteins

    OpenAIRE

    Querol, Luis; Rojas-García, Ricard; Diaz-Manera, Jordi; Barcena, Joseba; Pardo, Julio; Ortega-Moreno, Angel; Sedano, Maria Jose; Seró-Ballesteros, Laia; Carvajal, Alejandra; Ortiz, Nicolau; Gallardo, Eduard; Illa, Isabel

    2015-01-01

    Objective: To describe the response to rituximab in patients with treatment-resistant chronic inflammatory demyelinating polyneuropathy (CIDP) with antibodies against paranodal proteins and correlate the response with autoantibody titers. Methods: Patients with CIDP and IgG4 anti–contactin-1 (CNTN1) or anti–neurofascin-155 (NF155) antibodies who were resistant to IV immunoglobulin and corticosteroids were treated with rituximab and followed prospectively. Immunocytochemistry was used to detec...

  15. An approach for chemical evaluation of immunoconjugates of “cold” 177lutetium-rituximab

    OpenAIRE

    Gjorgieva Ackova, Darinka; Smilkov, Katarina; Stafilov, Trajče; Kiprijanovska, Sanja; Sukarova Stefanovska, Emilija; Janevik-Ivanovska, Emilija

    2014-01-01

    Various radiolabeled monoclonal antibodies have been developed for the treatment and diagnosis of malignancies. Rituximab is a chimeric mouse-human monoclonal antibody. Rituximab selectively binds with high affinity to the CD20 antigen (human B-lymphocyte restricted differentiation antigen, Bp35), a hydrophobic transmembrane protein, which is expressed on B-lymphocytes and on >90% of B cell non-Hodgkin’s lymphomas. These properties make the CD20 receptor a suitable target for radioactive ther...

  16. Retrospective analysis of rituximab therapy and splenectomy in childhood chronic and refractory immune thrombocytopenic purpura.

    Science.gov (United States)

    Ay, Yilmaz; Karapinar, Tuba H; Oymak, Yesim; Toret, Ersin; Demirag, Bengu; Ince, Dilek; Ozcan, Esin; Moueminoglou, Nergial; Koker, Sultan A; Vergin, Canan

    2016-06-01

    Immune thrombocytopenic purpura (ITP) results from accelerated platelet destruction mediated by autoantibodies to platelet glycoproteins. Some patients with chronic ITP are refractory to all therapies [steroids, intravenous immunoglobulin (IVIG), anti-D and immunosuppresive drugs] and have chronic low platelet counts and episodic bleeding. We retrospectively evaluated the efficacy and safety of rituximab treatment and splenectomy in paediatric patients diagnosed with chronic and refractory ITP who were unresponsive to steroids, IVIG, cyclosporine and mycophenolate mofetil. Records of patients with chronic and refractory ITP in 459 patients with primary ITP who were followed up in our hospital from January 2005 to December 2014 were reviewed. Fifteen of patients received rituximab and/or applied splenectomy. Fifteen chronic ITP patients (10 boys, five girls) with a mean age of 10 years were enrolled in the study. Two of these patients were suffering from Evans syndrome. The median time since diagnosis of ITP was 10 years. The median follow-up duration after starting Rituximab and splenectomy were 13 and 9.5 months, respectively.None of the seven patients who were treated with rituximab achieved a response. A splenectomy was performed in six of the seven patients who had been treated with rituximab. Complete and partial responses were achieved in 67 and 33% of the patients, respectively. We evaluated the clinical characteristics and responses of chronic ITP patients who did not receive rituximab therapy and underwent a splenectomy. The success rate was 100% in the eight patients with chronic and refractory ITP. Rituximab therapy might not be beneficial for some children with severe chronic ITP who are refractory to standard agents. A splenectomy might be useful and preferable to rituximab. PMID:26656905

  17. Critical appraisal of rituximab in the maintenance treatment of advanced follicular lymphoma

    Directory of Open Access Journals (Sweden)

    Aguiar-Bujanda D

    2015-10-01

    Full Text Available David Aguiar-Bujanda, María Jesús Blanco-Sánchez, María Hernández-Sosa, Saray Galván-Ruíz, Samuel Hernández-Sarmiento Department of Medical Oncology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain Abstract: Rituximab is an IgG1, chimeric monoclonal antibody specifically designed to recognize the CD20 antigen expressed on the surface of normal and malignant B-lymphocytes, from the B-cell precursor to the mature B-cells of the germinal center, and by most neoplasms derived from B-cells. After 2 decades of use, rituximab is firmly positioned in the treatment of follicular lymphoma (FL, both in the front line and in the relapsing disease, improving previous results by including it in classical chemotherapy regimens. However, the pharmacology of rituximab continues to generate controversial issues especially regarding the mechanisms of action in vivo. The contribution of rituximab as a maintenance treatment in FL has been significant progress in the management of this disease without an increase in side effects or a decrease in the quality of life of patients. With the widespread use of rituximab, there are new security alerts and side effects not previously detected in the pivotal trials that clinicians should learn to recognize and manage. In this article, we will review the pharmacokinetics and pharmacodynamics of rituximab, the management issues in the treatment of advanced FL focusing on maintenance rituximab, its long-term efficacy and safety profile, and its effect on the quality of life. Keywords: follicular lymphoma, long-term efficacy, maintenance, rituximab, toxicity

  18. Intermediate doses of rituximab used as adjuvant therapy in refractory pemphigus

    Directory of Open Access Journals (Sweden)

    Pradnya J Londhe

    2014-01-01

    Full Text Available Background: Rituximab, a monoclonal anti-CD20 antibody, has been used with encouraging results in pemphigus. We describe herein refractory cases of pemphigus vulgaris (n = 23 and pemphigus foliaceus (n = 1 treated with rituximab in addition to steroids and immunosuppressants. Aims: To assess the response to treatment, the duration of clinical remission, serology of the response and adverse effects of rituximab in pemphigus patients. Methods: We recorded observations of 24 patients with pemphigus having either refractory disease in spite of high dose of steroids and immunosuppressants, corticosteroid-dependent disease, strong contraindications to corticosteroids, or severe disease. The patients were treated with infusions of one injection per week for three consecutive weeks of 375 mg of rituximab per m 2 of body-surface area. One similar infusion was repeated after 3 months of 3 rd dose. We observed the clinical outcome after 6 months of 3 rd dose of rituximab and looked for complete healing of cutaneous and mucosal lesions (complete remission. Observations: After follow-up of 7-24 months, five patients showed only partial improvement while 19 of 24 patients had a complete remission 3 months after rituximab. Of these 19 patients, 12 patients achieved complete remission and are off all systemic therapy, and the rest are continuing with no or low dose of steroids with immunosuppressants. Two patients relapsed after initial improvement; one was given moderate dose of oral steroids and immunosuppressant and the other was given repeat single dose of rituximab to control relapse. Conclusion: Rituximab is able to induce a prolonged clinical remission in pemphigus after a single course of four infusions. The high cost and limited knowledge of long term adverse effects are limitations to the use of this biologic agent.

  19. Rituximab induction therapy in highly sensitized kidney transplant recipients

    Institute of Scientific and Technical Information of China (English)

    YIN Hang; WAN Hao; HU Xiao-peng; LI Xiao-bei; WANG Wei; LIU Hang; REN Liang; ZHANG Xiao-dong

    2011-01-01

    Background The number of highly sensitized patients is rising, and sensitization can lead to renal transplant failure.The present study aimed to investigate the safety and efficacy of renal transplantation following induction therapy with rituximab in highly sensitized kidney transplant recipients.Methods Seven highly sensitized kidney transplant recipients who underwent rituximab therapy from December 2008 to December 2009 were retrospectively analyzed. There were 3 men and 4 women, with a mean age of 38.5 years (range, 21-47 years). The duration of hemodialysis was 3-12 months, with a mean duration of 11 months. For 4 patients,this was the second transplant; the previous graft survival time was 2-11 years, with a mean survival time of 5.8 years. All the female recipients had history of multiple pregnancies, and all patients had previously received blood transfusions. All donors were men, with a mean age of 32.5 years (range, 25-37 years). In 2 of the 7 patients, both class I and class II of panel reactive antibody were high; the remaining 5 patients showed either high in class I or in class II of panel reactive antibody. The mean panel reactive antibody value was 31% for class I and 51% for class II respectively. The donors and the recipients had the same blood type, with low lymphocyte cytotoxicity ranging from 2% to 5%. The human leukocyte antigen (HLA) mismatch numbers were from 2 to 4. All patients received tacrolimus (0.1 mg·kg-1·d-1) and mycophenolate mofetil (750 mg twice per day) orally 3 days prior to surgery. All patients received a single dose of 600 mg rituximab (375 mg/m2) infusion on the day before surgery and polyclonal antibody (antithymocyte globulin) on the day of surgery.Postoperative creatinine, creatinine clearance rate, and occurrence of rejection by pathological biopsy confirmation were monitored.Results No patient had delayed graft function after surgery. Two patients had acute rejection, one on day 7 and the other on day 13 post

  20. USE OF RITUXIMAB IN AUTOIMMUNE DISEASES: NEW ASPECTS

    Directory of Open Access Journals (Sweden)

    Dmitry Evgenyevich Karateyev

    2010-01-01

    Full Text Available It has been noted that off-label indication for Rituximab (RTX in rheumatological care indubitably requires its confirmation in the randomized clinical trials. A particular cautious approach should be taken in extending the indications for therapy with gene-engineering biologicals because of the intricacy and interaction of different immunoregulatory mechanisms. Nonetheless, it is stated that much clinical experience with RTX used in most severely ill therapy-resistant patients may serve as a basis for its prescription in a number of most complex inflammatory rheumatic diseases (RDs. There is new evidence for the use of RTX in various RDs differing in their clinical picture, course, and pathogenesis, such as spondyloarthritis, systemic lupus erythematosus, systemic vasculitis.

  1. First-line chemoimmunotherapy with bendamustine and rituximab versus fludarabine, cyclophosphamide, and rituximab in patients with advanced chronic lymphocytic leukaemia (CLL10)

    DEFF Research Database (Denmark)

    Eichhorst, Barbara; Fink, Anna-Maria; Bahlo, Jasmin;

    2016-01-01

    BACKGROUND: Chemoimmunotherapy with fludarabine, cyclophosphamide, and rituximab is the standard therapy for physically fit patients with advanced chronic lymphocytic leukaemia. This international phase 3 study compared the efficacy and tolerance of the standard therapy with a potentially less...... toxic combination consisting of bendamustine and rituximab. METHODS: Treatment-naive fit patients with chronic lymphocytic leukaemia (aged 33-81 years) without del(17p) were enrolled after undergoing a central screening process. Patients were randomly assigned (1:1) with a computer...... or to intravenous bendamustine (90 mg/m(2) per day) for the first 2 days of each cycle. Rituximab 375 mg/m(2) was given intravenously in both groups on day 0 of cycle 1 and subsequently was given at 500 mg/m(2) during the next five cycles on day 1. The primary endpoint was progression-free survival...

  2. Radiolabeling parameters of {sup 177}Lu-DOTA-RITUXIMAB

    Energy Technology Data Exchange (ETDEWEB)

    Massicano, Adriana V.F.; Alcarde, Lais F.; Oliveira, Ricardo S.; Mengatti, Jair; Araujo, Elaine B. de, E-mail: adriana.avfernandes@gmail.com [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil)

    2013-07-01

    Cancer treatment using radioimmunotherapy (RIT) has been the focus of much research in the last two decades. In RIT, a radioisotope is coupled to a monoclonal antibody (mAb) to form a tumor-specific target agent to improve the cytocidal effect of the mAbs. RIT allows the systemic delivery of radiation to disease target by mAbs while sparing normal tissues. Rituximab® (Mabthera - Roche) is a chimeric mouse-human monoclonal antibody; it selectively binds with high affinity to the CD20 antigen, a hydrophobic transmembrane protein, which is expressed on B-lymphocytes and in more than 90% of B cell non-Hodgkin's lymphomas (NHL). The conjugation and radiolabeling process involve special conditions of pH and temperature, long processes of manipulation and mixing. All this process can damage the antibody structure and compromise its clinical application. Therefore, these parameters must be largely studied. The aim of this work was to evaluate the best radiolabeling conditions of DOTA-rituximab. Briefly, 10 mg of antibody previously purified by ultrafiltration device was conjugated with DOTA-NHS-ester (Macrocyclics) in 50 fold molar excess. The reaction was conducted for 1 hour in phosphate buffer pH 8.0 and gently mixing at room temperature, remaining for 24 hours under refrigeration. The immunoconjugated was purified by size exclusion column and ultrafiltration device. The radiolabeled parameters studied were: immunoconjugated mass, activity of {sup 177}LuCl{sub 3}, reaction time, temperature and pH. The radiochemical purity of the preparations was determined using analysis by thin layer chromatography (TLC-SG plates). The best studied condition presented radiochemical purity above 95% and the integrity of antibody was preserved. (author)

  3. The Factors That May Predict Response to Rituximab Therapy in Recurrent Focal Segmental Glomerulosclerosis: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Carlos E. Araya

    2011-01-01

    Full Text Available Recurrence of FSGS occurs in 30–40% of allografts. Therapies for recurrence are not well established. We retrieved all published reports depicting kidney transplant recipients with focal segmental glomerulosclerosis (FSGS recurrence, treated with rituximab, to determine factors associated with treatment response. We found 18 reports of 39 transplant recipients who received rituximab. By univariate analysis for two outcomes (no response versus any response, fewer rituximab infusions and normal serum albumin at recurrence were associated with treatment response. For 3 outcomes (no response, partial and complete remission, male gender, fewer rituximab infusions, shorter time to rituximab treatment, and normal serum albumin were associated with remission. Multivariate analysis for both models revealed that normal serum albumin at FSGS recurrence and lower age at transplant were associated with response. Rituximab for recurrence of FSGS may be beneficial for only some patients. A younger age at transplant and normal serum albumin level at recurrence diagnosis may predict response.

  4. Early-onset neutropenia induced by rituximab in a patient with lupus nephritis and hemolytic anemia.

    Science.gov (United States)

    Arroyo-Ávila, Mariangelí; Fred-Jiménez, Ruth M; Vilá, Luis M

    2015-01-01

    Rituximab is an anti-CD20 monoclonal antibody that has been used to treat several complications of systemic lupus erythematosus (SLE) including nephritis, cerebritis, and hematological disorders. Neutropenia is among the adverse events associated with rituximab; this usually occurs several weeks after therapy. However, early-onset neutropenia has been reported only in a few cases. Herein, we describe a 36-year-old Hispanic SLE woman who developed severe early-onset neutropenia (0.3 × 10(9)/L) after the second weekly rituximab infusion (375 mg/m(2) weekly × 4) given for nephritis and hemolytic anemia. She also had early-onset thrombocytopenia after rituximab therapy. Both hematological disorders resolved 12 days after the fourth and final dose. This case, together with few others, suggests that early-onset neutropenia may occur during rituximab therapy. Even though rituximab-induced neutropenia seems to be transient, it may predispose SLE patients to severe complications such as infections. PMID:25767732

  5. Early-Onset Neutropenia Induced by Rituximab in a Patient with Lupus Nephritis and Hemolytic Anemia

    Directory of Open Access Journals (Sweden)

    Mariangelí Arroyo-Ávila

    2015-01-01

    Full Text Available Rituximab is an anti-CD20 monoclonal antibody that has been used to treat several complications of systemic lupus erythematosus (SLE including nephritis, cerebritis, and hematological disorders. Neutropenia is among the adverse events associated with rituximab; this usually occurs several weeks after therapy. However, early-onset neutropenia has been reported only in a few cases. Herein, we describe a 36-year-old Hispanic SLE woman who developed severe early-onset neutropenia (0.3 × 109/L after the second weekly rituximab infusion (375 mg/m2 weekly × 4 given for nephritis and hemolytic anemia. She also had early-onset thrombocytopenia after rituximab therapy. Both hematological disorders resolved 12 days after the fourth and final dose. This case, together with few others, suggests that early-onset neutropenia may occur during rituximab therapy. Even though rituximab-induced neutropenia seems to be transient, it may predispose SLE patients to severe complications such as infections.

  6. Linfoma hepático primario: Evolución favorable con quimioterapia combinada con rituximab Primary hepatic lymphoma: favorable outcome with chemotherapy plus rituximab

    Directory of Open Access Journals (Sweden)

    I. Serrano-Navarro

    2008-11-01

    Full Text Available Comunicamos el caso de una paciente con un linfoma hepático primario tratado con éxito con quimioterapia combinada con rituximab. Utilizando los "encabezamientos estándar para búsquedas bibliográficas informatizadas" (Medical Subject Heading revisamos los casos publicados hasta la fecha de esta infrecuente entidad.This article describes the case of a patient with a non-Hodgkin primary hepatic lymphoma who was successfully treated with chemotherapy combined with rituximab. Using the Medical Subject Headings the published reports of this rare entity were reviewed.

  7. Rituximab efficiently depletes B cells in lung tumors and normal lung tissue [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Albane Joly-Battaglini

    2016-01-01

    Full Text Available Rituximab is a monoclonal antibody that targets the CD20 B-cell-specific antigen and is widely used as therapy for B-cell lymphoma. Since rituximab depletes both malignant and normal B cells, it is increasingly being used to treat various conditions in which normal B cells have a pathogenic role, such as rheumatoid arthritis and multiple sclerosis. It is well-established that rituximab efficiently eliminates B cells in blood, lymph nodes, and spleen. In contrast, the effect of rituximab in non-lymphoid tissues remains poorly documented and is debated. Here, we report a rheumatoid arthritis patient who was treated with rituximab before receiving thoracic surgery for non-small cell lung cancer. Using flow cytometry and immunohistochemistry, we show that rituximab efficiently depleted CD20-positive B cells in a primary lung tumor, in lung-associated lymph nodes, and in normal lung tissue. We conclude that rituximab may be very efficient at depleting normal B cells in the lungs. This property of rituximab may potentially be exploited for the treatment of conditions in which pathogenic B cells reside in the lungs. On the other hand, the clearance of lung B cells may provide an explanation for the rare cases of severe non-infectious pulmonary toxicity of rituximab.

  8. Safety and efficacy of combined cyclophosphamide and rituximab treatment in recalcitrant childhood lupus.

    Science.gov (United States)

    Ale'ed, Ashwaq; Alsonbul, Abdullah; Al-Mayouf, Sulaiman M

    2014-04-01

    To report the safety and efficacy of combined cyclophosphamide and rituximab treatment in Saudi children with systemic lupus erythematosus (SLE). Medical records of all children with SLE treated with cyclophosphamide and rituximab between June 2007 and June 2012 at King Faisal Specialist Hospital and Research Center, Riyadh, were reviewed for demographic characteristics, age at diagnosis, concomitant treatments, indication of using rituximab and adverse events during the treatment period. Clinical and serologic response parameters included SLE Disease Activity Index (SLEDAI), complement, anti-ds DNA antibody and ANA levels, and mean daily corticosteroid dose assessed 3 months before combined cyclophosphamide and rituximab infusion course and at 6-month interval afterward. Sixteen patients (13 girls) with refractory SLE treated with cyclophosphamide and rituximab were included. The mean age at onset of SLE was 7.8 + 3.3 years, while the mean age at diagnosis was 8.1 + 3.4 years; the mean disease duration was 4.7 + 3.2 years. All patients were treated with corticosteroid and immunosuppressive drugs. Nephritis (8 patients) was the most frequent indication; other indications included refractory arthritis, thrombocytopenia, severe mucocutaneous lesions and central nervous system involvement. All patients received 2 doses, but 4 required 4-8 extra doses. All patients showed improvement in response parameters. There was significant reduction in SLEDAI (P < 0.0002) and corticosteroid dose (P < 0.005). A total of 4 adverse events were notified; 2 developed infusion-related reactions. One patient had severe soft tissue fungal infection, and other patient had pancreatitis. Our data showed beneficial therapeutic and steroid-sparing effects of rituximab as adjunctive treatment for children with refractory SLE including both renal and extrarenal manifestations. Although rituximab was well tolerated by the majority of patients, it may associated with various adverse events.

  9. Clinical response, pharmacokinetics, development of human anti-chimaeric antibodies, and synovial tissue response to rituximab treatment in patients with rheumatoid arthritis

    NARCIS (Netherlands)

    R.M. Thurlings; O. Teng; K. Vos; D.M. Gerlag; L. Aarden; S.O. Stapel; J.M. van Laar; P.P. Tak; G.J. Wolbink

    2010-01-01

    Objectives: To analyse whether persistence of synovial B lineage cells and lack of clinical response to rituximab treatment in patients with rheumatoid arthritis (RA) are associated with low rituximab serum levels and anti-rituximab antibody (ARA) formation. Methods: Fifty-eight patients with RA wer

  10. Practical considerations on the use of rituximab in autoimmune neurological disorders

    Science.gov (United States)

    Kosmidis, Mixalis L.; Dalakas, Marinos C.

    2010-01-01

    Rituximab (Mabthera, Rituxan) is a chimeric human/murine monoclonal antibody against CD-20 surface antigen expressed on B-cells. Rituximab, by causing B-cell depletion, appears to be effective in several autoimmune disorders; it has been approved for rheumatoid arthritis and is a promising new agent in the treatment of several autoimmune neurological disorders. A controlled study in patients with relapsing remitting multiple sclerosis has shown that rituximab significantly reduces the number of new MRI lesions and improves clinical outcome; it also showed some promise in a subset of patients with primary progressive MS. The drug is also effective in a number of patients with Devic’s disease, myasthenia gravis, autoimmune neuropathies, and inflammatory myopathies. The apparent effectiveness of rituximab has moved B-cells into the center stage of clinical and laboratory investigation of autoimmune neurological disorders. We review the evidence-based effectiveness of rituximab in neurological disorders based on controlled trials and anecdotal reports, including our own experience, and address the immunobiology of B-cells in autoimmune central nervous system (CNS) and peripheral nervous system (PNS) disorders. In addition, we provide practical guidelines on how best to use this drug in clinical practice and highlight its potential toxicity. PMID:21179602

  11. Practical considerations on the use of rituximab in autoimmune neurological disorders.

    Science.gov (United States)

    Kosmidis, Mixalis L; Dalakas, Marinos C

    2010-03-01

    Rituximab (Mabthera, Rituxan) is a chimeric human/murine monoclonal antibody against CD-20 surface antigen expressed on B-cells. Rituximab, by causing B-cell depletion, appears to be effective in several autoimmune disorders; it has been approved for rheumatoid arthritis and is a promising new agent in the treatment of several autoimmune neurological disorders. A controlled study in patients with relapsing remitting multiple sclerosis has shown that rituximab significantly reduces the number of new MRI lesions and improves clinical outcome; it also showed some promise in a subset of patients with primary progressive MS. The drug is also effective in a number of patients with Devic's disease, myasthenia gravis, autoimmune neuropathies, and inflammatory myopathies. The apparent effectiveness of rituximab has moved B-cells into the center stage of clinical and laboratory investigation of autoimmune neurological disorders. We review the evidence-based effectiveness of rituximab in neurological disorders based on controlled trials and anecdotal reports, including our own experience, and address the immunobiology of B-cells in autoimmune central nervous system (CNS) and peripheral nervous system (PNS) disorders. In addition, we provide practical guidelines on how best to use this drug in clinical practice and highlight its potential toxicity.

  12. MRI assessment of suppression of structural damage in patients with rheumatoid arthritis receiving rituximab

    DEFF Research Database (Denmark)

    Peterfy, Charles; Emery, Paul; Tak, Paul P;

    2014-01-01

    OBJECTIVE: To evaluate changes in structural damage and joint inflammation assessed by MRI following rituximab treatment in a Phase 3 study of patients with active rheumatoid arthritis (RA) despite methotrexate (MTX) who were naive to biological therapy. METHODS: Patients were randomised to receive...... two infusions of placebo (n=63), rituximab 500 mg (n=62), or rituximab 1000 mg (n=60) intravenously on days 1 and 15. MRI scans and radiographs of the most inflamed hand and wrist were acquired at baseline, weeks 12 (MRI only), 24 and 52. The primary end point was the change in MRI erosion score from...... baseline at week 24. RESULTS: Patients treated with rituximab demonstrated significantly less progression in the mean MRI erosion score compared with those treated with placebo at weeks 24 (0.47, 0.18 and 1.60, respectively, p=0.003 and p=0.001 for the two rituximab doses vs placebo) and 52 (-0.30, 0...

  13. Remission Achieved in Refractory Advanced Takayasu Arteritis Using Rituximab

    Directory of Open Access Journals (Sweden)

    D. Ernst

    2012-01-01

    Full Text Available A 25-year-old patient was referred due to subclavian stenosis, identified on echocardiography. She presented with exertional dizziness and dyspnoea. Questioning revealed bilateral arm claudication. Examination demonstrated an absent right ulnar pulse and asymmetrical brachial blood pressure. Bruits were evident over both common carotid arteries. Doppler ultrasound and MRI angiograms revealed occlusion or stenosis in multiple large arteries. Takayasu arteritis (TA was diagnosed and induction therapy commenced: 1 mg/kg oral prednisolone and 500 mg/m2 intravenous cyclophosphamide (CYC. Attempts to reduce prednisolone below 15 mg/d proved impossible due to recurring disease activity. Adjuvant azathioprine 100 mg/d was subsequently added. Several weeks later, the patient was admitted with a left homonymous hemianopia. The culprit lesion in the right carotid artery was surgically managed and the patient discharged on azathioprine 150 mg/d and prednisolone 30 mg/d. Despite this, deteriorating exertional dyspnoea and angina pectoris were reported. Reimaging confirmed new stenosis in the right pulmonary artery. Surgical treatment proved infeasible. Given evidence of refractory disease activity on maximal standard therapy, we initiated rituximab, based on recently reported B-cell activity in TA.

  14. Inhibition of joint damage and improved clinical outcomes with rituximab plus methotrexate in early active rheumatoid arthritis: the IMAGE trial

    NARCIS (Netherlands)

    P.P. Tak; W.F. Rigby; A. Rubbert-Roth; C.G. Peterfy; R.F. van Vollenhoven; W. Stohl; E. Hessey; A. Chen; H. Tyrrell; T.M. Shaw

    2011-01-01

    Objectives Rituximab is an effective treatment in patients with established rheumatoid arthritis (RA). The objective of the IMAGE study was to determine the efficacy of rituximab in the prevention of joint damage and its safety in combination with methotrexate (MTX) in patients initiating treatment

  15. The Efficacy and Safety of Rituximab in a Patient with Rheumatoid Spondylitis

    Directory of Open Access Journals (Sweden)

    Şenol Kobak

    2013-01-01

    Full Text Available Rheumatoid arthritis (RA is considered as a connective tissue disease while ankylosing spondylitis (AS is a prototype of spondyloarthritis. These diseases are seen concomitantly only very rarely. Also, rituximab has proven efficacy in the treatment of RA while its role in the treatment of AS is unclear. In this presentation, the concomitant presence of RA and AS in a 43-year-old male patient as well as the efficacy and safety of rituximab is discussed. Rituximab was given due to lack of response to treatment with anti-TNF-alpha. Evaluations made at the 6th and 12th months of treatment showed complete response for RA and partial response for AS.

  16. Detecting CD20-Rituximab specific interactions on lymphoma cells using atomic force microscopy

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    Elucidating the underlying mechanisms of cell physiology is currently an important research topic in life sciences. Atomic force microscopy methods can be used to investigate these molecular mechanisms. In this study, single-molecule force spectroscopy was used to explore the specific recognition between the CD20 antigen and anti-CD20 antibody Rituximab on B lymphoma cells under near-physiological conditions. The CD20-Rituximab specific binding force was measured through tip functionalization. Distribution of CD20 on the B lymphoma cells was visualized three-dimensionally. In addition, the relationship between the intramolecular force and the molecular extension of the CD20-Rituximab complex was analyzed under an external force. These results facilitate further investigation of the mechanism of Rituximab’s anti-cancer effect.

  17. Rituximab in Adult –Onset Still’s Disease: Case Report

    Directory of Open Access Journals (Sweden)

    G Mehrpoor

    2009-01-01

    Full Text Available Summary: Adult-onset Still’s disease (AOSD is a rare systemic inflammatory disorder of unknown etiology. It is characterized by high grade fever, skin rash, arthritis, leukocytosis, increased ESR, CRP and liver enzyme levels and high levels of ferritin. The treatment of AOSD includes NSAIDs, steroids, and disease-modifying antirheumatic drugs (DMARDs. Recently biologic agents have been used for treatment of some rheumatologic disorders. Rituximab(MabThera, an anti-CD20 monoclonal antibody is one of the biologic agents which is used by only a few researchers for treatment of refractory AOSD. Herein, we describe a 23 year old woman, who was treated with Rituximab ,three years after diagnosis of AOSD .She did not respond to Metotroxate and Cellcept .After administration of Rituximab, clinical and laboratory remission was achieved .

  18. Two courses of rituximab (anti-CD20 monoclonal antibody) for recalcitrant pemphigus vulgaris

    DEFF Research Database (Denmark)

    Faurschou, A.; Gniadecki, R.

    2008-01-01

    Background Pemphigus vulgaris (PV) is a severe autoimmune blistering disease involving the skin and mucous membranes. The response to therapy varies greatly amongst patients and treatment may be challenging. Rituximab is a chimeric monoclonal antibody that selectively targets cell surface antigen...... CD20, thus depleting mature B cells in vivo. Methods We report the results of rituximab treatment in two patients with severe PV. In both patients, high-dose oral prednisolone and adjuvant therapy with intravenous immunoglobulins and mycophenolate mofetil failed to control disease activity....... Consequently, the patients were treated with two courses of four weekly intravenous infusions of rituximab (375 mg/m(2)) with a 6-month interval. Results Clinical improvement was already noticeable 3-6 weeks after the first infusion. After the second course, complete remission was achieved. Oral prednisolone...

  19. Selective response to rituximab in a young child with MuSK-associated myasthenia gravis.

    Science.gov (United States)

    Govindarajan, Raghav; Iyadurai, Stanley J; Connolly, Anne; Zaidman, Craig

    2015-08-01

    Neuromuscular junction disorders in children are either genetic, such as congenital myasthenic syndrome, or autoimmune with circulating antibodies most commonly against acetylcholine receptors. There is limited experience recognizing and treating children with myasthenia associated with muscle-specific tyrosine kinase antibodies. We report a seven-year-old child with intermittent esotropia since age 3 months, and two years of progressive and severe diplopia, dysarthria, dysphagia, and facial weakness. Acetylcholine receptor antibodies and genetic testing for congenital myasthenic syndrome were negative. Muscle specific tyrosine kinase antibodies were significantly elevated. Ophthalmoplegia and bulbar weakness were refractory to treatment with acetylcholinesterase inhibitors, corticosteroids and IVIg but completely resolved following treatment with rituximab. Her neurologic examination remained normal at the most recent follow-up, 15 months after initiation of rituximab. Children with MuSK myasthenia, like adults, can respond to rituximab despite long standing disease and failure to improve on other immunosuppressant medications. PMID:25998611

  20. Rituximab as a first-line agent for the treatment of dermatomyositis.

    LENUS (Irish Health Repository)

    2012-02-01

    B cells may play a pivotal role in the pathophysiology of DM, and reports have claimed that targeting B cells is a viable treatment option in patients with dermatomyositis. A 20-year-old girl presented in October 2007, with few weeks\\' history of proximal muscle weakness. Gottron\\'s papules were noted on her knuckles. She had normal inflammatory markers and negative autoantibody screen. Her CPK was 7,000 U\\/L (normal range 0-170) with an LDH of 1,300 U\\/L (normal range 266-500). EMG and muscle biopsy was consistent with active myositis. She had normal pulmonary function tests. HRCT showed no interstitial lung disease. She was started with 60 mg glucocorticoids (1 mg\\/kg), with a good clinical response. However, any attempt to taper down the steroid dose led to recurrence of her symptoms. The options of available immunosuppressive therapies, including the experimental usage of rituximab, were discussed with her; averse to long-term systemic treatments, she opted to try a course of rituximab. She had rituximab 1,000 mg on days 0 and 14, and her glucocorticoids were tapered in next few weeks. Now, 24 months since her rituximab infusions, she remains in complete clinical and biochemical remission and is naive to other immunosuppressive agents apart from glucocorticoids and rituximab. Depleting peripheral B cells with rituximab (one course) in our patient has led not only to complete resolution of muscle and skin disease (induction) but also remains off all immunosuppressives including glucocorticoids.

  1. Successful rituximab treatment in an elderly patient with recurrent thrombotic thrombocytopenic purpura.

    Science.gov (United States)

    Matsubara, Etsuko; Yamanouchi, Jun; Hato, Takaaki; Takeuchi, Kazuto; Niiya, Toshiyuki; Yasukawa, Masaki

    2016-07-01

    An 81-year-old man presenting with fever, neurological symptoms, thrombocytopenia, and hemolytic anemia was diagnosed with acquired idiopathic thrombotic thrombocytopenic purpura (TTP). His disintegrin-like and metalloproteinase with thrombospondin type 1 motifs 13 (ADAMTS13) activity was TTP recurrence based on ADAMTS13 activity TTP in Japan, we report the efficacy and safety of rituximab in an elderly patient with recurrent TTP. We suggest that rituximab therapy should be started as soon as possible for recurrent TTP in patients with high titers of ADAMTS13 inhibitor. PMID:27498731

  2. B lymphocyte depletion with the monoclonal antibody rituximab in Graves' disease: a controlled pilot study

    DEFF Research Database (Denmark)

    El Fassi, Daniel; Nielsen, Claus H; Bonnema, Steen J;

    2007-01-01

    Graves' disease (GD) is a common TSH receptor autoantibody (TRAb)-mediated disorder. Because B lymphocytes are important self-antigen presenting cells and precursors for antibody-secreting plasma cells, temporary B-lymphocyte depletion with the monoclonal antibody rituximab (RTX) might be of bene......Graves' disease (GD) is a common TSH receptor autoantibody (TRAb)-mediated disorder. Because B lymphocytes are important self-antigen presenting cells and precursors for antibody-secreting plasma cells, temporary B-lymphocyte depletion with the monoclonal antibody rituximab (RTX) might...

  3. Treatment of immune thrombocytopenia after allogeneic cord blood stem cell transplantation with rituximab: a case report

    Institute of Scientific and Technical Information of China (English)

    Mengxing Li; Jishi Wang; Yan Zhang; Zhiqiang Sun; Yanju Li; Xiaoli Zhou

    2013-01-01

    Immune thrombocytopenia (ITP) is a chronic disease resulting from increased platelet destruction and impaired platelet production. Secondary ITP can be a manifestation of chronic graft-versus-host disease (GVHD) and represent a lymphoproliferative disorder. A boy with chronic graft-versus-host disease after cord blood stem cell transplantation who had severe refractory immune-mediated thrombocytopenia received infusion of rituximab weekly, 375 mg/m2, for 4 weeks. Platelets count of the patient was recovered, and rituximab was well tolerated with no severe toxicity observed during treatment.

  4. Rituximab used in three cases with relapsed non-Hodgkin’s lymphoma

    OpenAIRE

    Elli, Murat; YILMAZ, SEMA; AYDIN, RAMAZAN; MURAT, SADRIYE; Bilgici, Meltem Ceyhan; DAGDEMIR, AYHAN

    2013-01-01

    Relapsed or refractory B-cell non-Hodgkin’s lymphoma (B-NHL) patients have a poor prognosis. New treatment modalities have been used to improve survival rates in children with relapsed or refractory B-NHL. CD20 is expressed in >98% of childhood B-NHL and a chimeric anti-CD20 monoclonal antibody, rituximab, is increasingly being used at relapse. The aim of the present study was to determine the efficacy of rituximab on relapsed B-NHL. Three B-NHL cases were treated successfully with a combinat...

  5. A case of "refractory" lupus erythematosus profundus responsive to rituximab [case report].

    LENUS (Irish Health Repository)

    McArdle, Adrian

    2012-02-01

    Lupus erythematosus profundus is a rare complication of systemic lupus erythematosus characterized by the presence of deep, tender subcutaneous nodules. A 22-year-old African-American female with extensive lupus profundus resistant to conventional therapies was treated with two infusions of the anti-CD20 monoclonal antibody, rituximab, at a dosage of 1,000 mg each. The patient demonstrated a remarkable clinical response as indicated by the disappearance of the nodules. B-cell depletion therapy with rituximab used alone or in combination with other therapies may be a viable option in patients with lupus profundus refractory to current therapies.

  6. The Result of Multiple I-131 Treatments on the Effective Half-Life of Retained Radioactivity in Patients Ablated for Differentiated Thyroid Cancer: Possible Evidence for Thyroid Remnant Function Impairment.

    Science.gov (United States)

    Okkalides, Demetrios

    2016-03-01

    The ablation of differentiated thyroid cancer by ingested I-131 depends on the activity absorbed by the remnant. This depends on the function of the thyroid cells and on the rate that radioactivity is excreted from the blood. The reduction of radioiodine is described by the effective half-life (EHL), which is the time taken to half the retained radioactivity. If the tumor recurs, more treatments are prescribed, often with escalating activities. Patients may receive several treatments during the evolution of the disease, and the total radioactivity administered (TRA) is the sum of all such activities. The patients' archived information permitted the calculation of EHL and TRA. The patient cohort processed here comprised 274 females and 101 males treated during 1997 to 2015. The TRA to the patients ranged between 1.1 and 129.5 GBq (average = 7.93 ± 9.9 GBq) and the EHL varied between 5.06 and 43.87 hours (average = 14.13 ± 5.7 hours). The data were processed as follows: (a) the EHL corresponding to the last treatment of each patient was plotted against TRA to patients who were treated once and to those treated several times for comparison and (b) using a small subgroup of 16 patients who were treated at least 5 times, the EHL and TRA corresponding to each treatment of each patient were plotted. A function of the form y = p-k·ln(x) was fitted on the data in all graphs and k was calculated. For patients treated once, EHL was independent of TRA. A decrease was seen in (a) multitreated patients, with the gradient (k) ranging between -0.541 and -13.880 and (b) 13 out of 16 patients, with the gradient (k) ranging between -5.55 and -31.17, both indicating an impairment of the remnant function, perhaps identified as "stunning." Since this is not avoidable, the uptake may be boosted by splitting the prescribed activity into low radioactivity fractions, which will also reduce patient hospitalization.

  7. Efficacy and safety of rituximab therapy for systemic lupus erythematosus: a systematic review and meta-analysis

    Institute of Scientific and Technical Information of China (English)

    Lan LAN; Fei HAN; Jiang-hua CHEN

    2012-01-01

    Objective:To review the efficacy and safety of rituximab therapy for systemic lupus erythematosus (SLE).Methods:We searched for randomized controlled trails and observational studies that evaluated the effect of rituximab based on the systemic lupus erythematosus disease activity index (SLEDAI),British Isles lupus assessment group index (BILAG),urine protein levels,and the prednisolone dose,and had adequate data to calculate the mean,standard deviation (SD),and 95% confidence intervals,and to systematically review and meta-analyze observational studies with fixed effects model or random effects model.Results:We included 2 randomized controlled studies and 19observational clinical studies.We summarized the data from the 19 observational studies,analyzed the heterogeneity of the literature,and then used fixed effect model or random effect model for statistical analysis.The SLEDAI,BILAG,and urine protein levels and the prednisolone dosage were decreased after rituximab treatment,and the decreases in the BILAG,urine protein levels,and the prednisolone dose were found to be significant (P<0.05),when compared with baseline level.Rituximab's adverse effects generally could be controlled with an effective dosing regimen.Conclusions:Although there are still controversies about rituximab's treatment on SLE,but our study had showed that rituximab had favorable effects on refractory lupus.The long-term efficacy and safety of rituximab require further study.

  8. A pioneer experience in Malaysia on In-house Radio-labelling of (131)I-rituximab in the treatment of Non-Hodgkin's Lymphoma and a case report of high dose (131)I-rituximab-BEAM conditioning autologous transplant.

    Science.gov (United States)

    Kuan, Jew Win; Law, Chiong Soon; Wong, Xiang Qi; Ko, Ching Tiong; Awang, Zool Hilmi; Chew, Lee Ping; Chang, Kian Meng

    2016-10-01

    Radioimmunotherapy is an established treatment modality in Non-Hodgkin's lymphoma. The only two commercially available radioimmunotherapies - (90)Y-ibritumomab tiuxetan is expensive and (131)I-tositumomab has been discontinued from commercial production. In resource limited environment, self-labelling (131)I-rituximab might be the only viable practical option. We reported our pioneer experience in Malaysia on self-labelling (131)I-rituximab, substituting autologous haematopoietic stem cell transplantation (HSCT) and a patient, the first reported case, received high dose (131)I-rituximab (6000MBq/163mCi) combined with BEAM conditioning for autologous HSCT. PMID:27472826

  9. A pioneer experience in Malaysia on In-house Radio-labelling of (131)I-rituximab in the treatment of Non-Hodgkin's Lymphoma and a case report of high dose (131)I-rituximab-BEAM conditioning autologous transplant.

    Science.gov (United States)

    Kuan, Jew Win; Law, Chiong Soon; Wong, Xiang Qi; Ko, Ching Tiong; Awang, Zool Hilmi; Chew, Lee Ping; Chang, Kian Meng

    2016-10-01

    Radioimmunotherapy is an established treatment modality in Non-Hodgkin's lymphoma. The only two commercially available radioimmunotherapies - (90)Y-ibritumomab tiuxetan is expensive and (131)I-tositumomab has been discontinued from commercial production. In resource limited environment, self-labelling (131)I-rituximab might be the only viable practical option. We reported our pioneer experience in Malaysia on self-labelling (131)I-rituximab, substituting autologous haematopoietic stem cell transplantation (HSCT) and a patient, the first reported case, received high dose (131)I-rituximab (6000MBq/163mCi) combined with BEAM conditioning for autologous HSCT.

  10. Salvage therapy for primary CNS lymphoma with a combination of rituximab and temozolomide

    NARCIS (Netherlands)

    Enting, Roeline; Demopoulos, A; DeAngelis, LM; Abrey, LE

    2004-01-01

    The authors evaluated the efficacy of a combination of rituximab and temozolomide for recurrent or refractory primary CNS lymphoma (PCNSL). Fifteen patients with a median age of 69 years had a 53% objective response rate with acceptable toxicity. Median overall survival is 14 months and median progr

  11. Rituximab Leads to Long Remissions in Patients with Chronic Immune Thrombocytopenia

    Directory of Open Access Journals (Sweden)

    Khalid Al-Habsi

    2015-03-01

    Full Text Available Objectives: To assess the response rate and duration of response in patients with chronic immune thrombocytopenia (ITP receiving rituximab. Methods: We retrospectively analyzed 32 consecutive patients with chronic ITP who were treated in two tertiary centers in Oman. Response assessment was based on the American Society of Hematology criteria. Results: Nineteen patients (59% had an initial response. However, six of the 19 patients lost their response leaving 13 patients with long-lasting remissions. The median age at diagnosis was 25 years (range 14–58. The median time from diagnosis to rituximab therapy was 21 months. The median follow-up after starting rituximab was 26 months. The overall cumulative response rate was 59% (complete response 44%, partial response 15% and the median time to respond was 30 days with a response rate of 44% at four weeks. In all responders, the cumulative rate of loss of response was 32% with a median time to lose response of 54 months. Conclusions: The use of rituximab in ITP achieves high response rate and long remission duration. Our study was limited by the small sample size and further larger prospective studies are recommended.

  12. Rituximab-induced depletion of anti-PLA2R autoantibodies predicts response in membranous nephropathy.

    Science.gov (United States)

    Beck, Laurence H; Fervenza, Fernando C; Beck, David M; Bonegio, Ramon G B; Malik, Fahim A; Erickson, Stephen B; Cosio, Fernando G; Cattran, Daniel C; Salant, David J

    2011-08-01

    Autoantibodies to the M-type phospholipase A(2) receptor (PLA(2)R) are sensitive and specific for idiopathic membranous nephropathy. The anti-B cell agent rituximab is a promising therapy for this disease, but biomarkers of early response to treatment currently do not exist. Here, we investigated whether levels of anti-PLA(2)R correlate with the immunological activity of membranous nephropathy, potentially exhibiting a more rapid response to treatment than clinical parameters such as proteinuria. We measured the amount of anti-PLA(2)R using Western blot immunoassay in serial serum samples from a total of 35 patients treated with rituximab for membranous nephropathy in two distinct cohorts. Pretreatment samples from 25 of 35 (71%) patients contained anti-PLA(2)R, and these autoantibodies declined or disappeared in 17 (68%) of these patients within 12 months after rituximab. Those who demonstrated this immunologic response fared better clinically: 59% and 88% attained complete or partial remission by 12 and 24 months, respectively, compared with 0% and 33% among those with persistent anti-PLA(2)R levels. Changes in antibody levels preceded changes in proteinuria. One subject who relapsed during follow-up had a concomitant return of anti-PLA(2)R. In summary, measuring anti-PLA(2)R levels by immunoassay may be a method to follow and predict response to treatment with rituximab in membranous nephropathy.

  13. High in Vitro Anti-Tumor Efficacy of Dimeric Rituximab/Saporin-S6 Immunotoxin

    Directory of Open Access Journals (Sweden)

    Massimo Bortolotti

    2016-06-01

    Full Text Available The anti-CD20 mAb Rituximab has revolutionized lymphoma therapy, in spite of a number of unresponsive or relapsing patients. Immunotoxins, consisting of toxins coupled to antibodies, are being investigated for their potential ability to augment Rituximab efficacy. Here, we compare the anti-tumor effect of high- and low-molecular-weight Rituximab/saporin-S6 immunotoxins, named HMW-IT and LMW-IT, respectively. Saporin-S6 is a potent and stable plant enzyme belonging to ribosome-inactivating proteins that causes protein synthesis arrest and consequent cell death. Saporin-S6 was conjugated to Rituximab through an artificial disulfide bond. The inhibitory activity of HMW-IT and LMW-IT was evaluated on cell-free protein synthesis and in two CD20+ lymphoma cell lines, Raji and D430B. Two different conjugates were separated on the basis of their molecular weight and further characterized. Both HMW-IT (dimeric and LMW-IT (monomeric maintained a high level of enzymatic activity in a cell-free system. HMW-IT, thanks to a higher toxin payload and more efficient antigen capping, showed stronger in vitro anti-tumor efficacy than LMW-IT against lymphoma cells. Dimeric HMW-IT can be used for lymphoma therapy at least for ex vivo treatments. The possibility of using HMW-IT augments the yield in immunotoxin preparation and allows the targeting of antigens with low internalization rates.

  14. Early plasmapheresis and rituximab for acute humoral rejection after ABO-compatible liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Nassim Kamar; Laurence Lavayssière; Fabrice Muscari; Janick Selves; Céline Guilbeau-Frugier; Isabelle Cardeau; Laure Esposito; Olivier Cointault; Marie Béatrice Nogier; Jean Marie Peron; Philippe Otal; Marylise Fort; Lionel Rostaing

    2009-01-01

    Acute humoral rejection (AHR) is uncommon after ABOcompatible liver transplantation. Herein, we report two cases of AHR treated with plasmapheresis and rituximab in two ABO-compatible liver-transplant patients with preformed anti-human leukocyte antigen donor-specific antibodies. Patient 1 experienced a biopsy-proven AHR at day 10 post-transplant. She was treated by steroid pulses, and OKT3. Because of persisting signs of biopsy-proven AHR at day 26, she was treated by plasmapheresis and rituximab. Liver enzyme levels did not improve, and she died on day 41. Patient 2 experienced a biopsy-proven AHR on day 10 post-transplant. She was treated by steroid pulses, plasmapheresis, and rituximab.Liver enzymes returned to within normal range 18 dafter diagnosis. Liver biopsies, at 3 and 9 mo post-transplant,showed complete resolution of AHR. We conclude that plasmapheresis should be started as soon as AHR is diagnosed, and be associated with a B-cell depleting agent. Rituximab may be considered as a first-line therapy.

  15. High in Vitro Anti-Tumor Efficacy of Dimeric Rituximab/Saporin-S6 Immunotoxin.

    Science.gov (United States)

    Bortolotti, Massimo; Bolognesi, Andrea; Battelli, Maria Giulia; Polito, Letizia

    2016-01-01

    The anti-CD20 mAb Rituximab has revolutionized lymphoma therapy, in spite of a number of unresponsive or relapsing patients. Immunotoxins, consisting of toxins coupled to antibodies, are being investigated for their potential ability to augment Rituximab efficacy. Here, we compare the anti-tumor effect of high- and low-molecular-weight Rituximab/saporin-S6 immunotoxins, named HMW-IT and LMW-IT, respectively. Saporin-S6 is a potent and stable plant enzyme belonging to ribosome-inactivating proteins that causes protein synthesis arrest and consequent cell death. Saporin-S6 was conjugated to Rituximab through an artificial disulfide bond. The inhibitory activity of HMW-IT and LMW-IT was evaluated on cell-free protein synthesis and in two CD20⁺ lymphoma cell lines, Raji and D430B. Two different conjugates were separated on the basis of their molecular weight and further characterized. Both HMW-IT (dimeric) and LMW-IT (monomeric) maintained a high level of enzymatic activity in a cell-free system. HMW-IT, thanks to a higher toxin payload and more efficient antigen capping, showed stronger in vitro anti-tumor efficacy than LMW-IT against lymphoma cells. Dimeric HMW-IT can be used for lymphoma therapy at least for ex vivo treatments. The possibility of using HMW-IT augments the yield in immunotoxin preparation and allows the targeting of antigens with low internalization rates. PMID:27338475

  16. Rituximab purging and/or maintenance in patients undergoing autologous transplantation for relapsed follicular lymphoma

    DEFF Research Database (Denmark)

    Pettengell, Ruth; Schmitz, Norbert; Gisselbrecht, Christian;

    2013-01-01

    The objective of this randomized trial was to assess the efficacy and safety of rituximab as in vivo purging before transplantation and as maintenance treatment immediately after high-dose chemotherapy and autologous stem-cell transplantation (HDC-ASCT) in patients with relapsed follicular lympho...

  17. Treatment of posttransplant lymphoproliferatieve disease with rituximab : The remission, the relapse, and the complication

    NARCIS (Netherlands)

    Verschuuren, EAM; Stevens, SJC; Van Imhoff, GW; Middeldorp, JM; De Boer, C; Koeter, G; The, TH; Van Der Bij, W

    2002-01-01

    Background. Rituximab, a humanized anti-CD20 monoclonal antibody, is a promising new tool for the treatment of posttransplant lymphoproliferative disease (PTLD), especially for patients transplanted with rejection prone transplants of vital organs, such as patients after lung transplantation. Thus f

  18. A series of patients with minimal change nephropathy treated with rituximab during adolescence and adulthood

    NARCIS (Netherlands)

    M.J. Dekkers (Marinus J.); J. Groothoff (Jaap); R. Zietse (Robert); M.G.H. Betjes (Michiel)

    2015-01-01

    textabstractBackground: The treatment of immune suppression dependent minimal change nephropathy (MCN) can be challenging and frequently leads to serious complications. In paediatric patients, successful treatment with rituximab is described in steroid-dependent MCN. There is limited information abo

  19. B lymphocyte depletion with the monoclonal antibody rituximab in Graves' disease: a controlled pilot study

    DEFF Research Database (Denmark)

    El Fassi, Daniel; Nielsen, Claus H; Bonnema, Steen Joop;

    2007-01-01

    CONTEXT: Graves' disease (GD) is a common TSH receptor autoantibody (TRAb)-mediated disorder. Because B lymphocytes are important self-antigen presenting cells and precursors for antibody-secreting plasma cells, temporary B-lymphocyte depletion with the monoclonal antibody rituximab (RTX) might...

  20. An Open-Label Trial of Rituximab Therapy in Pulmonary Alveolar Proteinosis

    OpenAIRE

    Kavuru, Mani S.; Malur, Anagha; Marshall, Irene; Barbara P. Barna; Meziane, Moulay; Huizar, Isham; Dalrymple, Heidi; Karnekar, Reema; Thomassen, Mary Jane

    2011-01-01

    Rituximab, a monoclonal antibody directed against the B-lymphocyte antigen CD20, has shown promise in several autoimmune disorders. Pulmonary Alveolar Proteinosis (PAP) is an autoimmune disorder characterized by autoantibodies to Granulocyte-Macrophage Colony Stimulating Factor (GM-CSF).

  1. Updated consensus statement on the use of rituximab in patients with rheumatoid arthritis

    NARCIS (Netherlands)

    M.H. Buch; J.S. Smolen; N. Betteridge; F.C. Breedveld; G. Burmester; T. Dörner; G. Ferraccioli; J.E. Gottenberg; J. Isaacs; T.K. Kvien; X. Mariette; E. Martin-Mola; K. Pavelka; P.P. Tak; D. van der Heijde; R.F. van Vollenhoven; P. Emery

    2011-01-01

    Background Since initial approval for the treatment of rheumatoid arthritis (RA), rituximab has been evaluated in clinical trials involving various populations with RA. Information has also been gathered from registries. This report therefore updates the 2007 consensus document on the use of rituxim

  2. ‘Les liaisons dangereuses’: Hepatitis C, Rituximab and B-cell non-Hodgkin’s lymphomas

    Institute of Scientific and Technical Information of China (English)

    Massimo; Marignani; Michela; di; Fonzo; Paola; Begini; Elia; Gigante; Ilaria; Deli; Adriano; M; Pellicelli; Sara; Gallina; Emanuela; de; Santis; Gianfranco; Delle; Fave; M; Christina; Cox

    2012-01-01

    Rituximab has provided a revolutionary contribution to the treatment of B-cell non-Hodgkin’s lymphomas (NHL). A high prevalence of hepatitis C virus (HCV) infection has been described in B-cell NHL patients. Cases of liver dysfunction in HCV-positive patients have been reported with Rituximab-containing regimens. In this paper we review the recent data regarding the effects of Rituximab in NHL patients with HCV infection. We also added a section devoted to improving communication between oncohaematologists and hepatologists. Furthermore, we propose a common methodological ground to study hepatic toxicity emerging during chemotherapy.

  3. Anti-Phospholipase A2 Receptor Antibody Titer Predicts Post-Rituximab Outcome of Membranous Nephropathy.

    Science.gov (United States)

    Ruggenenti, Piero; Debiec, Hanna; Ruggiero, Barbara; Chianca, Antonietta; Pellé, Timothee; Gaspari, Flavio; Suardi, Flavio; Gagliardini, Elena; Orisio, Silvia; Benigni, Ariela; Ronco, Pierre; Remuzzi, Giuseppe

    2015-10-01

    Rituximab induces nephrotic syndrome (NS) remission in two-thirds of patients with primary membranous nephropathy (MN), even after other treatments have failed. To assess the relationships among treatment effect, circulating nephritogenic anti-phospholipase A2 receptor (anti-PLA2R) autoantibodies and genetic polymorphisms predisposing to antibody production we serially monitored 24-hour proteinuria and antibody titer in patients with primary MN and long-lasting NS consenting to rituximab (375 mg/m(2)) therapy and genetic analyses. Over a median (range) follow-up of 30.8 (6.0-145.4) months, 84 of 132 rituximab-treated patients achieved complete or partial NS remission (primary end point), and 25 relapsed after remission. Outcomes of patients with or without detectable anti-PLA2R antibodies at baseline were similar. Among the 81 patients with antibodies, lower anti-PLA2R antibody titer at baseline (P=0.001) and full antibody depletion 6 months post-rituximab (hazard ratio [HR], 7.90; 95% confidence interval [95% CI], 2.54 to 24.60; PPLA2R antibody depletion. On average, 50% anti-PLA2R titer reduction preceded equivalent proteinuria reduction by 10 months. Re-emergence of circulating antibodies predicted disease relapse (HR, 6.54; 95% CI, 1.57 to 27.40; P=0.01), whereas initial complete remission protected from the event (HR, 6.63; 95% CI, 2.37 to 18.53; PPLA2R1 and HLA-DQA1 polymorphisms and of previous immunosuppressive treatment. Therefore, assessing circulating anti-PLA2R autoantibodies and proteinuria may help in monitoring disease activity and guiding personalized rituximab therapy in nephrotic patients with primary MN.

  4. Barriers to the Access and Use of Rituximab in Patients with Non-Hodgkin’s Lymphoma and Chronic Lymphocytic Leukemia: A Physician Survey

    Directory of Open Access Journals (Sweden)

    William H. Baer II

    2014-05-01

    Full Text Available Biologics such as rituximab are an important component of oncology treatment strategies, although access to such therapies is challenging in countries with limited resources. This study examined access to rituximab and identified potential barriers to its use in the United States, Mexico, Turkey, Russia, and Brazil. The study also examined whether availability of a biosimilar to rituximab would improve access to, and use of, rituximab. Overall, 450 hematologists and oncologists completed a survey examining their use of rituximab in patients with non-Hodgkin’s lymphoma (NHL and chronic lymphocytic leukemia (CLL. Less than 40% of physicians considered rituximab as easy to access from a cost perspective. Furthermore, many physicians chose not to treat, were unable to treat, or had to modify treatment with rituximab despite guidelines recommending its use in NHL and CLL patients. Insurance coverage, reimbursement, and cost to patient were commonly reported as barriers to the use of rituximab. Across all markets, over half of physicians reported that they would increase use of rituximab if a biosimilar was available. We conclude that rituximab use would increase across all therapy types and markets if a biosimilar was available, although a biosimilar would have the greatest impact in Brazil, Mexico, and Russia.

  5. Barriers to the Access and Use of Rituximab in Patients with Non-Hodgkin's Lymphoma and Chronic Lymphocytic Leukemia: A Physician Survey.

    Science.gov (United States)

    Baer Ii, William H; Maini, Archana; Jacobs, Ira

    2014-01-01

    Biologics such as rituximab are an important component of oncology treatment strategies, although access to such therapies is challenging in countries with limited resources. This study examined access to rituximab and identified potential barriers to its use in the United States, Mexico, Turkey, Russia, and Brazil. The study also examined whether availability of a biosimilar to rituximab would improve access to, and use of, rituximab. Overall, 450 hematologists and oncologists completed a survey examining their use of rituximab in patients with non-Hodgkin's lymphoma (NHL) and chronic lymphocytic leukemia (CLL). Less than 40% of physicians considered rituximab as easy to access from a cost perspective. Furthermore, many physicians chose not to treat, were unable to treat, or had to modify treatment with rituximab despite guidelines recommending its use in NHL and CLL patients. Insurance coverage, reimbursement, and cost to patient were commonly reported as barriers to the use of rituximab. Across all markets, over half of physicians reported that they would increase use of rituximab if a biosimilar was available. We conclude that rituximab use would increase across all therapy types and markets if a biosimilar was available, although a biosimilar would have the greatest impact in Brazil, Mexico, and Russia. PMID:24810947

  6. Methodology to administer therapeutic dose of I-131; Metodologia para administrar dosis terapeutica de I-131

    Energy Technology Data Exchange (ETDEWEB)

    Basteris M, J.; Gomez D, R. [Universidad Autonoma de Yucatan, Facultad de Medicina, Merida, Yucatan (Mexico)

    2007-07-01

    The present work suggests the use of measures guided to eliminate the resulting chronic sialoadenitis of the treatment of the thyroid cancer with Iodine-131, as well as the use of citric fruits to stimulate the salivation, the post-dose administration of liquids to accelerate the gastric emptying avoiding the secondary effects as the vomit is included. (Author)

  7. Efficacy and Safety of Rituximab in the Treatment of Vasculitic Leg Ulcers Associated with Hepatitis C Virus Infection

    Directory of Open Access Journals (Sweden)

    Fabio Bonilla-Abadía

    2012-01-01

    Full Text Available Vasculitic leg ulcers are a cutaneous manifestation of hepatitis C virus (HCV infection often associated with cryoglobulinemia. Their treatment is difficult and is based on steroids and immunosuppressive drugs with an erratic response and a high probability of adverse reaction. We report three patients with vasculitic leg ulcers associated with hepatitis C virus infection who were treated successfully with rituximab. The pain control and healing were achieved quickly. No adverse effects with rituximab in these patients were presented.

  8. Rituximab induced lung injury in a case of NHL: Diagnosis and follow up on FDG PET/CT

    Energy Technology Data Exchange (ETDEWEB)

    Joshi, Prathamesh; Lele, Vikram [Jaslok Hospital and Research Centre, Worli (United States); Saikia, Tapan [Prince Aly Khan Hospital, Mumbai (India)

    2012-09-15

    Rituximab induced lung injury is a rare but serious side effect of this agent. We describe the valuable role played by 18F fluorodeoxyglucose positron emission tomography computed tomography (FDG PET CT)in the diagnosis and follow up of this condition in a patient with non Hodgkin's lymphoma (NHL)receiving rituximab. Abnormal uptake of FDG in lungs of patients receiving this drug should be care fully evaluated to diagnose this potentially fatal side effect.

  9. Imaging and measuring the rituximab-induced changes of mechanical properties in B-lymphoma cells using atomic force microscopy

    Energy Technology Data Exchange (ETDEWEB)

    Li, Mi [State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Sciences, Shenyang 110016 (China); Graduate University of Chinese Academy of Sciences, Beijing 100049 (China); Liu, Lianqing, E-mail: lqliu@sia.cn [State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Sciences, Shenyang 110016 (China); Xi, Ning, E-mail: xin@egr.msu.edu [State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Sciences, Shenyang 110016 (China); Department of Electrical and Computer Engineering, Michigan State University, East Lansing, MI 48824 (United States); Wang, Yuechao; Dong, Zaili [State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Sciences, Shenyang 110016 (China); Tabata, Osamu [Department of Micro Engineering, Kyoto University, Kyoto 606-8501 (Japan); Xiao, Xiubin [Department of Lymphoma, Affiliated Hospital of Military Medical Academy of Sciences, Beijing 100071 (China); Zhang, Weijing, E-mail: zhangwj3072@163.com [Department of Lymphoma, Affiliated Hospital of Military Medical Academy of Sciences, Beijing 100071 (China)

    2011-01-14

    Research highlights: {yields} Single B-lymphoma living cells were imaged by AFM with the assistance of microfabricated pillars. {yields} The apoptosis of B-lymphoma cells triggered by rituximab without cross-linking was observed by AO/EB double fluorescent staining. {yields} The B-lymphoma cells became dramatically softer after adding rituximab. -- Abstract: The topography and mechanical properties of single B-lymphoma cells have been investigated by atomic force microscopy (AFM). With the assistance of microfabricated patterned pillars, the surface topography and ultrastructure of single living B-lymphoma cell were visualized by AFM. The apoptosis of B-lymphoma cells induced by rituximab alone was observed by acridine orange/ethidium bromide (AO/EB) double fluorescent staining. The rituximab-induced changes of mechanical properties in B-lymphoma cells were measured dynamically and the results showed that B-lymphoma cells became dramatically softer after incubation with rituximab. These results can improve our understanding of rituximab'effect and will facilitate the further investigation of the underlying mechanisms.

  10. Statins impair antitumor effects of rituximab by inducing conformational changes of CD20.

    Directory of Open Access Journals (Sweden)

    Magdalena Winiarska

    2008-03-01

    Full Text Available BACKGROUND: Rituximab is used in the treatment of CD20+ B cell lymphomas and other B cell lymphoproliferative disorders. Its clinical efficacy might be further improved by combinations with other drugs such as statins that inhibit cholesterol synthesis and show promising antilymphoma effects. The objective of this study was to evaluate the influence of statins on rituximab-induced killing of B cell lymphomas. METHODS AND FINDINGS: Complement-dependent cytotoxicity (CDC was assessed by MTT and Alamar blue assays as well as trypan blue staining, and antibody-dependent cellular cytotoxicity (ADCC was assessed by a 51Cr release assay. Statins were found to significantly decrease rituximab-mediated CDC and ADCC of B cell lymphoma cells. Incubation of B cell lymphoma cells with statins decreased CD20 immunostaining in flow cytometry studies but did not affect total cellular levels of CD20 as measured with RT-PCR and Western blotting. Similar effects are exerted by other cholesterol-depleting agents (methyl-beta-cyclodextrin and berberine, but not filipin III, indicating that the presence of plasma membrane cholesterol and not lipid rafts is required for rituximab-mediated CDC. Immunofluorescence microscopy using double staining with monoclonal antibodies (mAbs directed against a conformational epitope and a linear cytoplasmic epitope revealed that CD20 is present in the plasma membrane in comparable amounts in control and statin-treated cells. Atomic force microscopy and limited proteolysis indicated that statins, through cholesterol depletion, induce conformational changes in CD20 that result in impaired binding of anti-CD20 mAb. An in vivo reduction of cholesterol induced by short-term treatment of five patients with hypercholesterolemia with atorvastatin resulted in reduced anti-CD20 binding to freshly isolated B cells. CONCLUSIONS: Statins were shown to interfere with both detection of CD20 and antilymphoma activity of rituximab. These studies

  11. Rituximab-induced interleukin-15 reduction associated with clinical improvement in rheumatoid arthritis

    Science.gov (United States)

    Díaz-Torné, César; Ortiz de Juana, M Angels; Geli, Carme; Cantó, Elisabet; Laiz, Ana; Corominas, Héctor; Casademont, Jordi; de Llobet, Josep M; Juárez, Cándido; Díaz-López, César; Vidal, Sílvia

    2014-01-01

    Rituximab therapy alters all aspects of B-cell participation in the disturbed immune response of rheumatoid arthritis patients. To determine the impact of B-cell depletion on other immune compartments, we analysed levels of soluble and surface interleukin-15 (IL-15) along with the frequency of IL-15-related subsets after rituximab treatment. We then studied the correlation of observed changes with clinical activity. Heparinized blood samples from 33 rheumatoid arthritis patients were collected on days 0, 30, 90 and 180 after each of three rituximab cycles. Serum cytokine levels were determined by ELISA. Interleukin-15 trans-presentation was analysed by cytometry. Flow cytometry with monoclonal antibodies was performed to analyse circulating cell subsets. Interleukin-15 was detected in the serum of 25 patients before initiating the treatment. Rituximab then progressively reduced serum IL-15 (138 ± 21 pg/ml at baseline, 48 ± 18 pg/ml after third cycle, P = 0·03) along with IL-17 (1197 ± 203 pg/ml at baseline, 623 ± 213 pg/ml after third cycle, P = 0·03) and tended to increase the frequency of circulating regulatory T cells (3·1 ± 1 cells/μl at baseline, 7·7 ± 2 cells/μl after third cycle). Rituximab also significantly decreased IL-15 trans-presentation on surface monocytes of patients negative for IL-15 serum (mean fluorescence intensity: 4·82 ± 1·30 at baseline, 1·42 ± 0·69 after third cycle P = 0·05). Reduction of serum IL-15 was associated with decrease in CD8+ CD45RO+/RA+ ratio (1·17 ± 0·21 at baseline, 0·36 ± 0·06 at third cycle, P = 0·02). DAS28, erythrocyte sedimentation rate and C-reactive protein correlated significantly with CD8+ CD45RO+/RA+ ratio (R = 0·323, R = 0·357, R = 0·369 respectively, P < 0·001). Our results suggest that sustained clinical improvement after rituximab treatment is associated with IL-15/memory T-cell-related mechanisms beyond circulating B cells. PMID:24219764

  12. Rituximab improves the treatment results of DHAP-VIM-DHAP and ASCT in relapsed/progressive aggressive CD20+ NHL: A prospective randomized HOVON trial

    OpenAIRE

    Vellenga, Edo; van Putten, Wim; Veer, Mars; Zijlstra, Josée; Fibbe, Willem; Oers, Marinus; Verdonck, Leo; Wijermans, Pierre; van Imhoff, Gustaaf; Lugtenburg, Pieternella; Huijgens, Peter

    2008-01-01

    textabstractWe evaluated the role of rituximab during remission induction chemotherapy in relapsed aggressive CD20+non-Hodgkin lymphoma. Of 239 patients, 225 were evaluable for analysis. Randomized to DHAP (cisplatin-cytarabine- dexamethasone)-VIM (etoposide-ifosfamide-methotrexate)-DHAP (cisplatin- cytarabine-dexamethasone) chemotherapy with rituximab (R; R-DHAP arm) were 119 patients (113 evaluable) and to chemotherapy without rituximab (DHAP arm) 120 patients (112 evaluable). Patients in c...

  13. Immunreconstitution and Infectious Complications After Rituximab Treatment in Children and Adolescents: What Do We Know and What Can We Learn from Adults?

    OpenAIRE

    Jennifer Worch; Olga Makarova; Birgit Burkhardt

    2015-01-01

    Rituximab, an anti CD20 monoclonal antibody, is widely used in the treatment of B-cell malignancies in adults and increasingly in pediatric patients. By depleting B-cells, rituximab interferes with humoral immunity. This review provides a comprehensive overview of immune reconstitution and infectious complications after rituximab treatment in children and adolescents. Immune reconstitution starts usually after six months with recovery to normal between nine to twelve months. Extended rituxima...

  14. Clinical scale preparation and evaluation of 131I-Rituximab for Non-Hodgkin's lymphoma

    International Nuclear Information System (INIS)

    Radioimmunotherapy (RIT) with anti CD20 MoAb conjugated to a β- emitting radioisotope like 131I or 90Y has the added advantage of delivering radiation not only to tumor cells that bind the antibody but also due to a crossfire effect, to neighboring tumor cells inaccessible to the antibody. In order to make available an indigenous radioimmunotherapeutic agent for Non Hodgkin's Lymphoma (NHL), radioiodinated Rituximab has been prepared and evaluated at a clinical scale. Radioiodination of Rituximab was performed by the conventional Chloramine T method using 7.4 GBq Na131I in a lead shielded plant. Six batches of radioiodination were prepared and characterized by electrophoresis and HPLC to evaluate the reproducibility of the product. The product remained stable retaining the radiochemical purity > 95% upto 5 days after radioiodination. In vitro cell binding studies and biodistribution studies in normal Swiss mice have indicated the potential of this molecule as a radioimmunotherapeutic agent for NHL. (orig.)

  15. Posterior reversible encephalopathy syndrome masquerading as progressive multifocal leukoencephalopathy in rituximab treated neuromyelitis optica.

    Science.gov (United States)

    Berger, Joseph R; Neltner, Janna; Smith, Charles; Cambi, Franca

    2014-11-01

    Both progressive multifocal leukoencephalopathy (PML) and posterior reversible encephalopathy syndrome (PRES) have been reported as complications of rituximab therapy. These disorders may appear indistinguishable on magnetic resonance imaging (MRI). We report on a 42 year old woman with neuromyelitis optica (NMO) of 10 years duration who developed extensive white matter disease affecting chiefly both parietal lobes 6 months after her first and only dose of rituximab. The MRI findings suggested the diagnosis of PML, but her history was more consistent with PRES. Ultimately, a brain biopsy was performed which was consistent with the diagnosis of PRES. PRES and PML may have overlapping symptomatology and be indistinguishable on MRI. An approach to distinguishing between these two disorders is addressed.

  16. False Positive B-Cells Crossmatch after Prior Rituximab Exposure of the Kidney Donor

    Directory of Open Access Journals (Sweden)

    Judith Desoutter

    2016-01-01

    Full Text Available Crossmatching is essential prior to kidney transplantation to confirm compatibility between the donor and the recipient, particularly to prevent acute antibody-mediated rejection. An unexpected positive crossmatch may be obtained in recipients with an autoimmune disease or preexisting antibodies not detected by single-antigen bead array due to complement interference or who have been previously treated by desensitization protocols such as rituximab, antithymocyte globulin, or intravenous immunoglobulins. We report donor and recipient investigations that revealed unexpected positive B-cells crossmatch, probably due to donor cells, as the donor had received rituximab therapy shortly before organ harvesting, in a context of severe idiopathic thrombocytopenic purpura. We consequently detected unexpected Class II IgG complement-dependent cytotoxicity for all sera tested. Other laboratory investigations failed to elucidate the reasons for this recipient-related positivity.

  17. Abatacept experience in steroid and rituximab-resistant focal segmental glomerulosclerosis.

    Science.gov (United States)

    Jayaraman, Vinothkumar Kavarthapol; Thomas, Mark

    2016-01-01

    Primary focal segmental glomerular sclerosis (FSGS), one of the major causes of nephrotic syndrome, eventually results in end-stage renal disease. Currently, FSGS is treated with immunosuppressive therapies, which include calcinuerin inhibitors (cyclosporine), glucocorticoids, B-cell depleting agents (rituximab) and, recently, a T-cell co-stimulatory inhibitor (abatacept). Until recently, there had been no cases reporting resistance to all current therapies. We report a case of a 62-year-old Caucasian man with biopsy-proven FSGS, who responded well to oral prednisolone therapy. However, 2 years later, he had a relapse and failed to respond to prednisolone. Subsequent treatments then included cyclosporine, rituximab and cyclophosphamide, which were not successful. The patient was then administered abatacept, a novel T-cell co-stimulatory inhibitor-though he did not experience any side effects, there was no change in proteinuria nor in creatinine. PMID:26887886

  18. Leuconostoc sp. Meningitis in a Patient Treated with Rituximab for Mantle Cell Lymphoma

    Directory of Open Access Journals (Sweden)

    Hrvoje Holik

    2015-09-01

    Full Text Available We present a 64-year-old man who was treated with R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone chemoimmunotherapy for mantle cell lymphoma and developed purulent meningitis, probably caused by Leuconostoc sp. The patient had severe hypogammaglobulinemia, which is a possible complication of rituximab therapy. To our knowledge and after reviewing the available medical literature, this is the first described case of purulent meningitis caused by Leuconostoc sp. in a patient with mantle cell lymphoma that appeared after treatment with the R-CHOP protocol. The diagnosis of purulent meningitis was based on clinical, laboratory and cytological cerebrospinal fluid findings, in addition to blood culture results in which we isolated Leuconostoc sp. The patient was treated with meropenem with full recovery.

  19. Response to rituximab in a refractory case of thrombotic thrombocytopenic purpura associated with systemic lupus erythematosus

    Directory of Open Access Journals (Sweden)

    Niaz Faraz

    2010-01-01

    Full Text Available Thrombotic thrombocytopenic purpura (TTP is a serious disorder with a significant morbidity and mortality. Majority of cases of TTP are idiopathic, but some cases may be secon-dary to connective tissue diseases. TTP has been rarely associated with systemic lupus erythe-matosus (SLE and may be refractory to treatment with plasma exchange, requiring immuno-suppressive therapy. We describe a patient with TTP and SLE who was refractory to plasma exchange and corticosteroids but responded to anti-CD20 antibody rituximab with continued re-mission after eight months of follow-up. Rituximab appears to be an effective treatment in re-fractory cases of TTP associated with SLE.

  20. Rituximabe para o tratamento da artrite reumatoide: revisão sistemática

    Directory of Open Access Journals (Sweden)

    Lívia Lovato Pires de Lemos

    2014-06-01

    Full Text Available Introdução: A artrite reumatoide (AR é uma doença autoimune crônica caracterizada por inflamação articular sistêmica que, com frequência, leva a significativa incapacitação. Vários agentes anti-TNF têm sido usados efetivamente, mas alguns pacientes demonstraram resposta inadequada. Rituximabe é um anticorpo monoclonal terapêutico indicado em tais casos. Métodos: Realizou-se uma revisão sistemática para avaliar a eficácia e a segurança de rituximabe em pacientes com AR ativa previamente tratados ou não com agentes anti-TNF e para relacionar o desfecho com a sorologia para FR e anti-CCP. Pesquisaram-se importantes bancos de dados eletrônicos e a literatura não convencional, além de se fazer uma busca manual de referências. Para a meta-análise, utilizou-se o programa Review Manager® 5.1. Resultados: Consideramos seis ERCs comparando rituximabe 1000 mg com placebo. Em ambos os grupos usou-se Metotrexato. O tratamento com rituximabe foi mais efetivo em pacientes jamais tratados e nos que não obtiveram sucesso com a terapia anti-TNF - critérios ACR 20/50/70 e EULAR. No grupo de rituximabe, observaram-se mudanças menos expressivas nos escores de Sharp/Genant, de erosão e de estreitamento do espaço articular; nesse grupo, os escores SF-36, FACIT-T e HAQ-DI também foram melhores. Não foram notadas diferenças entre grupos com relação aos desfechos de segurança, com exceção das reações agudas à infusão, que foram mais comuns no grupo de rituximabe. Ainda no grupo de rituximabe, um número maior de pacientes soropositivos para FR/anti-CCP alcançou ACR20, em comparação com pacientes negativos para RF/anti-CCP. Conclusão: Os dados disponíveis falam em favor do uso de rituximabe para o tratamento da AR, como opção efetiva e segura para pacientes jamais tratados ou que não obtiveram sucesso com o tratamento anti-TNF. FR e anti-CCP parecem influenciar os resultados do tratamento, mas essa inferência ainda est

  1. Rituximab-induced neutropenia in a patient with inflammatory myopathy and systemic sclerosis overlap disease.

    Science.gov (United States)

    Akram, Qasim; Roberts, Mark; Oddis, Chester; Herrick, Arianne; Chinoy, Hector

    2016-01-01

    Rituximab (RTX) is a monoclonal chimeric antibody directed against the CD20 antigen of B lymphocytes. Late onset neutropenia (LON) is a recognised complication of rituximab usually occurring 4 weeks after the last dose and is reported in both haematological and rheumatological conditions. However, it has never been described in a patient with myositis and systemic sclerosis overlap disease. We describe a case of LON in a 54-year-old man who was diagnosed with myositis and then systemic sclerosis overlap disease. It resolved within 7 days, and the patient did not suffer neutropenic sepsis or any other complications. We propose similar mechanisms for LON as described in other conditions and routine blood monitoring in such patients.

  2. Rituximab-induced neutropenia in a patient with inflammatory myopathy and systemic sclerosis overlap disease

    Science.gov (United States)

    Roberts, Mark; Oddis, Chester; Herrick, Arianne; Chinoy, Hector

    2016-01-01

    Rituximab (RTX) is a monoclonal chimeric antibody directed against the CD20 antigen of B lymphocytes. Late onset neutropenia (LON) is a recognised complication of rituximab usually occurring 4 weeks after the last dose and is reported in both haematological and rheumatological conditions. However, it has never been described in a patient with myositis and systemic sclerosis overlap disease. We describe a case of LON in a 54-year-old man who was diagnosed with myositis and then systemic sclerosis overlap disease. It resolved within 7 days, and the patient did not suffer neutropenic sepsis or any other complications. We propose similar mechanisms for LON as described in other conditions and routine blood monitoring in such patients. PMID:27407275

  3. Successful therapy with rituximab of refractory acute humoral renal transplant rejection: a case report.

    Science.gov (United States)

    Celik, A; Saglam, F; Cavdar, C; Sifil, A; Atila, K; Sarioglu, S; Bora, S; Gulay, H; Camsari, T

    2008-01-01

    Acute humoral rejection (AHR) is generally less responsive to conventional anti-rejection treatment with consequent allograft losses. Therapeutic options include antilymphocyte antibody (ATG), intravenous immunglobulin (IVIG), plasmapheresis, or immunoadsorption with protein A together with intensification of immunsuppression with a tacrolimus/mycophenolate mofetil combination. This report describes a transplant recipient who responded to rituximab therapy as treatment for steroid-, ATG-, IVIG-, and plasmapheresis-resistant AHR. PMID:18261611

  4. Rituximab-induced subacute interstitial pneumonitis: A case report and review of literature

    Directory of Open Access Journals (Sweden)

    Subramanian Murali

    2010-01-01

    Full Text Available Rituximab is a chimeric anti-CD20 monoclonal antibody used to treat CD20+ non-Hodgkin′s lymphoma (NHL. Some pulmonary adverse reactions such as cough, rhinitis, bronchospasm and dyspnea are relatively common. Severe respiratory conditions like cryptogenic organizing pneumonia, interstitial pneumonitis have rarely been reported. We present a case of interstitial pneumonitis in a patient who was treated with R-CHOP for extranodal NHL. He responded to the steroids.

  5. Lymphoma in a patient with rheumatoid arthritis receiving methotrexate treatment: successful treatment with rituximab

    OpenAIRE

    Stewart, M; Malkovska, V; Krishnan, J.; Lessin, L; Barth, W.

    2001-01-01

    A 55 year old man with chronic lymphocytic leukaemia (CLL) and rheumatoid arthritis (RA), treated for four years with methotrexate (MTX), who developed a B cell non-Hodgkin's lymphoma (B-NHL), is described. The tumour was localised to the shoulder and axillary lymph nodes, and positive for Epstein-Barr viral antigens. After failure of radiation and chemotherapy, a complete remission was achieved with a combination of antibody treatment (rituximab) and EPOCH. The development of a second malign...

  6. Brain Abscess following Rituximab Infusion in a Patient with Pemphigus Vulgaris

    OpenAIRE

    Al-Harbi, Talal M.; Muammer, Shahad A.; Ellis, Ronald J.

    2015-01-01

    Patient: Female, 52 Final Diagnosis: Brain abscess Symptoms: Fever • headache • weakness, left sided Medication: Prednisolone • Azathioprine • Rituximab Clinical Procedure: Stereotactic brain biopsy and LP Specialty: Neurology Objective: Rare disease Background: Immunocompromised patients are at increased risk for developing meningitis or, rarely, brain abscess with opportunistic organisms like Listeria monocytogenes. Case Report: A 52 year-old Saudi Arabian woman who was diagnosed with pemph...

  7. Fatal haemoptysis in a case of lymphomatoid granulomatosis treated with rituximab.

    Science.gov (United States)

    Jaffre, S; Jardin, F; Dominique, S; Duet, E; Hubscher, Ph; Genevois, A; Corne, F; Bota, S; Nouvet, G; Thiberville, L

    2006-03-01

    Lymphomatoid granulomatosis is a rare angiocentric and angiodestructive disease, which commonly involves the lungs but also the brain, kidneys, liver and skin. This report describes the case of a 33-yr-old female with an aggressive form of lymphoid granulomatosis treated with an anti-CD20 antibody. Dramatic radiological improvement was seen at the fourth week. However, the patient died at home 1 month after the last rituximab administration from a massive haemoptysis. PMID:16507866

  8. Rituximab Treatment for Membranous Nephropathy: A French Clinical and Serological Retrospective Study of 28 Patients

    Directory of Open Access Journals (Sweden)

    Pierre-Antoine Michel

    2011-12-01

    Full Text Available The development of well-tolerated and effective therapies that target the pathogenesis of membranous nephropathy (MN would be useful. Our objective was to evaluate the efficacy of rituximab in MN. We analyzed the outcome of 28 patients treated with rituximab for idiopathic MN. Anti-PLA2R antibodies in serum and PLA2R antigen in kidney biopsy were assessed in 10 and 9 patients, respectively. Proteinuria was significantly decreased by 56, 62 and 87% at 3, 6 and 12 months, respectively. At 6 months, 2 patients achieved complete remission (CR and 12 partial remission (PR; overall renal response, 50%. At 12 months (n = 23, CR was achieved in 6 patients and PR in 13 patients (overall renal response, 82.6%. Three patients suffered a relapse of nephrotic proteinuria 27–50 months after treatment. Univariate analysis suggested that the degree of renal failure (MDRD estimated glomerular filtration rate 2 is an independent factor that predicts lack of response to rituximab. Anti-PLA2R antibodies were detected in the serum of 10 patients, and PLA2R antigen in immune deposits in 8 of 9 patients. Antibodies became negative in all 5 responsive patients with available follow-up sera. In this retrospective study, a high rate of remission was achieved 12 months after treatment.

  9. Assessment of Physicochemical Properties of Rituximab Related to Its Immunomodulatory Activity

    Directory of Open Access Journals (Sweden)

    Mariana P. Miranda-Hernández

    2015-01-01

    Full Text Available Rituximab is a chimeric monoclonal antibody employed for the treatment of CD20-positive B-cell non-Hodgkin’s lymphoma, chronic lymphocytic leukemia, rheumatoid arthritis, granulomatosis with polyangiitis and microscopic polyangiitis. It binds specifically to the CD20 antigen expressed on pre-B and consequently on mature B-lymphocytes of both normal and malignant cells, inhibiting their proliferation through apoptosis, CDC, and ADCC mechanisms. The immunomodulatory activity of rituximab is closely related to critical quality attributes that characterize its chemical composition and spatial configuration, which determine the recognition of CD20 and the binding to receptors or factors involved in its effector functions, while regulating the potential immunogenic response. Herein, we present a physicochemical and biological characterization followed by a pharmacodynamics and immunogenicity study to demonstrate comparability between two products containing rituximab. The physicochemical and biological characterization revealed that both products fit within the same response intervals exhibiting the same degree of variability. With regard to clinical response, both products depleted CD20+ B-cells until posttreatment recovery and no meaningful differences were found in their pharmacodynamic profiles. The evaluation of anti-chimeric antibodies did not show differential immunogenicity among products. Overall, these data confirm that similarity of critical quality attributes results in a comparable immunomodulatory activity.

  10. Rituximab induces sustained reduction of pathogenic B cells in patients with peripheral nervous system autoimmunity

    Science.gov (United States)

    Maurer, Michael A.; Rakocevic, Goran; Leung, Carol S.; Quast, Isaak; Lukačišin, Martin; Goebels, Norbert; Münz, Christian; Wardemann, Hedda; Dalakas, Marinos; Lünemann, Jan D.

    2012-01-01

    The B cell–depleting IgG1 monoclonal antibody rituximab can persistently suppress disease progression in some patients with autoimmune diseases. However, the mechanism underlying these long-term beneficial effects has remained unclear. Here, we evaluated Ig gene usage in patients with anti–myelin-associated glycoprotein (anti-MAG) neuropathy, an autoimmune disease of the peripheral nervous system that is mediated by IgM autoantibodies binding to MAG antigen. Patients with anti-MAG neuropathy showed substantial clonal expansions of blood IgM memory B cells that recognized MAG antigen. The group of patients showing no clinical improvement after rituximab therapy were distinguished from clinical responders by a higher load of clonal IgM memory B cell expansions before and after therapy, by persistence of clonal expansions despite efficient peripheral B cell depletion, and by a lack of substantial changes in somatic hypermutation frequencies of IgM memory B cells. We infer from these data that the effectiveness of rituximab therapy depends on efficient depletion of noncirculating B cells and is associated with qualitative immunological changes that indicate reconfiguration of B cell memory through sustained reduction of autoreactive clonal expansions. These findings support the continued development of B cell–depleting therapies for autoimmune diseases. PMID:22426210

  11. Rituximab Therapy for Severe Cutaneous Leukocytoclastic Angiitis Refractory to Corticosteroids, Cellcept and Cyclophosphamide

    Directory of Open Access Journals (Sweden)

    Kamel El-Reshaid

    2013-04-01

    Full Text Available We report our clinical experience with rituximab in the treatment of 2 patients with idiopathic cutaneous angiitis who relapsed after treatment with high-dose corticosteroids and cyclophosphamide. A 39-year-old woman and a 51-year-old man presented with ulcerating maculopapular rash in both lower limbs which relapsed 6 months after treatment with a combination of high-dose corticosteroids and cyclophosphamide. After treatment with 2 g of rituximab, the first patient has still been in clinical remission for 32 months while the second has finished 28 months. Interestingly, CD19 which had dropped to 0.5% 8 months later in both patients. Despite that, our patients are still in clinical remission. No significant side effects were noted during infusions and up to the period of follow-up. In conclusion, rituximab is a useful and safe agent in the treatment of idiopathic cutaneous angiitis refractory to conventional therapy. Clinical remission persists years after improvement of B-cell suppression.

  12. Rituximab and dexamethasone vs dexamethasone monotherapy in newly diagnosed patients with primary immune thrombocytopenia

    DEFF Research Database (Denmark)

    Gudbrandsdottir, Sif; Birgens, Henrik Sverre; Frederiksen, Henrik;

    2013-01-01

    In this study, we report the results from the largest cohort to date of newly diagnosed adult immune thrombocytopenia patients randomized to treatment with dexamethasone alone or in combination with rituximab. Eligible were patients with platelet counts ≤25×10(9)/L or ≤50×10(9)/L with bleeding...... symptoms. A total of 133 patients were randomly assigned to either dexamethasone 40 mg/day for 4 days (n = 71) or in combination with rituximab 375 mg/m(2) weekly for 4 weeks (n = 62). Patients were allowed supplemental dexamethasone every 1 to 4 weeks for up to 6 cycles. Our primary end point, sustained...... response (ie, platelets ≥50×10(9)/L) at 6 months follow-up, was reached in 58% of patients in the rituximab + dexamethasone group vs 37% in the dexamethasone group (P = .02). The median follow-up time was 922 days. We found longer time to relapse (P = .03) and longer time to rescue treatment (P = .007...

  13. Rituximab and new regimens for indolent lymphoma: a brief update from 2012 ASCO Annual Meeting

    Directory of Open Access Journals (Sweden)

    Zhao Jiangning

    2012-08-01

    Full Text Available Abstract Indolent lymphoma (IL, the second most common lymphoma, remains incurable with chemotherapy alone. While R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone remains the standard frontline regimen for diffuse Large B –cell lymphoma, the optimal chemotherapy regimen for frontline therapy of advanced IL remains uncertain. FCR (fludarabine, cyclophosphamide, rituximab has been shown to be better than fludarabine alone and fludarabine plus cyclophosphamide for IL. In FOLL05 trial, R-CHOP was compared with R-CVP (cyclophosphamide, vincristine, prednisone and R-FM (fludarabine, mitoxantrone. The study showed that R-CHOP appears to have the best risk-benefit ratio for IL. The StiL NHL1 trial showed that BR (bendamustine, rituximab has longer progression free survival and is better tolerated than R-CHOP. Long-term complications with secondary malignancies between the two regimens appear to be comparable. In this review, new combination regimens reported at 2012 ASCO annual meeting were evaluated for frontline and salvage therapy of indolent lymphoma.

  14. Effects of hypertonic buffer composition on lymph node uptake and bioavailability of rituximab, after subcutaneous administration.

    Science.gov (United States)

    Fathallah, Anas M; Turner, Michael R; Mager, Donald E; Balu-Iyer, Sathy V

    2015-03-01

    The subcutaneous administration of biologics is highly desirable; however, incomplete bioavailability after s.c. administration remains a major challenge. In this work we investigated the effects of excipient dependent hyperosmolarity on lymphatic uptake and plasma exposure of rituximab as a model protein. Using Swiss Webster (SW) mice as the animal model, we compared the effects of NaCl, mannitol and O-phospho-L-serine (OPLS) on the plasma concentration of rituximab over 5 days after s.c. administration. An increase was observed in plasma concentrations in animals administered rituximab in hypertonic buffer solutions, compared with isotonic buffer. Bioavailability, as estimated by our pharmacokinetic model, increased from 29% in isotonic buffer to 54% in hypertonic buffer containing NaCl, to almost complete bioavailability in hypertonic buffers containing high dose OPLS or mannitol. This improvement in plasma exposure is due to the improved lymphatic trafficking as evident from the increase in the fraction of dose trafficked through the lymph nodes in the presence of hypertonic buffers. The fraction of the dose trafficked through the lymphatics, as estimated by the model, increased from 0.05% in isotonic buffer to 13% in hypertonic buffer containing NaCl to about 30% for hypertonic buffers containing high dose OPLS and mannitol. The data suggest that hypertonic solutions may be a viable option for improving s.c. bioavailability.

  15. Initial evaluation of {sup 227}Th-p-benzyl-DOTA-rituximab for low-dose rate {alpha}-particle radioimmunotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Dahle, Jostein [Department of Radiation Biology, Rikshospitalet-Radiumhospitalet HE, Montebello, 0310 Oslo (Norway)]. E-mail: jostein.dahle@labmed.uio.no; Borrebaek, Jorgen [Algeta ASA, Kjelsasveien 172 A, 0411 Oslo (Norway); Melhus, Katrine B. [Department of Radiation Biology, Rikshospitalet-Radiumhospitalet HE, Montebello, 0310 Oslo (Norway); Bruland, Oyvind S. [Department of Clinical Medicine, University of Oslo, 0316 Oslo (Norway); Department of Oncology, Rikshospitalet-Radiumhospitalet HE, Montebello, 0310 Oslo (Norway); Salberg, Gro [Algeta ASA, Kjelsasveien 172 A, 0411 Oslo (Norway); Olsen, Dag Rune [Department of Radiation Biology, Rikshospitalet-Radiumhospitalet HE, Montebello, 0310 Oslo (Norway); Larsen, Roy H. [Algeta ASA, Kjelsasveien 172 A, 0411 Oslo (Norway)

    2006-02-15

    Radioimmunotherapy has proven clinically effective in patients with non-Hodgkin's lymphoma. Radioimmunotherapy trials have so far been performed with {beta}-emitting isotopes. In contrast to {beta}-emitters, the shorter range and high linear energy transfer (LET) of {alpha} particles allow for more efficient and selective killing of individually targeted tumor cells. However, there are several obstacles to the use of {alpha}-particle immunotherapy, including problems with chelation chemistry and nontarget tissue toxicity. The {alpha}-emitting radioimmunoconjugate {sup 227}Th-DOTA-p-benzyl-rituximab is a new potential anti-lymphoma agent that might overcome some of these difficulties. The present study explores the immunoreactivity, in vivo stability and biodistribution, as well as the effect on in vitro cell growth, of this novel radioimmunoconjugate. To evaluate in vivo stability, uptake in balb/c mice of the {alpha}-particle-emitting nuclide {sup 227}Th alone, the chelated form, {sup 227}Th-p-nitrobenzyl-DOTA and the radioimmunoconjugate {sup 227}Th-DOTA-p-benzyl-rituximab was compared in a range of organs at increasing time points after injection. The immunoreactive fraction of {sup 227}Th-DOTA-p-benzyl-rituximab was 56-65%. During the 28 days after injection of radioimmunoconjugate only, very modest amounts of the {sup 227}Th had detached from DOTA-p-benzyl-rituximab, indicating a relevant stability in vivo. The half-life of {sup 227}Th-DOTA-p-benzyl-rituximab in blood was 7.4 days. Incubation of lymphoma cells with {sup 227}Th-DOTA-p-benzyl-rituximab resulted in a significant antigen-dependent inhibition of cell growth. The data presented here warrant further studies of {sup 227}Th-DOTA-p-benzyl-rituximab.

  16. Initial evaluation of 227Th-p-benzyl-DOTA-rituximab for low-dose rate α-particle radioimmunotherapy

    International Nuclear Information System (INIS)

    Radioimmunotherapy has proven clinically effective in patients with non-Hodgkin's lymphoma. Radioimmunotherapy trials have so far been performed with β-emitting isotopes. In contrast to β-emitters, the shorter range and high linear energy transfer (LET) of α particles allow for more efficient and selective killing of individually targeted tumor cells. However, there are several obstacles to the use of α-particle immunotherapy, including problems with chelation chemistry and nontarget tissue toxicity. The α-emitting radioimmunoconjugate 227Th-DOTA-p-benzyl-rituximab is a new potential anti-lymphoma agent that might overcome some of these difficulties. The present study explores the immunoreactivity, in vivo stability and biodistribution, as well as the effect on in vitro cell growth, of this novel radioimmunoconjugate. To evaluate in vivo stability, uptake in balb/c mice of the α-particle-emitting nuclide 227Th alone, the chelated form, 227Th-p-nitrobenzyl-DOTA and the radioimmunoconjugate 227Th-DOTA-p-benzyl-rituximab was compared in a range of organs at increasing time points after injection. The immunoreactive fraction of 227Th-DOTA-p-benzyl-rituximab was 56-65%. During the 28 days after injection of radioimmunoconjugate only, very modest amounts of the 227Th had detached from DOTA-p-benzyl-rituximab, indicating a relevant stability in vivo. The half-life of 227Th-DOTA-p-benzyl-rituximab in blood was 7.4 days. Incubation of lymphoma cells with 227Th-DOTA-p-benzyl-rituximab resulted in a significant antigen-dependent inhibition of cell growth. The data presented here warrant further studies of 227Th-DOTA-p-benzyl-rituximab

  17. Rituximab therapy in pulmonary alveolar proteinosis improves alveolar macrophage lipid homeostasis

    Directory of Open Access Journals (Sweden)

    Malur Anagha

    2012-06-01

    Full Text Available Abstract Rationale Pulmonary Alveolar Proteinosis (PAP patients exhibit an acquired deficiency of biologically active granulocyte-macrophage colony stimulating factor (GM-CSF attributable to GM-CSF specific autoantibodies. PAP alveolar macrophages are foamy, lipid-filled cells with impaired surfactant clearance and markedly reduced expression of the transcription factor peroxisome proliferator-activated receptor gamma (PPARγ and the PPARγ-regulated ATP binding cassette (ABC lipid transporter, ABCG1. An open label proof of concept Phase II clinical trial was conducted in PAP patients using rituximab, a chimeric murine-human monoclonal antibody directed against B lymphocyte specific antigen CD20. Rituximab treatment decreased anti-GM-CSF antibody levels in bronchoalveolar lavage (BAL fluid, and 7/9 patients completing the trial demonstrated clinical improvement as measured by arterial blood oxygenation. Objectives This study sought to determine whether rituximab therapy would restore lipid metabolism in PAP alveolar macrophages. Methods BAL samples were collected from patients pre- and 6-months post-rituximab infusion for evaluation of mRNA and lipid changes. Results Mean PPARγ and ABCG1 mRNA expression increased 2.8 and 5.3-fold respectively (p ≤ 0.05 after treatment. Lysosomal phospholipase A2 (LPLA2 (a key enzyme in surfactant degradation mRNA expression was severely deficient in PAP patients pre-treatment but increased 2.8-fold post-treatment. In supplemental animal studies, LPLA2 deficiency was verified in GM-CSF KO mice but was not present in macrophage-specific PPARγ KO mice compared to wild-type controls. Oil Red O intensity of PAP alveolar macrophages decreased after treatment, indicating reduced intracellular lipid while extracellular free cholesterol increased in BAL fluid. Furthermore, total protein and Surfactant protein A were significantly decreased in the BAL fluid post therapy. Conclusions Reduction in GM

  18. Safety and efficacy of intrathecal rituximab in children with B cell lymphoid CD20+ malignancies: An international retrospective study.

    Science.gov (United States)

    Ceppi, Francesco; Weitzman, Sheila; Woessmann, Wilhelm; Davies, Kimberly; Lassaletta, Alvaro; Reismüller, Bettina; Mellgren, Karin; Uyttebroeck, Anne; Maia, Iris; Abdullah, Shaker; Miakova, Natasha; Glaser, Darryl; Cohn, Richard; Abla, Oussama; Attarbaschi, Andishe; Alexander, Sarah

    2016-05-01

    Central nervous system (CNS) involvement in patients with mature B non-Hodgkin lymphoma, post-transplantation proliferative disorder and acute lymphoblastic leukemia confers a significantly inferior prognosis as compared to patients without CNS disease. Intrathecal (IT) or intraventricular administration of rituximab is an option for this group of patients. We report 25 children with CNS involvement of CD20+ B lymphoid malignancies who received in total 163 IT/intraventricular rituximab doses. The median number of doses received by each patient was 6, with a median dose of 25 mg. The most common adverse events were Grades 1 and 2 peripheral neuropathies in five patients (20%), allergy in two patients, and headache in two patients. These events were self-limited, occurring in the 48 hours after treatment and resolving within 24 hr. Three patients presented with more severe though transient side effects, one with a Grade III neuropathy and two with seizure. Eighteen patients (72%) of those treated with IT/intraventricular rituximab, with or without other CNS directed treatment, achieved a CNS remission. This case series suggests that IT/intraventricular rituximab has therapeutic efficacy and relatively limited toxicity. Prospective trials of IT/intraventricular rituximab for patients with CNS involvement of CD20 + B lymphoid malignancies are warranted. Am. J. Hematol. 91:486-491, 2016. © 2016 Wiley Periodicals, Inc. PMID:26872652

  19. Different sensitivity of rituximab-treatment to B-cells between ABO-incompatible kidney and liver transplantation.

    Science.gov (United States)

    Morimoto, Hiroshi; Ide, Kentaro; Tanaka, Yuka; Ishiyama, Kohei; Ohira, Masahiro; Tahara, Hiroyuki; Akita, Tomonori; Tanaka, Junko; Ohdan, Hideki

    2016-06-01

    A desensitization protocol with rituximab is currently widely used for kidney transplantation (KT) and liver transplantation (LT) across the ABO blood group-incompatible (ABO-I) barrier. However, it remains to be elucidated whether rituximab is equally effective for B-cell and T-cell immune responses in both KT and LT recipients. To clarify these effects of rituximab, we enrolled 46 KT and 77 LT recipients in this study. The proportion of peripheral blood B-cells was determined at the perioperative period. T-cell responses to allostimulation were evaluated by a mixed lymphocyte reaction (MLR) assay. One week after rituximab administration, peripheral B-cells became undetectable in ABO-I KT recipients but remained detectable in some of the ABO-I LT recipients; B-cells were undetectable in both groups by week 2. B-cells remained below the detection limit throughout the first year in the ABO-I KT recipients, whereas they reappeared in the periphery after 6months in the ABO-I LT recipients. There were no significant differences in alloreactive T-cell responses based on MLR analyses between ABO-I and ABO-compatible groups. This study indicates that rituximab has differing B-cell sensitivity between KT and LT recipients and a minimal effect on the alloreactive T-cell responses in KT and LT recipients. PMID:27085793

  20. A multi-centre retrospective study of rituximab use in the treatment of relapsed or resistant warm autoimmune haemolytic anaemia.

    LENUS (Irish Health Repository)

    Maung, Su W

    2013-10-01

    This retrospective analysis assessed the response, safety and duration of response to standard dose rituximab 375 mg\\/m(2) weekly for four weeks as therapy for patients with primary or secondary warm autoimmune haemolytic anaemia (WAIHA), who had failed initial treatment. Thirty-four patients received rituximab for WAIHA in seven centres in the Republic of Ireland. The overall response rate was 70·6% (24\\/34) with 26·5% (9\\/34) achieving a complete response (CR). The time to response was 1 month post-initiation of rituximab in 87·5% (21\\/24) and 3 months in 12·5% (3\\/24) of patients. The median duration of follow-up was 36 months (range 6-90 months). Of the patients who responded, 50% (12\\/24) relapsed during follow up with a median time to next treatment of 16·5 months (range 6-60 months). Three patients were re-treated with rituximab 375 mg\\/m2 weekly for four weeks at relapse and responded. There was a single episode of neutropenic sepsis. Rituximab is an effective and safe treatment for WAIHA but a significant number of patients will relapse in the first two years post treatment. Re-treatment was effective in a small number of patients, suggesting that intermittent pulse treatment or maintenance treatment may improve long-term response.

  1. Randomized trial of bendamustine-rituximab or R-CHOP/R-CVP in first-line treatment of indolent NHL or MCL: the BRIGHT study

    OpenAIRE

    Flinn, Ian W.; van der Jagt, Richard; Kahl, Brad S.; Wood, Peter; Hawkins, Tim E.; MacDonald, David; Hertzberg, Mark; Kwan, Yiu-Lam; Simpson, David; Craig, Michael; Kolibaba, Kathryn; Issa, Samar; Clementi, Regina; Hallman, Doreen M.; Munteanu, Mihaela

    2014-01-01

    The complete response rate for first-line bendamustine/rituximab was statistically noninferior to R-CHOP or R-CVP in indolent NHL or MCL.The safety profile of bendamustine/rituximab is distinct from that of R-CHOP/R-CVP.

  2. Highest clinical effectiveness of rituximab in autoantibody-positive patients with rheumatoid arthritis and in those for whom no more than one previous TNF antagonist has failed

    DEFF Research Database (Denmark)

    Chatzidionysiou, Katerina; Lie, Elisabeth; Nasonov, Evgeny;

    2011-01-01

    To assess the 6-month effectiveness of the first rituximab (RTX) course in rheumatoid arthritis (RA) and to identify possible predictors of response.......To assess the 6-month effectiveness of the first rituximab (RTX) course in rheumatoid arthritis (RA) and to identify possible predictors of response....

  3. Study of conjugation and radiolabeling of monoclonal antibody rituximab for use in radionuclide therapy; Estudo da conjugacao e radiomarcacao do anticorpo monoclonal rituximab para aplicacao em terapia radionuclidica

    Energy Technology Data Exchange (ETDEWEB)

    Massicano, Adriana Vidal Fernandes

    2011-07-01

    Lymphomas are tumors originated from the transformation of a lymphocyte in the lymphatic system. The most common lymphoma is the Non-Hodgkin Lymphoma (NHL). Advances in immunology and molecular biology have been improving NHL's detection and treatment strategies development, such as Radioimmunotherapy (RIT). Rituximab is an anti-CD20 monoclonal antibody used as immunotherapeutic to treat refractory or relapsed NHL. The goal of the present work was to conjugate this antibody to DOTA-NHS-ester bifunctional chelator and to radiolabel it with {sup 177}Lu radioisotope in order to develop a radio immunotherapeutic agent for NHL's treatment. Different rituximab to DOTA molar ratios (1:5, 1:10, 1:20, 1:50, 1:250, 1:500 and 1:1000) were evaluated in order to determine the best condition for obtaining the highest radiochemical purity of radio immunotherapeutic. The stability of the unlabeled immuno conjugated was evaluated by high performance liquid chromatography (HPLC) for up to 240 days in different storage conditions. The stability of the labeled preparations was evaluated either after storing at 2-8 degree C or incubation in human serum at 37 degree C. The binding to serum proteins was also determined. In vivo studies were performed in healthy Swiss mice, in order to characterize the biological properties of labeled conjugate. Finally, preliminary studies of radio immuno conjugated competitive binding to CD20 positive Raji cells were carried out in order to analyze if the process of conjugation and radiolabeling compromises the immunoreactivity of the antibody. The conjugation applying lower antibody to chelator molar ratios (1:5, 1:10 and 1:20) showed high stability when stored for up to 240 days in different conditions. The HPLC analysis showed that the monoclonal antibody conjugated in molar ratio 1:50 was labeled with higher radiochemical purity (> 95%) when purified in PD-10 column. This conjugate showed reasonable stability at 2-8 degree C. The analysis

  4. Comparison of the immunoreactivity of rituximab antibody labeled with either I-125 or Re-188 for radioimmunotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Tae Hyun; Chung, Hye Kyung; Lee, Tae Sup; Chung, Wee Sup; Woo, Kwang Sun; Lee, Myung Jin; Kim, So Yeon; Chung, Jae Ho; CHoi, Chang Woon; Lim, Sang Moo [KIRAMS, Seoul (Korea, Republic of); Darwati, Siti [National Nuclear Energy Agency, Tangerang (Indonesia)

    2004-07-01

    Monoclonal antibodies against tumor-associated antigens can be applied as delivery vehicles for radionuclides to treat tumors. The specificity of MAbs for tumor-associated antigens can be exploited to direct radionuclides selectively to tumor cells after systemic administration. In radioimmunotherapy, therapeutic efficacy depends on the choice of the radionuclide. The chemical characteristics of radioiodine and radiometals (Re-188) differ significantly with respect to labeling procedure and consequently the specificity of monoclonal antibody can be affected due to discrepancy of labeling condition. Rituximab is a genetically engineered, chimeric anti-CD20 monoclonal antibody with mouse variable and human constant region. The CD-20 itself plays an important role in human B-cell proliferation and is an effective target for immunotherapy. In the present study, we compared the immunoreactivity of I-125-labeled Rituximab with Re-188-labeled Rituximab according to radionuclide-optimized labeling condition in cell binding assay of Lindmo method.

  5. Comparative Study on Rituximab Combined with Chemotherapy and Single Chemotherapy for Diffuse Large B Cell Lymphoma

    Directory of Open Access Journals (Sweden)

    Ji-feng FENG

    2015-06-01

    Full Text Available Objective: To explore the clinical efficacy and safety of rituximab combined with chemotherapy and single chemotherapy for diffuse large B cell lymphoma (DLBCL. Methods: A total of 97 patients with DLBCL were selected. Patients treated by single chemotherapy were designed as control group, while those by rituximab combined with chemotherapy as observational group. All patients were treated for at least 4 cycles. The short-term and long-term efficacy and related adverse reactions of 2 groups were observed. Results: The rate of complete remission (CR in observational group was significantly higher than in control group (χ2=4.6589, P=0.0309. However, there was no significant difference in objective remission rate (ORR between 2 groups (P=0.3651. The rates of 3-year overall survival (OS, progression-free survival (PFS and disease-free survival (DFS were 80.30% (53/66, 69.70% (46/66 and 59.09% (39/66 in observational group, and 61.29% (19/31, 58.06% (18/31 and 58.06% (18/31 in control group, respectively. The OS in observational group was significantly longer than in control group (P=0.035. However, there was no significant difference in PFS, DFS and rate adverse reactions between 2 groups (P=0.089; P=0.438; χ2=0.1562, P=0.6927. Conclusion: Rituximab combined with chemotherapy can improve the efficacy of DLBCL without increasing the adverse reactions, which can be used as the first-line treatment for DLBCL, thus deserving to be widely applied in clinic.

  6. Refractory myasthenia gravis – clinical profile, comorbidities and response to rituximab

    Science.gov (United States)

    Sudulagunta, Sreenivasa Rao; Sepehrar, Mona; Sodalagunta, Mahesh Babu; Settikere Nataraju, Aravinda; Bangalore Raja, Shiva Kumar; Sathyanarayana, Deepak; Gummadi, Siddharth; Burra, Hemanth Kumar

    2016-01-01

    Introduction: Myasthenia gravis (MG) is an antibody mediated autoimmune neuromuscular disorder characterized by fatigable muscle weakness. A proportion of myasthenia gravis patients are classified as refractory due to non responsiveness to conventional treatment. This retrospective study was done to evaluate clinical profile, epidemiological, laboratory, and features of patients with MG and mode of management using rituximab and complications. Methods: Data of myasthenia gravis patients admitted or presented to outpatient department (previous medical records) with MG between January 2008 and January 2016 were included. A total of 512 patients fulfilled the clinical and diagnostic criteria of myasthenia gravis of which 76 patients met the diagnostic certainty for refractory myasthenia gravis and were evaluated. Results: Out of 76 refractory MG patients, 53 (69.73%) patients fulfilled all the three defined criteria. The median age of onset of the refractory MG group was 36 years with a range of 27–53 years. In our study 25 patients (32.89%) belonged to the age group of 21–30 years. Anti-MuSK antibodies were positive in 8 non-refractory MG patients (2.06%) and 36 refractory MG patients (47.36%). Mean HbA1C was found to be 8.6±2.33. The dose of administered prednisone decreased by a mean of 59.7% (p=3.3x10–8) to 94.6% (p=2.2x10–14) after the third cycle of rituximab treatment. Conclusion: The refractory MG patients are most commonly female with an early age of onset, anti-MuSK antibodies, and thymomas. Refractory MG patients have higher prevalence and poor control (HbA1C >8%) of diabetes mellitus and dyslipidemia probably due to increased steroid usage. Rituximab is very efficient in treatment of refractory MG with adverse effects being low. PMID:27790079

  7. Comparative Study on Rituximab Combined with Chemotherapy and Single Chemotherapy for Diffuse Large B Cell Lymphoma

    Institute of Scientific and Technical Information of China (English)

    FENG Ji-feng

    2015-01-01

    Objective:To explore the clinical efifcacy and safety of rituximab combined with chemotherapy and single chemotherapy for diffuse large B cell lymphoma (DLBCL). Methods:A total of 97 patients with DLBCL were selected. Patients treated by single chemotherapy were designed as control group, while those by rituximab combined with chemotherapy as observational group. All patients were treated for at least 4 cycles. The short-term and long-term efifcacy and related adverse reactions of 2 groups were observed. Results:The rate of complete remission (CR) in observational group was signiifcantly higher than in control group (χ2=4.6589,P=0.0309). However, there was no signiifcant difference in objective remission rate (ORR) between 2 groups (P=0.3651). The rates of 3-year overall survival (OS), progression-free survival (PFS) and disease-free survival (DFS) were 80.30% (53/66), 69.70% (46/66) and 59.09% (39/66) in observational group, and 61.29% (19/31), 58.06% (18/31) and 58.06% (18/31) in control group, respectively. The OS in observational group was signiifcantly longer than in control group (P=0.035). However, there was no signiifcant difference in PFS, DFS and rate adverse reactions between 2 groups (P=0.089;P=0.438;χ2=0.1562,P=0.6927). Conclusion: Rituximab combined with chemotherapy can improve the efficacy of DLBCL without increasing the adverse reactions, which can be used as the ifrst-line treatment for DLBCL, thus deserving to be widely applied in clinic.

  8. Cytomegalovirus infection in autologous stem cell transplant recipients in the era of rituximab.

    Science.gov (United States)

    Jain, Tania; John, Jisha; Kotecha, Aditya; Deol, Abhinav; Saliminia, Tanaz; Revankar, Sanjay; Chandrasekar, Pranatharthi

    2016-08-01

    The incidence of cytomegalovirus (CMV) reactivation/disease after autologous stem cell transplant (ASCT) is much lower than that after allogeneic stem cell transplantation. With the recent use of rituximab during cancer chemotherapy or conditioning regimens prior to transplantation, there has been an increasing concern of opportunistic infections including CMV. In the present study, we reviewed the patients undergoing ASCT from December 2007 to December 2013 to identify those developing CMV reactivation/disease. Out of the 978 patients who underwent ASCT at the Karmanos Cancer Institute, 239 patients were tested for symptomatic CMV reactivation based on clinical suspicion. Of the tested patients, 7/239 (2.9 %) were documented to have CMV reactivation within 90 days of ASCT. The median time to develop CMV viremia was 32 days from transplantation. Of the 239 patients tested, CMV viremia was detected in 3 out of 72 patients who received rituximab as compared to 4 out of 167 patients who did not. Three of these seven viremic patients were treated with anti-viral drugs; viremia resolved in all patients at a median of 24 days. Three patients were found to develop other bacterial and/or fungal infections following CMV viremia. Two of the seven patients died during 1-year follow-up, due to primary disease progression or Candida sepsis. None of the patients developed proven tissue-invasive CMV disease. The study did not evaluate the incidence of asymptomatic CMV infection/reactivation. Despite prior publications based on limited data, rituximab does not appear to contribute to an increased frequency of symptomatic CMV reactivation following ASCT. PMID:27225264

  9. In Vitro Cytotoxicity of Low-Dose-Rate Radioimmunotherapy by the Alpha-Emitting Radioimmunoconjugate Thorium-227-DOTA-Rituximab

    International Nuclear Information System (INIS)

    Purpose: To determine whether the low-dose-rate α-particle-emitting radioimmunoconjugate 227Th-1,4,7,10-p-isothiocyanato-benzyl-tetraazacyclododecane-1,4,7, 10-tetraacetic acid (DOTA)-rituximab can be used to inactivate lymphoma cells growing as single cells and small colonies. Methods and Materials: CD20-positive lymphoma cell lines were treated with 227Th-DOTA-rituximab for 1-5 weeks. To simulate the in vivo situation with continuous but decreasing supply of radioimmunoconjugates from the blood pool, the cells were not washed after incubation with 227Th-DOTA-rituximab, but half of the medium was replaced with fresh medium, and cell concentration and cell-bound activity were determined every other day after start of incubation. A microdosimetric model was established to estimate the average number of hits in the nucleus for different localizations of activity. Results: There was a specific targeted effect on cell growth of the 227Th-DOTA-rituximab treatment. Although the cells were not washed after incubation with 227Th-DOTA-rituximab, the average contribution of activity in the medium to the mean dose was only 6%, whereas the average contribution from activity on the cells' own surface was 78%. The mean dose rates after incubation with 800 Bq/mL 227Th-DOTA-rituximab varied from 0.01 to 0.03 cGy/min. The average delay in growing from 105 to 107 cells/mL was 15 days when the cells were treated with a mean absorbed radiation dose of 2 Gy α-particle radiation from 227Th-DOTA-rituximab, whereas it was 11 days when the cells were irradiated with 6 Gy of X-radiation. The relative biologic effect of the treatment was estimated to be 2.9-3.4. Conclusions: The low-dose-rate radioimmunoconjugate 227Th-DOTA-rituximab is suitable for inactivation of single lymphoma cells and small colonies of lymphoma cells.

  10. A phase III randomized trial comparing glucocorticoid monotherapy versus glucocorticoid and rituximab in patients with autoimmune haemolytic anaemia

    DEFF Research Database (Denmark)

    Birgens, Henrik; Frederiksen, Henrik; Hasselbalch, Hans Carl;

    2013-01-01

    The impact of first-line treatment with the anti-CD 20 chimeric monoclonal antibody rituximab in patients with warm-antibody reactive autoimmune haemolytic anaemia (WAIHA) is unknown. We report the first randomized study of 64 patients with newly diagnosed WAIHA who received prednisolone and ritu......The impact of first-line treatment with the anti-CD 20 chimeric monoclonal antibody rituximab in patients with warm-antibody reactive autoimmune haemolytic anaemia (WAIHA) is unknown. We report the first randomized study of 64 patients with newly diagnosed WAIHA who received prednisolone...

  11. Is rituximab effective for induction of remission in ANCA-associated vasculitis?

    OpenAIRE

    Carmen Rain; Tatiana Yáñez; Gabriel Rada

    2015-01-01

    La adición de rituximab al tratamiento con corticoides se ha planteado como alternativa terapéutica para inducir remisión en las vasculitis asociadas a anticuerpos anticitoplasma de neutrófilos (ANCA), especialmente en pacientes con deseo de preservar fertilidad que persisten activos después del tratamiento estándar, o en aquellos que tienen contraindicación o mala tolerancia a ciclofosfamida. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases d...

  12. Systemic adverse events following rituximab therapy in patients with Graves' disease

    DEFF Research Database (Denmark)

    El Fassi, D; Nielsen, Claus Henrik; Junker, Michael Peter;

    2011-01-01

    Background and aim: Rituximab (RTX) therapy has shown promising results in Graves´ disease (GD), with or without ophthalmopathy. We examined the occurrence of adverse events in GD patients treated with RTX. Subjects and methods: Ten patients received RTX and methimazole, while ten patients received...... had the third highest increase in immunoglobulin deposition on monocytes by day 14. The arthralgias persisted in two of the patients, despite glucocorticoid rescue therapy. Conclusions: We report articular adverse events in three and gastrointestinal symptoms in two out of ten GD patients who received...

  13. Activity and safety of combined rituximab with chlorambucil in patients with mantle cell lymphoma.

    Science.gov (United States)

    Bauwens, Deborah; Maerevoet, Marie; Michaux, Lucienne; Théate, Ivan; Hagemeijer, Anne; Stul, Michel; Danse, Etienne; Costantini, Sabrina; Vannuffel, Pascal; Straetmans, Nicole; Vekemans, Marie-Christiane; Deneys, Véronique; Ferrant, Augustin; Van Den Neste, Eric

    2005-11-01

    We evaluated the combination of rituximab with chlorambucil in patients with mantle cell lymphoma (MCL) not eligible for aggressive therapy. Fourteen patients (male/female: 9/5) were included (two newly diagnosed, 12 relapsed/refractory). The toxicities were neutropenia, thrombopenia and infection. Nine (64%) patients responded; five (36%) achieved complete remission and four (29%) achieved partial remission. The median progression-free survival for responders was 26 months (95% CI, 4-48). Marrow polymerase chain reaction negativity was attained in seven responders. These results suggest that this schedule may have notable antitumour activity in patients with MCL, including patients in relapse after autologous stem cell transplantation. PMID:16225653

  14. Efficacy of rituximab in gastric diffuse large B cell lymphoma patients

    Institute of Scientific and Technical Information of China (English)

    Davide; Leopardo; Giuseppe; Di; Lorenzo; Amalia; De; Renz

    2010-01-01

    AIM:To evaluate retrospectively the efficacy of rituximab plus chemotherapy in gastric diffuse large B cell lymphoma(DLBCL).METHODS:Sixty patients(median age:58 years)with histologically confirmed gastric DLBCL treated at four Italian institutions between 2000 and 2007,were included in this analysis.Patients were selected by stage (Ⅰ-Ⅳ,Lugano staging system),European Cooperative Oncology Group performance status(0-2)and treatment strategies.Treatment strategies were chemotherapy alone(group A,n=30)[schedule...

  15. Rituximab maintenance improves clinical outcome of relapsed/resistant follicular non-Hodgkin lymphoma in patients both with and without rituximab during induction: results of a prospective randomized phase 3 intergroup trial

    NARCIS (Netherlands)

    M.H.J. van Oers; R. Klasa; R.E. Marcus; M. Wolf; E. Kimby; R.D. Gascoyne; A. Jack; M. van't Veer; A. Vranovsky; H. Holte; M. van Glabbeke; I. Teodorovic; C. Rozewicz; A. Hagenbeek

    2006-01-01

    We evaluated the role of rituximab (R) both in remission induction and maintenance treatment of relapsed/resistant follicular lymphoma (FL). A total of 465 patients were randomized to induction with 6 cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) (every 3 weeks) or R-CH

  16. Immunreconstitution and infectious complications after rituximab treatment in children and adolescents: what do we know and what can we learn from adults?

    Science.gov (United States)

    Worch, Jennifer; Makarova, Olga; Burkhardt, Birgit

    2015-01-01

    Rituximab, an anti CD20 monoclonal antibody, is widely used in the treatment of B-cell malignancies in adults and increasingly in pediatric patients. By depleting B-cells, rituximab interferes with humoral immunity. This review provides a comprehensive overview of immune reconstitution and infectious complications after rituximab treatment in children and adolescents. Immune reconstitution starts usually after six months with recovery to normal between nine to twelve months. Extended rituximab treatment results in a prolonged recovery of B-cells without an increase of clinically relevant infections. The kinetic of B-cell recovery is influenced by the concomitant chemotherapy and the underlying disease. Intensive B-NHL treatment such as high-dose chemotherapy followed by rituximab bears a risk for prolonged hypogammaglobulinemia. Overall transient alteration of immune reconstitution and infections after rituximab treatment are acceptable for children and adolescent without significant differences compared to adults. However, age related disparities in the kinetic of immune reconstitution and the definitive role of rituximab in the treatment for children and adolescents with B-cell malignancies need to be evaluated in prospective controlled clinical trials. PMID:25643241

  17. Immunreconstitution and Infectious Complications After Rituximab Treatment in Children and Adolescents: What Do We Know and What Can We Learn from Adults?

    Directory of Open Access Journals (Sweden)

    Jennifer Worch

    2015-01-01

    Full Text Available Rituximab, an anti CD20 monoclonal antibody, is widely used in the treatment of B-cell malignancies in adults and increasingly in pediatric patients. By depleting B-cells, rituximab interferes with humoral immunity. This review provides a comprehensive overview of immune reconstitution and infectious complications after rituximab treatment in children and adolescents. Immune reconstitution starts usually after six months with recovery to normal between nine to twelve months. Extended rituximab treatment results in a prolonged recovery of B-cells without an increase of clinically relevant infections. The kinetic of B-cell recovery is influenced by the concomitant chemotherapy and the underlying disease. Intensive B-NHL treatment such as high-dose chemotherapy followed by rituximab bears a risk for prolonged hypogammaglobulinemia. Overall transient alteration of immune reconstitution and infections after rituximab treatment are acceptable for children and adolescent without significant differences compared to adults. However, age related disparities in the kinetic of immune reconstitution and the definitive role of rituximab in the treatment for children and adolescents with B-cell malignancies need to be evaluated in prospective controlled clinical trials.

  18. Rapid infusion with rituximab: short term safety in systemic autoimmune diseases

    DEFF Research Database (Denmark)

    Larsen, Janni Lisander; Jacobsen, Soren

    2013-01-01

    To describe the incidence, types and severity of adverse events, related to an accelerated regime of rituximab infusion in patients with various autoimmune diseases. Fifty-four patients with systemic autoimmune disease, to be treated with 1,000 mg of rituximab twice 2 weeks apart, participated. Pre......-medication (oral prednisolone, anti-histamine and paracetamol) was administered 1-4 h before infusion start. The first infusion was administered over a period of 195 min. The second infusion over a period of 90 min. Any adverse events were classified using the Clinical Trials Classification of Adverse Events...... (CTCAE) v. 3.0. Ten patients (18.5%) experienced at least one infusion-related reaction (IRR) ever. The first infusion was associated with reactions in 4 CTCAE categories of which rhinitis were the most frequent. The CTCAE severity grading showed six patients (11.1%) had a grade 1 reaction. One patient...

  19. Is rituximab effective for induction of remission in ANCA-associated vasculitis?

    Directory of Open Access Journals (Sweden)

    Carmen Rain

    2015-08-01

    Full Text Available La adición de rituximab al tratamiento con corticoides se ha planteado como alternativa terapéutica para inducir remisión en las vasculitis asociadas a anticuerpos anticitoplasma de neutrófilos (ANCA, especialmente en pacientes con deseo de preservar fertilidad que persisten activos después del tratamiento estándar, o en aquellos que tienen contraindicación o mala tolerancia a ciclofosfamida. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos solo una revisión sistemática que incluye tres estudios aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que el uso de rituximab podría resultar en poca o nula diferencia en mortalidad, mientras que existe incertidumbre sobre si disminuye las recaídas o aumenta los efectos adversos serios, como infecciones o neoplasias.

  20. Neuromyelitis optica: Contribution of therapeutic responses markers monitoring in patients given rituximab.

    Science.gov (United States)

    Romero, G; Ticchioni, M; Cohen, M; Rosenthal-Allieri, M A; Mondot, L; Lebrun Frenay, C

    2016-03-01

    Neuromyelitis optica (NMO) is a central nervous system inflammatory autoimmune disease characterized by medullary and/or optical nerve damage. It is rare but life-threatening. Concerning the treatment of NMO, many drugs have been used in background therapy. Some studies have shown efficacy of rituximab (an antiCD20 monoclonal anti-body) either on the reduction of the annual number of exacerbation or the mean score EDSS. In 2013, a Korean team reported a new protocol during which they administered rituximab only when memory B lymphocytes CD27+ were detectable in the bloodstream. In our patient, institution of this protocol led to clinical benefit with a major decrease in the EDSS score over time (7 in August 2012 vs. 1 in October 2015), a reduction of the total administered dose (4g in 2013 vs. 1.375g in 2014 vs. 0g in 2015) and side effects. Compared with the rate of theoretical administration, health expenditure savings reached 1700 Euros per month over the 11-month treatment. Monitoring therapeutic response markers with memory B lymphocyte counts appear to be an efficient cost-effective way to measure clinical efficiency, reduce total doses, and limit side effects. PMID:26915311

  1. Rituximab therapy for flare-up of rheumatoid arthritis after total knee replacement surgery.

    Science.gov (United States)

    Mirza, Rabeea; Ishaq, Saliha; Khan, Muhammad Owais; Memon, Adil

    2012-10-01

    A variety of drug types are used alone or in combination to manage Rheumatoid Arthritis along with physiotherapy. We report herein the case of a 51 year old female patient with a history of Rheumatoid Arthritis whose disease remained active despite being on routinely used multiple disease modifying antirheumatic drugs. The patient underwent bilateral total knee arthroplasty with subtotal synovectomy due to the severe pain caused by her concomitant age related osteoarthritis which was only aggravated by her active rheumatoid arthritis disease. Three months following surgery, the patient's knee pain with typical rheumatoid flare and swelling reappeared for which a B cell monoclonal antibody, rituximab, was given. Her number of tender and swollen joints reduced to less than three and her C-reactive protein levels and erythrocyte sedimentation rate reduced significantly along with considerable improvement in her Global Assessment score. Her severity of pain also decreased to 3 from an initial score of 8 on the Visual Analog Scale. Thus, Rituximab helped improve our patient's symptoms from recurrence of synovitis after total knee replacement.

  2. Lymphomatoid granulomatosis treated successfully with rituximab in a renal transplant patient.

    Science.gov (United States)

    Castrale, Cindy; El Haggan, Wael; Chapon, Françoise; Reman, Oumedaly; Lobbedez, Thierry; Ryckelynck, Jean Philippe; Hurault de Ligny, Bruno

    2011-01-01

    Lymphomatoid granulomatosis (LYG) in renal transplant recipients is rare multisystemic angiocentric lymphoproliferative disorder with significant malignant potential. Here, we describe LYG in a 70-year-old renal allograft recipient who, 4 years after transplantation, on tacrolimus and mycophenolate mofetil and prednisone maintenance immunosuppression, complained of low-grade fever, persistent headache and gait disturbance. The MRI of the brain revealed diffuse periventricular cerebral and cerebellar contrast-enhanced lesions. The CT scan of the thorax showed multiple pulmonary nodular opacities in both lung fields. The patient was diagnosed LYG based on the cerebral biopsy showing perivascular infiltration of CD20-positive B-lymphocytes with granulomatous lesions and immunofluorescence staining with anti-EBV antibodies. With careful reduction of the immunossuppression combined with the use of rituximab, our patient showed a complete disappearance of LYG, and she is clinically well more than 4 years after the diagnosis, with good kidney function. No recurrence has been observed by radiological imaging until now. This is the first report of a durable (>4 years) complete remission of LYG after treatment with rituximab in renal transplantation. PMID:21559262

  3. Lymphomatoid Granulomatosis Treated Successfully with Rituximab in a Renal Transplant Patient

    Directory of Open Access Journals (Sweden)

    Cindy Castrale

    2011-01-01

    Full Text Available Lymphomatoid granulomatosis (LYG in renal transplant recipients is rare multisystemic angiocentric lymphoproliferative disorder with significant malignant potential. Here, we describe LYG in a 70-year-old renal allograft recipient who, 4 years after transplantation, on tacrolimus and mycophenolate mofetil and prednisone maintenance immunosuppression, complained of low-grade fever, persistent headache and gait disturbance. The MRI of the brain revealed diffuse periventricular cerebral and cerebellar contrast-enhanced lesions. The CT scan of the thorax showed multiple pulmonary nodular opacities in both lung fields. The patient was diagnosed LYG based on the cerebral biopsy showing perivascular infiltration of CD20-positive B-lymphocytes with granulomatous lesions and immunofluorescence staining with anti-EBV antibodies. With careful reduction of the immunossuppression combined with the use of rituximab, our patient showed a complete disappearance of LYG, and she is clinically well more than 4 years after the diagnosis, with good kidney function. No recurrence has been observed by radiological imaging until now. This is the first report of a durable (>4 years complete remission of LYG after treatment with rituximab in renal transplantation.

  4. Common variable immunodeficiency unmasked by treatment of immune thrombocytopenic purpura with Rituximab

    DEFF Research Database (Denmark)

    Mogensen, Trine H; Jensen, Jens Magnus Bernth; Petersen, Charlotte C;

    2013-01-01

    BACKGROUND: Hypogammaglobulinemia may be part of several different immunological or malignant conditions, and its origin is not always obvious. Furthermore, although autoimmune cytopenias are known to be associated with common variable immunodeficiency (CVID) and even may precede signs of immunod......BACKGROUND: Hypogammaglobulinemia may be part of several different immunological or malignant conditions, and its origin is not always obvious. Furthermore, although autoimmune cytopenias are known to be associated with common variable immunodeficiency (CVID) and even may precede signs...... of immunodeficiency, this is not always recognized. Despite novel insight into the molecular immunology of common variable immunodeficiency, several areas of uncertainty remain. In addition, the full spectrum of immunological effects of the B cell depleting anti-CD20 antibody Rituximab has not been fully explored....... To our knowledge this is the first report of development of CVID in a patient with normal immunoglobulin prior to Rituximab treatment. CASE PRESENTATION: Here we describe the highly unusual clinical presentation of a 34-year old Caucasian male with treatment refractory immune thrombocytopenic purpura...

  5. Pre-emptive treatment with rituximab of molecular relapse after autologous stem cell transplantation in mantle cell lymphoma

    DEFF Research Database (Denmark)

    Andersen, Niels S; Pedersen, Lone B; Laurell, Anna;

    2009-01-01

    PURPOSE: Minimal residual disease (MRD) is predictive of clinical progression in mantle-cell lymphoma (MCL). According to the Nordic MCL-2 protocol we prospectively analyzed the efficacy of pre-emptive treatment using rituximab to MCL patients in molecular relapse after autologous stem cell...

  6. Rearrangements of MYC gene facilitate risk stratification in diffuse large B-cell lymphoma patients treated with rituximab-CHOP

    DEFF Research Database (Denmark)

    Tzankov, Alexandar; Xu-Monette, Zijun Y; Gerhard, Marc;

    2014-01-01

    In order to address the debatable prognostic role of MYC rearrangements in diffuse large B-cell lymphoma patients treated with rituximab, cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisone, we evaluated MYC rearrangements by fluorescence in situ hybridization in 563 cases using br...

  7. Complement activation on B lymphocytes opsonized with rituximab or ofatumumab produces substantial changes in membrane structure preceding cell lysis

    NARCIS (Netherlands)

    Beum, Paul V.; Lindorfer, Margaret A.; Beurskens, Frank; Stukenberg, P. Todd; Lokhorst, Henk M.; Pawluczkowycz, Andrew W.; Parren, Paul W. H. I.; van de Winkel, Jan G. J.; Taylor, Ronald P.

    2008-01-01

    Binding of the CD20 mAb rituximab (RTX) to B lymphocytes in normal human serum (NHS) activates complement (C) and promotes C3b deposition on or in close proximity to cell-bound RTX. Based on spinning disk confocal microscopy analyses, we report the first real-time visualization of C3b deposition and

  8. Efficacy and safety of low-dose rituximab combined with different dosage of glucocorticoids for immune thrombocytopenia

    Institute of Scientific and Technical Information of China (English)

    邢伟伟

    2013-01-01

    Objective To compare the efficacy and safety of low-dose rituximab combined with different dosage of glucocorticoids for immune thrombocytopenia (ITP) .Methods Seventy-four patients (35 male,median age 34years,range 18—70 years) including 60 newly-diagnosed,6 persistent,5 chronic and 3 refractory patients

  9. Nye behandlinger af Graves' sygdom med fokus på det B-lymfocyt-depleterende antistof rituximab

    DEFF Research Database (Denmark)

    Nielsen, Claus Henrik; El Fassi, Daniel; Hegedüs, Laszlo

    2008-01-01

    Graves' disease (GD) is caused by autoantibodies to the thyrotropin receptor (TRAb). In a controlled study using the B-lymphocyte depleting agent rituximab (RTX), an RTX-specific effect was found on long-term remission following methimazole (MMI) therapy. However, benefits were limited to patients...

  10. Responsiveness of disease activity indices ESSPRI and ESSDAI in patients with primary Sjogren's syndrome treated with rituximab

    NARCIS (Netherlands)

    Meiners, P. M.; Arends, S.; Brouwer, E.; Spijkervet, F. K. L.; Vissink, A.; Bootsma, H.

    2012-01-01

    Objective To evaluate the responsiveness of the EULAR Sjogren's Syndrome Patient Reported Index (ESSPRI) and EULAR Sjogren's Syndrome Disease Activity Index (ESSDAI) in patients with primary Sjogren's syndrome (pSS) treated with rituximab. Methods Twenty-eight patients with pSS treated with rituxima

  11. Higher World Health Organization grades of follicular lymphoma correlate with better outcome in two Nordic Lymphoma Group trials of rituximab without chemotherapy

    DEFF Research Database (Denmark)

    Wahlin, Björn Engelbrekt; Sundström, Christer; Sander, Birgitta;

    2014-01-01

    Abstract A common treatment for follicular lymphoma is rituximab monotherapy. To identify patients for whom this regimen is adequate as first-line therapy, we applied the World Health Organization (WHO) classification for grading follicular lymphoma in a prospective central pathology review...... of the biopsies of previously untreated patients in two randomized trials of rituximab without chemotherapy. In the first trial (n₁ = 53), higher WHO grades correlated with longer time to next treatment, independently of clinical prognostic factors (p = 0.030); the finding was replicated in the second trial (n₂...... increased with the malignant cell size (p rituximab monotherapy. WHO grading might provide a clinically useful tool for personalized therapy....

  12. Repeated injections of {sup 131}I-rituximab show patient-specific stable biodistribution and tissue kinetics

    Energy Technology Data Exchange (ETDEWEB)

    Antonescu, Cristian; Bischof Delaloye, Angelika; Schaffland, Andreas O.; Grannavel, Carine [University Hospital of Lausanne, Service of Nuclear Medicine, Lausanne (Switzerland); Kosinski, Marek [University Hospital of Lausanne, Service of Nuclear Medicine, Lausanne (Switzerland); University of Lausanne, Institute of Applied Radiophysics, Lausanne (Switzerland); Monnin, Pascal; Verdun, Francis R. [University of Lausanne, Institute of Applied Radiophysics, Lausanne (Switzerland); Ketterer, Nicolas [University Hospital of Lausanne, Multidisciplinary Oncology Center, Lausanne (Switzerland); Kovacsovics, Tibor [Oregon Health and Science University, Center for Hematological Malignancies, Portland, OR (United States); Buchegger, Franz [University Hospital of Lausanne, Service of Nuclear Medicine, Lausanne (Switzerland); University Hospital of Geneva, Service of Nuclear Medicine, Geneva (Switzerland)

    2005-08-01

    It is generally assumed that the biodistribution and pharmacokinetics of radiolabelled antibodies remain similar between dosimetric and therapeutic injections in radioimmunotherapy. However, circulation half-lives of unlabelled rituximab have been reported to increase progressively after the weekly injections of standard therapy doses. The aim of this study was to evaluate the evolution of the pharmacokinetics of repeated {sup 131}I-rituximab injections during treatment with unlabelled rituximab in patients with non-Hodgkin's lymphoma (NHL). Patients received standard weekly therapy with rituximab (375 mg/m{sup 2}) for 4 weeks and a fifth injection at 7 or 8 weeks. Each patient had three additional injections of 185 MBq {sup 131}I-rituximab in either treatment weeks 1, 3 and 7 (two patients) or weeks 2, 4 and 8 (two patients). The 12 radiolabelled antibody injections were followed by three whole-body (WB) scintigraphic studies during 1 week and blood sampling on the same occasions. Additional WB scans were performed after 2 and 4 weeks post {sup 131}I-rituximab injection prior to the second and third injections, respectively. A single exponential radioactivity decrease for WB, liver, spleen, kidneys and heart was observed. Biodistribution and half-lives were patient specific, and without significant change after the second or third injection compared with the first one. Blood T{sub 1/2}{beta}, calculated from the sequential blood samples and fitted to a bi-exponential curve, was similar to the T{sub 1/2} of heart and liver but shorter than that of WB and kidneys. Effective radiation dose calculated from attenuation-corrected WB scans and blood using Mirdose3.1 was 0.53+0.05 mSv/MBq (range 0.48-0.59 mSv/MBq). Radiation dose was highest for spleen and kidneys, followed by heart and liver. These results show that the biodistribution and tissue kinetics of {sup 131}I-rituximab, while specific to each patient, remained constant during unlabelled antibody therapy

  13. Assessment of flares in lupus patients enrolled in a phase II/III study of rituximab (EXPLORER).

    Science.gov (United States)

    Merrill, Jt; Buyon, Jp; Furie, Ra; Latinis, Km; Gordon, C; Hsieh, H-J; Brunetta, P

    2011-06-01

    The EXPLORER study was designed to assess the response to rituximab versus placebo in patients with moderate to severe extrarenal systemic lupus erythematosus (SLE) receiving background immunosuppression. The definition of response required reduced clinical activity without subsequent flares over 52 weeks, and the study did not meet its efficacy endpoint. The current exploratory analysis assessed flare rates in patients who achieved initial low disease activity response (British Isles Lupus Assessment Group [BILAG] C or better in all organs) during the study. Exploratory reanalysis of data from the EXPLORER trial was conducted, considering alternative definitions for flare. No difference was found between rituximab and placebo in preventing or delaying moderate to severe flares. However, when severe (BILAG A) flares alone were examined, rituximab reduced the risk of a subsequent first A flare (hazard ratio = 0.61; p = 0.052) and lowered mean ± SD annualized A flare rates (0.86 ± 1.47 vs. 1.41 ± 2.14; p = 0.038). Eighty-four (49.7%) rituximab-treated patients achieved low disease activity without subsequent A flares versus 31 (35.2%) placebo-treated patients (p = 0.027). Prednisone rescue for A flares was similar in rituximab- (24%) and placebo-treated (14%) patients (p = 0.204). This post hoc analysis evaluates the hypothesis that assessment of BILAG A flares may distinguish potential treatment effects with greater sensitivity than assessment of BILAG B flares. PMID:21478286

  14. Study of conjugation and radiolabeling of monoclonal antibody rituximab for use in radionuclide therapy

    International Nuclear Information System (INIS)

    Lymphomas are tumors originated from the transformation of a lymphocyte in the lymphatic system. The most common lymphoma is the Non-Hodgkin Lymphoma (NHL). Advances in immunology and molecular biology have been improving NHL's detection and treatment strategies development, such as Radioimmunotherapy (RIT). Rituximab is an anti-CD20 monoclonal antibody used as immunotherapeutic to treat refractory or relapsed NHL. The goal of the present work was to conjugate this antibody to DOTA-NHS-ester bifunctional chelator and to radiolabel it with 177Lu radioisotope in order to develop a radio immunotherapeutic agent for NHL's treatment. Different rituximab to DOTA molar ratios (1:5, 1:10, 1:20, 1:50, 1:250, 1:500 and 1:1000) were evaluated in order to determine the best condition for obtaining the highest radiochemical purity of radio immunotherapeutic. The stability of the unlabeled immuno conjugated was evaluated by high performance liquid chromatography (HPLC) for up to 240 days in different storage conditions. The stability of the labeled preparations was evaluated either after storing at 2-8 degree C or incubation in human serum at 37 degree C. The binding to serum proteins was also determined. In vivo studies were performed in healthy Swiss mice, in order to characterize the biological properties of labeled conjugate. Finally, preliminary studies of radio immuno conjugated competitive binding to CD20 positive Raji cells were carried out in order to analyze if the process of conjugation and radiolabeling compromises the immunoreactivity of the antibody. The conjugation applying lower antibody to chelator molar ratios (1:5, 1:10 and 1:20) showed high stability when stored for up to 240 days in different conditions. The HPLC analysis showed that the monoclonal antibody conjugated in molar ratio 1:50 was labeled with higher radiochemical purity (> 95%) when purified in PD-10 column. This conjugate showed reasonable stability at 2-8 degree C. The analysis of the stability

  15. Mutational profile and prognostic significance of TP53 in diffuse large B-cell lymphoma patients treated with rituximab-CHOP

    DEFF Research Database (Denmark)

    Xu-Monette, Zijun Y; Wu, Lin; Visco, Carlo;

    2012-01-01

    TP53 mutation is an independent marker of poor prognosis in patients with diffuse large B-cell lymphoma (DLBCL) treated with cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisone (CHOP) therapy. However, its prognostic value in the rituximab immunochemotherapy era remains undefined. ...

  16. CD20 mutations involving the rituximab epitope are rare in diffuse large B-cell lymphomas and are not a significant cause of R-CHOP failure

    OpenAIRE

    Johnson, Nathalie A.; Leach, Stephen; Woolcock, Bruce; deLeeuw, Ronald J; Bashashati, Ali; Sehn, Laurie H.; Connors, Joseph M; Chhanabhai, Mukesh; Brooks-Wilson, Angela; Gascoyne, Randy D.

    2009-01-01

    The findings of this study indicate that CD20 mutations nvolving the rituximab epitope are rare in both de novo and relapsed diffuse large B-cell lymphoma, and do not represent a significant cause of R-CHOP resistance.

  17. The efficacy and safety of rituximab in treatment of Epstein-Barr virus disease post allogeneic hematopoietic stem-cell transplantation

    Institute of Scientific and Technical Information of China (English)

    许兰平

    2013-01-01

    Objective To investigate the efficacy and safety of rituximab on Epstein-Barr virus(EBV) disease post allogeneic hematopoietic stem-cell transplantation. Methods A retrospective analysis was performed based on clinical

  18. B-cell depletion with rituximab in the treatment of autoimmune diseases. Graves' ophthalmopathy the latest addition to an expanding family

    DEFF Research Database (Denmark)

    Nielsen, Claus H; El Fassi, Daniel; Hasselbalch, Hans C;

    2007-01-01

    In this review, the authors summarise the clinical results obtained after therapy with rituximab in autoimmune diseases, including Graves' disease and Graves' ophthalmopathy. On the basis of qualitative and quantitative analyses of B- and T-cell subsets, and autoantibody levels obtained in other...... diseases before and after rituximab therapy, the authors interpret the results of the only two clinical investigations of the efficacy of rituximab in the treatment of Graves' disease and Graves' opthalmopathy reported so far. No significant effect on autoantibody levels was observed. Nonetheless, 4 out...... of 10 Graves' disease patients remained in remission 400 days after rituximab treatment versus none in the control group, and remarkable improvements in the eye symptoms of patients with Graves' ophthalmopathy were observed. This supports a role for B cells in the pathogenesis of Graves' ophthalmopathy...

  19. B-cell depletion with rituximab in the treatment of autoimmune diseases. Graves' ophthalmopathy the latest addition to an expanding family

    DEFF Research Database (Denmark)

    Nielsen, Claus H; El Fassi, Daniel; Hasselbalch, Hans K;

    2007-01-01

    of 10 Graves' disease patients remained in remission 400 days after rituximab treatment versus none in the control group, and remarkable improvements in the eye symptoms of patients with Graves' ophthalmopathy were observed. This supports a role for B cells in the pathogenesis of Graves' ophthalmopathy......In this review, the authors summarise the clinical results obtained after therapy with rituximab in autoimmune diseases, including Graves' disease and Graves' ophthalmopathy. On the basis of qualitative and quantitative analyses of B- and T-cell subsets, and autoantibody levels obtained in other...... diseases before and after rituximab therapy, the authors interpret the results of the only two clinical investigations of the efficacy of rituximab in the treatment of Graves' disease and Graves' opthalmopathy reported so far. No significant effect on autoantibody levels was observed. Nonetheless, 4 out...

  20. Effect of response quality and line of treatment with rituximab on overall and disease-free survival of patients with B-cell lymphoma:

    OpenAIRE

    Horvat, Mateja; Novakovic, Barbara Jezersek

    2010-01-01

    Background The introduction of rituximab into the treatment of patients with non-Hodgkin’s lymphomas has improved the overall response rate, as well as the response duration and the overall survival of patients with B-cell lymphomas. But only a few studies have addressed the question whether the better response (complete response) and the early introduction of rituximab into the treatment translate into the better survival. The aim of this retrospective study was to assess the potential relat...

  1. {sup 99m}Tc-rituximab radiolabelled by photo-activation: a new non-Hodgkin's lymphoma imaging agent

    Energy Technology Data Exchange (ETDEWEB)

    Gmeiner Stopar, T.; Fettich, J.; Hojker, S. [University Medical Centre Ljubljana, Department for Nuclear Medicine, Ljubljana (Slovenia); Mlinaric-Rascan, I. [University of Ljubljana, Faculty of Pharmacy, Ljubljana (Slovenia); Mather, S.J. [St Bartholomew' s Hospital, Cancer Research UK, Department Nuclear Medicine, London (United Kingdom)

    2006-01-01

    Rituximab was the first chimeric monoclonal antibody to be approved for treatment of indolent B-cell non-Hodgkin's lymphoma (NHL). It is directed against the CD20 antigen, which is expressed by 95% of B-cell NHLs. The aim of this study was to explore the possibility of radiolabelling rituximab with {sup 99m}Tc for use as an imaging agent in NHL for early detection, staging, remission assessment, monitoring for metastatic spread and tumour recurrence, and assessment of CD20 expression prior to (radio)immunotherapy. Rituximab was purified from Mabthera solution (Roche), photo-activated at 302 nm by UV irradiation and radiolabelled with {sup 99m}Tc. The effectiveness of the labelling method was evaluated by determination of the number of free thiol groups per photoreduced antibody, radiochemical purity and in vitro stability of {sup 99m}Tc-rituximab. On average, 4.4 free thiol groups per photoreduced antibody were determined. Radiolabelling yields greater than 95% were routinely observed after storage of the photo-activated antibody at -80 C for 195 days. The direct binding assay showed preserved ability of {sup 99m}Tc-rituximab to bind to CD20, with an average immunoreactive fraction of 93.3%. The internalisation rate was proven to be low, with only 5.3% of bound {sup 99m}Tc-rituximab being internalised over 4 h at 37 C. Our results demonstrate that {sup 99m}Tc-rituximab of high radiochemical purity and with preserved binding affinity for the antigen can be prepared by photoreduction and that the method shows good reproducibility. {sup 99m}Tc-rituximab will be further explored as an imaging agent applicable in NHL for the purposes mentioned above. (orig.)

  2. Fatal Cytomegalovirus Disease after Combination Therapy with Corticosteroids and Rituximab for Granulomatosis with Polyangiitis

    Directory of Open Access Journals (Sweden)

    Talal Hilal

    2015-01-01

    Full Text Available The association of cytomegalovirus (CMV with autoimmune disease is poorly understood with suggested causality and reported viral reactivation coinciding with active inflammation. We report a case of a patient who presented with diffuse alveolar hemorrhage and acute renal failure from rapidly progressive glomerulonephritis ultimately diagnosed with granulomatosis with polyangiitis (GPA. She was acutely managed with plasmapheresis to reduce antibody-mediated end-organ damage, hemodialysis for worsening hyperkalemia and acidosis, and high-dose intravenous methylprednisolone. She was transitioned to oral prednisone and started on weekly rituximab with resultant remission induction over a three-week period at which point she developed reactivation of CMV causing severe fatal lung disease and viremia. The case highlights the multiple factors associated with CMV reactivation in cases of severe systemic inflammatory states and the need for further research to help establish practice guidelines regarding antimicrobial prophylaxis in patients with autoimmune diseases on prolonged courses of corticosteroids and biologic agents.

  3. Clopidogrel-induced refractory thrombotic thrombocytopenic purpura successfully treated with rituximab.

    Science.gov (United States)

    Khodor, Sara; Castro, Miguel; McNamara, Colin; Chaulagain, Chakra P

    2016-06-01

    Thrombotic thrombocytopenic purpura (TTP) is a multisystem disorder characterized by microvascular aggregation of platelets and fibrin strands causing thrombocytopenia, microangiopathic hemolytic anemia, and organ dysfunction. TTP can develop as a result of a deficiency in ADAMTS13 enzyme activity due to either a genetic defect or, more commonly, the development of anti-ADAMTS13 autoantibodies. TTP can also be associated with pregnancy, organ transplant, lupus, infections, and drugs. Here, we present a case of TTP that developed shortly after the start of clopidogrel treatment for acute ischemic stroke and acute myocardial infarction, and describe the clinical presentation, refractory course of the disease, and successful induction of remission through the use of rituximab in a setting of pre-existing autoimmune diseases. PMID:26684918

  4. Effective treatment with rituximab for the maintenance of remission in frequently relapsing minimal change disease

    Science.gov (United States)

    Shendi, Ali M.; Salama, Alan D.; Khosravi, Maryam; Connolly, John O.; Trompeter, Richard

    2016-01-01

    Abstract Aim Treatment of frequently relapsing or steroid‐dependent minimal change disease (MCD) in children and adults remains challenging. Glucocorticoids and/or other immunosuppressive agents are the mainstay of treatment, but patients often experience toxicity from prolonged exposure and may either become treatment dependent and/or resistant. Increasing evidence suggests that rituximab (RTX) can be a useful alternative to standard immunosuppression and allow withdrawal of maintenance immunosuppressants; however, data on optimal treatment regimens, long‐term efficacy and safety are still limited. Methods We undertook a prospective study of RTX to allow immunosuppression minimization in 15 young adults with frequently relapsing or steroid‐dependent, biopsy‐proven MCD. All patients were in remission at the start of treatment and on a calcineurin inhibitor. Two doses of RTX (1 gr) were given 6 months apart. A subset of patients also received an additional dose 12 months later, in order to examine the benefit of re‐treatment. Biochemical and clinical parameters were monitored over an extended follow‐up period of up to 43 months. Results Median steroid‐free survival after RTX was 25 months (range 4–34). Mean relapse frequency decreased from 2.60 ± 0.28 to 0.4 ± 0.19 (P < 0.001) after RTX. Seven relapses occurred, five of which (71%) when CD19 counts were greater than 100 µ. Immunoglobulin levels remained unchanged, and no major side effects were observed throughout the follow‐up period. Conclusions Rituximab therapy is effective at maintaining prolonged steroid‐free remission and reducing relapse frequency in this group of patients. Our study lends further support for the role of RTX in the treatment of patients with frequently relapsing or steroid‐dependent MCD. PMID:26860320

  5. Hyperinfection by Strongyloides stercoralis probably associated with Rituximab in a patient with mantle cell lymphoma and hyper eosinophilia Hiperinfección por Strongyloides stercoralis probablemente asociada con Rituximab en una paciente con linfoma e hipereosinofilia

    OpenAIRE

    Renzo Nino Incani; Marcos Hernández; María Elena González

    2010-01-01

    The first report to our knowledge, of hyperinfection by Strongyloides stercoralis (HS) and hypereosinophilia, associated to immune suppression by Rituximab (the only drug received for the last one year and 10 months), in a patient with mantle-cell lymphoma (MCL), is presented. The patient has a 3-year history of MCL, and developed two accesses of HS during 2008, including meningitis, pneumonia and presence of larvae of S. stercoralis in the lungs. We had a unique chance to look at cytotoxicit...

  6. Hepatitis C-Induced Hepatitis Flare in a Patient with Non-Hodgkin B-Cell Lymphoma Treated by Rituximab Including Chemotherapy (Rituximab, Cyclophosphamide, Hydroxydaunorubicin, Oncovin - Vincristine, Prednisolone Regimen

    Directory of Open Access Journals (Sweden)

    Asim Ulcay

    2014-06-01

    Full Text Available Hepatitis virus infections can lead to more critical outcomes such as severe hepatic dysfunction, failure and fulminancy in immunosuppressive patients compared to immunocompetent individuals. It is globally accepted that reactivation of both Hepatitis B virus [HBV ] and Hepatitis C virus [HCV] occurs after chemotherapy and antibody treatments of malignant diseases or solid organ/ bone marrow transplant in recipient patients. Especially among B-cell Non Hodgkin Lymphoma [NHL] patients, according to various studies, the seroprevelance of HCV is higher than that of the general population. On the other hand the role of HCV in the pathogenesis and etiology of NHL has been suggested. Today, cytotoxic drugs, corticosteroids, rituximab and hepatotoxic regimens are administered to NHL patients. Specifically, it has been emphasized that the utilization of rituximab [Anti CD20 antibody ] regiments for B-cell NHL patients may result with flares in HCV patients conspicuously. Here, we report the case of an acute flare up due to HCV infection in a patient who underwent a 4 month course of rituximab containing chemotherapy against a B cell NHL [CD20+ ] disease and a dramatic recovery from HCV infection at the end. [Dis Mol Med 2014; 2(3.000: 51-54

  7. The CXCR4 antagonist plerixafor enhances the effect of rituximab in diffuse large B-cell lymphoma cell lines

    DEFF Research Database (Denmark)

    Reinholdt, Linn; Laursen, Maria Bach; Schmitz, Alexander;

    2016-01-01

    . Accordingly, the fraction of apoptotic/dead cells significantly increased following addition of plerixafor to rituximab treatment. Furthermore, exposure of DLBCL cells to plerixafor resulted in a significant decrease in CXCR4 fluorescence intensity. CONCLUSIONS: Based on our results, implying that the anti......BACKGROUND: Diffuse large B-cell lymphoma (DLBCL) is an aggressive disease with variable clinical outcome, accounting for at least 25-30 % of adult non-Hodgkin lymphomas. Approximately one third of DLBCL patients are not cured by the currently used treatment regimen, R-CHOP. Hence, new treatment......-proliferative/pro-apoptotic effect of rituximab on DLBCL cells can be synergistically enhanced by the CXCR4 antagonist plerixafor, addition of plerixafor to the R-CHOP regimen can be suggested to improve treatment outcome for DLBCL patients....

  8. Unexpected and persistent depletion of B lymphocytes CD20 following a minimum dose of anti-CD20 antibody (Rituximab

    Directory of Open Access Journals (Sweden)

    V. Bruzzese

    2011-06-01

    Full Text Available Rituximab is a chemeric murine/human anti-B lymphocyte antigen CD20 monoclonal antibody used in the treatment of rheumatoid arthritis resistant to treatment by one or more anti TNF-alpha therapies (1. The recommended dose for an efficient depletion of the B CD 20 lymphocytes in rheumatoid arthritis is two infusions of 1000 mg, with the second infusion being administered two weeks after the first. At this dose, one obtains a rapid and persistent depletion of CD 20 cells, with repopulation occurring, on the average, in about eight months (2. Here, we present a case of a woman treated with only 50 mg of rituximab, who underwent both a rapid and pronounced reduction of B CD 20 lymphocytes...

  9. Rituximab Treatment Strategy for Patients with Diffuse Large B-Cell Lymphoma after First-Line Therapy: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Yuan-Rong Ren

    2015-01-01

    Full Text Available Background: Rituximab in combination with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP significantly prolonged event-free survival in first-line chemotherapy for patients with diffuse large B-cell lymphoma (DLBCL. But relapse and refractory DLBCL occur frequently. Although rituximab is effective, its role in salvage therapy after autologous transplant remains unclear. Maintenance therapy with rituximab in responding patients after first line chemotherapy may be a useful novel approach capable of eradicating minimal residual disease and to bring survival benefit. This systematic review and meta-analysis evaluated the effects of rituximab maintenance treatment and salvage therapy of patients with DLBCL. Methods: We performed a systematic review and meta-analysis of randomized controlled trials and compared rituximab maintenance or salvage therapy at relapse with observation. We searched the Cochrane Library, PubMed, EMBASE, conference proceedings, databases of ongoing trials, and references of published trials. Two reviewers independently assessed the quality of the trials and extracted data. Hazard ratios for time-to-event data were estimated and pooled. Results: Seven trials including 1470 DLBCL patients were included in this systematic review and meta-analysis. Patients treated with maintenance rituximab have better overall survival (OS and event-free survival (EFS than patients in the observation arm, but there was no statistical significance. Patients who received rituximab salvage therapy for relapse or refractory DLBCL have statistically significantly better OS [HR of death = 0.72, 95% CI (0.55-0.94, P = 0.02], progression-free survival (PFS [HR = 0.61, 95% CI (0.52-0.72, P < 0.05], odds ratio (OR [RR = 1.26, 95% CI (1.07-1.47, P = 0.004] than patients in the observation arm. The rate of infection-related adverse events was higher with rituximab treatment [RR = 1.37, 95% CI = (1.14 - 1.65 P =0.001]. Conclusions: After

  10. Freeze-dried kit formulations for preparation of Lu-177 conjugated rituximab for treatment of non-Hodgkin’s lymphoma

    OpenAIRE

    Smilkov, Katarina; Gjorgieva, Darinka; Gjorgoski, Icko; Carollo, Angela; Chinol, Marco; Papi, Stefano; Signore, Alberto; Janevik-Ivanovska, Emilija

    2014-01-01

    Two radiolabelled monoclonal antibodies are approved for the treatment of non-Hodgkin’s lymphoma, Yttrium-90-ibritumomab tiuxetan, (Zevalin®) and Iodine-131-tositumomab (Bexxar®). In the current clinical practice, rituximab, a chimeric monoclonal antibody is approved for the treatment of low-grade or follicular, CD-20 positive non-Hodgkin’s lymphoma, as a single agent or in combination with chemotherapy. The radioisotope Lu-177, has a potential to be used in a radiopharmaceutical preparation ...

  11. Hepatitis B reactivation in a patient with rheumatoid arthritis with antibodies to hepatitis B surface antigen treated with rituximab

    OpenAIRE

    Gigi, E; GEORGIOU T; Mougiou, D; Boura, P; Raptopoulou-Gigi, M

    2013-01-01

    Hepatitis B virus (HBV) can still be found within the hepatocytes after its clearance and the control of viral replication depends on the immune response. However during immunosuppression, seroconversion of HBsAg has been described followed by disease reactivation. Hepatitis B virus reactivation represents an emerging cause of liver disease in patients undergoing treatment with biologic agents and in particular, by the use of rituximab (anti-CD20) and alemtuzumab (anti-CD52) that cause profou...

  12. Clinical experience with lenalidomide alone or in combination with rituximab in indolent B-cell and mantle cell lymphomas.

    Science.gov (United States)

    Ruan, J; Shah, B; Martin, P; Schuster, S J

    2016-07-01

    Lenalidomide is an oral immunomodulatory drug with significant activity in indolent B-cell and mantle cell lymphomas. Lenalidomide has a manageable safety profile whether administered as a single agent or in combination with rituximab. The combination of lenalidomide with rituximab, known as the 'R(2)' regimen, enhances efficacy over what has been shown with monotherapy and has demonstrated activity in patients considered resistant to rituximab. Tolerability of these regimens has been consistent among studies. Asymptomatic neutropenia is the most common grade 3/4 adverse event, typically managed by dose interruption, followed by dose reduction once neutrophils have recovered. Nonhematologic toxicities (e.g. fatigue) are generally low-grade, manageable with concomitant treatment, and/or lenalidomide dose modification. More frequent with R(2), immune-related symptoms such as rash and tumor flare are important to recognize as lenalidomide-associated treatment effects in patients with lymphoma who require supportive care and potential dose modifications. Severe tumor flare reactions with painful lymphadenopathy are not typically observed outside of chronic lymphocytic leukemia/small lymphocytic lymphoma. Venous thromboembolism is uncommon in lymphomas, though prophylaxis is recommended. The general safety profile, differences between lenalidomide monotherapy and R(2) treatment, and optimal strategies for managing adverse events are discussed here. PMID:27052651

  13. Circulating miRNA-125b Is a Potential Biomarker Predicting Response to Rituximab in Rheumatoid Arthritis

    Directory of Open Access Journals (Sweden)

    Isabelle Duroux-Richard

    2014-01-01

    Full Text Available Although biologic therapies have changed the course of rheumatoid arthritis (RA, today’s major challenge remains to identify biomarkers to target treatments to selected patient groups. Circulating micro(miRNAs represent a novel class of molecular biomarkers whose expression is altered in RA. Our study aimed at quantifying miR-125b in blood and serum samples from RA patients, comparing healthy controls and patients with other forms of rheumatic diseases and arthritis, and evaluating its predictive value as biomarker for response to rituximab. Detectable levels of miR-125b were measured in total blood and serum samples and were significantly elevated in RA patients compared to osteoarthritic and healthy donors. The increase was however also found in patients with other forms of chronic inflammatory arthritis. Importantly, high serum levels of miR-125b at disease flare were associated with good clinical response to treatment with rituximab three months later (P=0.002. This predictive value was not limited to RA as it was also found in patients with B lymphomas. Our results identify circulating miR-125b as a novel miRNA over expressed in RA and suggest that serum level of miR-125b is potential predictive biomarker of response to rituximab treatment.

  14. Methodology to administer therapeutic dose of I-131

    International Nuclear Information System (INIS)

    The present work suggests the use of measures guided to eliminate the resulting chronic sialoadenitis of the treatment of the thyroid cancer with Iodine-131, as well as the use of citric fruits to stimulate the salivation, the post-dose administration of liquids to accelerate the gastric emptying avoiding the secondary effects as the vomit is included. (Author)

  15. Radioiodine I-131 For The Therapy Of Graves’ Disease

    OpenAIRE

    Mumtaz, Malik; Lin, Lim Shueh; Hui, Khaw Chong; Mohd Khir, Amir Sharifuddin

    2009-01-01

    Graves’ disease is a common cause of hyperthyroidism. Treatment options for Graves’ disease include antithyroid medication, surgery or radioactive iodine (I-31) or RAI. This review will focus on the approach to RAI therapy; discussing dose selection, patient preparation, and consideration before and after administering RAI, examining aspects of pre-treatment with antithyroid medication as well as discussing possible adverse events including hypothyroidism and possible worsening of thyroid-ass...

  16. Get the Facts About Exposure to I-131 Radiation

    Science.gov (United States)

    ... the world (mainly in the 1950s and 1960s) Nuclear power plant accidents (such as the Chernobyl accident in 1986 and the Fukushima accident in 2011 (primarily Americans in Japan) Releases from atomic weapons production plants (such as the Hanford facility in ...

  17. I-131-MIBG therapy: aspects of radiation protection

    International Nuclear Information System (INIS)

    In this short article the radiation protection during treatment of children with 131I-MIBG is described. A treatment of up to 200 mCi 131I-MIBG is safe. The dose equivalent of assisting parents stays under 3 mSv. The medical personnel receives at most 0.1 mSv during the administration. 3 refs

  18. Rituximab, fludarabine, and total body irradiation as conditioning regimen before allogeneic hematopoietic stem cell transplantation for advanced chronic lymphocytic leukemia: long-term prospective multicenter study.

    Science.gov (United States)

    Michallet, Mauricette; Socié, Gerard; Mohty, Mohamad; Sobh, Mohamad; Bay, Jacques-O; Morisset, Stéphane; Labussière-Wallet, Hélène; Tabrizi, Reza; Milpied, Noel; Bordigoni, Pierre; El-Cheikh, Jean; Blaise, Didier

    2013-02-01

    To evaluate the efficacy and toxicity of reduced-intensity conditioning (RIC) combining fludarabine, low-dose total body irradiation (TBI) and rituximab before allogeneic hematopoietic stem cell transplantation (allo-HSCT) from human leucocyte antigen (HLA) identical siblings, we conducted a prospective study in patients ≤65 years old with advanced chronic lymphocytic leukemia (CLL) stage B or C in response after a salvage treatment. Conditioning included rituximab (375 mg/m² on day 5), fludarabine (30 mg/m² from day 4 to day 2), TBI (2 Gy on day 0), and rituximab (500 mg/m² on days 1 and 8). Forty patients were included, 34 (85%) were male with a median age of 54 years (range, 35-65 years), 38 (95%) were in B stage, and 2 were in stage C; only 7 patients (17%) were in complete response. Seven (17%) patients did not receive rituximab. Thirty-nine (98%) patients engrafted, 17 patients developed acute graft-versus-host disease (GVHD) grade ≥II with a cumulative incidence at 3 months of 44% (36-52) with a significant protective effect of rituximab (p = 0.02). The cumulative incidence of chronic GVHD was 29% (21-36) at 12 months for both limited and extensive forms. The median overall survival was not reached with 5-years probability of 55% (41-74). The multivariate analysis showed a positive effect of rituximab on overall survival and event-free survival (hazard ratio [HR] = 0.1 [0-0.6], p = 0.02; and HR = 0.1 [0-0.4], p = 0.035, respectively). The association of fludarabine, TBI, and rituximab is feasible, well tolerated, and allows better outcomes in advanced CLL.

  19. Impact of Fc gamma-receptor polymorphisms on the response to rituximab treatment in children and adolescents with mature B cell lymphoma/leukemia.

    Science.gov (United States)

    Burkhardt, Birgit; Yavuz, Deniz; Zimmermann, Martin; Schieferstein, Jutta; Kabickova, Edita; Attarbaschi, Andishe; Lisfeld, Jasmin; Reiter, Alfred; Makarova, Olga; Worch, Jennifer; Bonn, Bettina R; Damm-Welk, Christine

    2016-09-01

    Recent studies in adult lymphoma patients have indicated a correlation between polymorphisms of Fc gamma-receptors (FcγRs, encoded by the respective FCGR genes) and the response to rituximab treatment. In vitro, cells expressing FcγRIIIa-158V mediate antibody-dependent cellular cytotoxicity (ADCC) more efficiently than cells expressing FcγRIIIa-158F. The impact of the FCGR2A-131HR polymorphism is unclear. In this study, the FCGR polymorphisms FCGR3A-158VF and FCGR2A-131HR were analyzed in pediatric patients with mature aggressive B cell non-Hodgkin lymphoma/leukemia (B-NHL). Pediatric patients received a single dose of rituximab monotherapy. Response was evaluated on day 5 followed by standard chemotherapy for B-NHL. Among 105 evaluable patients, a response to rituximab was observed in 21 % of those homozygous for FcγRIIa-131RR (5/24) compared to 48 % of patients who were HH and HR FcγRIIa-131 allele carriers (18/34 and 21/47, respectively; p = 0.044). Among patients with the FCGR3A-158 polymorphism, those homozygous for the FF genotype had a significantly favorable rituximab response rate of 59 % (22/37) compared to 32 % in patients who were FcγRIIIa-158VV and FcγRIIIa-VF allele carriers (2/9 and 20/59, respectively; p = 0.022). A stringent phase II response evaluation of children and adolescents with B-NHL after one dose of rituximab monotherapy showed a significant association between the rituximab response rate and FCGR polymorphisms. These findings support the hypothesis that FCGR polymorphisms represent patient-specific parameters that influence the response to rituximab. PMID:27376362

  20. Retreatment with rituximab based on a treatment-to-target approach provides better disease control than treatment as needed in patients with rheumatoid arthritis: a retrospective pooled analysis

    Science.gov (United States)

    Mease, Philip J.; Rubbert-Roth, Andrea; Curtis, Jeffrey R.; Müller-Ladner, Ulf; Gaylis, Norman B.; Williams, Sarah; Reynard, Mark; Tyrrell, Helen

    2011-01-01

    Objective. To assess the efficacy and safety profiles of two different rituximab retreatment regimens in patients with RA. Methods. Four hundred and ninety-three RA patients with an inadequate response to MTX recruited into rituximab Phase II/III studies received further courses of open-label rituximab based on two approaches: (i) treatment to target (TT): patients assessed 24 weeks after each course and retreated if not in remission [DAS in 28 joints based on ESR (DAS-28-ESR) ≥ 2.6]; (ii) treatment as needed (PRN): patients retreated at the physician’s discretion ≥24 weeks following the first course and ≥16 weeks following further courses, if both swollen and tender joint counts were ≥8. All courses consisted of i.v. rituximab 2 × 1000 mg 2 weeks apart plus MTX. Observed data were analysed according to treatment strategy. Results. Multiple courses of rituximab maintained or improved responses irrespective of regimen. TT provided tighter control of disease activity with significantly greater improvements in DAS-28-ESR and lower HAQ-disability index scores vs PRN. TT resulted in significantly more patients achieving major clinical response. PRN resulted in recurrence of disease symptoms between courses, with TT significantly reducing the incidence of RA flares. Despite more frequent retreatment with TT compared with PRN, the rates of serious adverse events and serious infections were comparable between regimens. Conclusions. Retreatment with rituximab based on 24-week evaluations and to a target of DAS-28-ESR remission leads to improved efficacy and tighter control of disease activity compared with PRN without a compromised safety profile. TT may be the preferable rituximab treatment regimen for patients with RA. PMID:21926153

  1. Fcγ receptor IIIA polymorphisms and efficacy of rituximab therapy on Chinese diffuse large B-cell lymphoma

    Institute of Scientific and Technical Information of China (English)

    ZHANG Wei; WANG Xuan; Li Jian; DUAN Ming-hui; ZHOU Dao-bin

    2010-01-01

    Background Rituximab is used extensively in combination with chemotherapy to cure non-Hodgkin's lymphoma (NHL), and not only accelerates short-term improvement, but also prolongs patient survival and decreases relapse. The aim of this study was to evaluate the impact of Fcγ receptor IIIA (FcγRIIIA) gene polymorphisms on the response to rituximab therapy for newly diagnosed B-cell lymphomas. Methods Patients with newly diagnosed histologically-proven CD20-positive B-cell lymphoma were eligible for the study. All of the patients received rituximab combined with chemotherapy (CHOP). The FcγRIIIA type was analyzed by PCR. The initial efficacy was assessed after 6 cycles and the long-term survival was determined. Results Thirty-four patients were recruited between October 2005 and April 2006. The FcγRIIIA distribution was as follows: 11 patients were W, 5 were FF, and 18 were VF. After a median of 6 cycles (range 4-8) of rituximab combined chemotherapy, the overall response rate was 79% (82% in the VV group, 83% in the VF group, and 60% in the FF group; P=0.04). After a median follow-up time of 37 months (range 34-41), there were 12 relapses among 27 responders (44%); 5 of 9 patients (5/9) in the VV group, 5 of 15 patients (33%) in the VF group, and 2 of 3 patients (2/3) in the FF group (P=0.21). The 1-year overall survival in the VV, FF, and VF groups was 80%, 60%, and 80%, respectively, and the 3-year overall survival was 58%, 40%, and 69%, respectively (P=0.08). After analysis by COX regression, only the international prognosis index and response to initial treatment were significantly related to overall survival. Conclusions The distribution of FcγRIIIA polymorphisms in this B-cell lymphoma population shows that VF is most frequently expressed, followed by VV and FF. Patients with the FcγRIIIA VV and VF types are more sensitive to the initial treatment of rituximab combined with chemotherapy and have superior long-term survival compared with those with FF

  2. Spotlight on rituximab in the treatment of antineutrophil cytoplasmic antibody-associated vasculitis: current perspectives

    Directory of Open Access Journals (Sweden)

    Moog P

    2015-11-01

    Full Text Available Philipp Moog, Klaus Thuermel Abteilung für Nephrologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany Abstract: A 54-year-old patient presented to his general practitioner because of strong muscle pain in both thighs. Inflammatory parameters (CRP 16.3 mg/dL and white blood cells (15 g/L were elevated. The patient reported a weight loss of 10 kg in 4 weeks. There was no fever or any other specific symptoms. Urine dipstick examination and computed tomography of the chest were unremarkable. Because of increasing symptoms, the patient was referred to our department. Magnetic resonance tomography showed diffuse inflammatory changes of the muscles of both thighs. Neurological examination and electrophysiology revealed axonal sensorimotor neuropathy and ground-glass opacities of both lungs had occurred. Serum creatinine increased to 229 µmol/L within a few days, with proteinuria of 3.3 g/g creatinine. Kidney biopsy showed diffuse pauci-immune proliferative glomerulonephritis. Proteinase 3-specific antineutrophil cytoplasmic antibodies were markedly increased. Birmingham Vasculitis Activity Score was 35. Within 2 days, serum creatinine further increased to 495 µmol/L. Plasma exchange, high-dose glucocorticosteroids, and hemodialysis were started. The patient received cyclophosphamide 1 g twice and rituximab 375 mg/m2 four times according to the RITUXVAS protocol. Despite ongoing therapy, hemodialysis could not be withdrawn and had to be continued over 3 weeks until diuresis normalized. Glucocorticosteroids were tapered to 20 mg after 2 months, and serum creatinine was 133 µmol/L. However, nephritic urinary sediment reappeared. Another dose of 1 g cyclophosphamide was given, and glucocorticosteroids were raised for another 4 weeks. After 6 months, the daily prednisolone dose was able to be tapered to 5 mg. Serum creatinine was 124 µmol/L, proteinuria further decreased to 382 mg/g creatinine, and the Birmingham

  3. Methodology for management of therapeutic dose of I-131; Metodologia para administrar dosis terapeutica de I-131

    Energy Technology Data Exchange (ETDEWEB)

    Basteris M, J.; Gomez D, R. [Universidad Autonoma de Yucatan, Facultad de Medicina, Merida, Yucatan (Mexico)

    2007-07-01

    The present work suggests the use of measures guided to eliminate the resulting chronic sialoadenitis of the treatment previously described with a therapeutic dose bigger than ablative of Iodine 131, as well as the use of citric fruits to stimulate the salivation, the administration of liquid post-dose is included to accelerate the gastric emptying avoiding the secondary effects as the vomit. (Author)

  4. The non-conventional therapeutical indications of I 131; Les indications therapeutiques non conventionnelles de l`I 131

    Energy Technology Data Exchange (ETDEWEB)

    Delisle, M.J.; Schvartz, C.; Maes, B.; Vaudrey, C.; Pochart, J.M. [I.J.G. BP 171, 51056 Reims (France)

    1997-12-31

    In our therapeutic activity the non-conventional indications represent 5-10% relative to the indisputable indications which the hyperthyroidism in the second half of the life and the differential thyroid cancers are. In this paper our experience since 1966 is revised and confronted with the data of international literature. In the last almost 40 years we have treated 178 hyperthyroidism of which 17 were youngsters between 16 and 20 years old, 17 multi-nodular euthyroid goiters (MEG), 85 advanced cardiopathies and 8 Cordarone cardiopathies. The indications are precise: relapses after ATS or surgery in young subjects, counter-indications or surgery refusal for the MEGs and cardiologic indications. The long term surveillance was managed by an adequate code. Immediate morbidity is null. The efficiency is high in the hyperthyroidism treatment. The hypothyroidism is diagnosed and early treated. The reduction of the MEG mass is significant. An objective amelioration of the heart state was obtained (23%). The evaluation of the preventive effect of induced hyperthyroidism by Cordarone is underway. In conclusion, the enlargement of indications concerns mainly the hyperthyroidism in young subjects. In order to avoid carcinogenic risks we excluded the children under 16 years, excepting for special situations. This extension to the procreation age imposes a rigorous application of contraception and radiation protection instructions and needs a prolonged evaluation of results

  5. Assessment of long-term radiotoxicity after treatment with the low-dose-rate alpha-particle-emitting radioimmunoconjugate {sup 227}Th-rituximab

    Energy Technology Data Exchange (ETDEWEB)

    Dahle, Jostein; Heyerdahl, Helen; Hjelmerud, Anne Kristine; Larsen, Roy H. [Oslo University Hospital, Department of Radiation Biology, The Norwegian Radium Hospital, Oslo (Norway); Jonasdottir, Thora J. [Norwegian School of Veterinary Science, Small Animal Section, Department of Companion Animal Clinical Sciences, Oslo (Norway); Nesland, Jahn M. [Oslo University Hospital, Division of Pathology, The Norwegian Radium Hospital, Oslo (Norway); University of Oslo, Faculty Division The Norwegian Radium Hospital, Medical Faculty, Oslo (Norway); Borrebaek, Joergen [Algeta AS, Oslo (Norway)

    2010-01-15

    The anti-CD20 antibody rituximab labelled with the {alpha}-particle-emitting radionuclide {sup 227}Th is of interest as a radiotherapeutic agent for treatment of lymphoma. Complete regression of human lymphoma Raji xenografts in 60% of mice treated with 200 kBq/kg {sup 227}Th-rituximab has been observed. To evaluate possible late side effects of {sup 227}Th-rituximab, the long-term radiotoxicity of this potential radiopharmaceutical was investigated. BALB/c mice were injected with saline, cold rituximab or 50, 200 or 1,000 kBq/kg {sup 227}Th-rituximab and followed for up to 1 year. In addition, nude mice with Raji xenografts treated with various doses of {sup 227}Th-rituximab were also included in the study. Toxicity was evaluated by measurements of mouse body weight, white blood cell (WBC) and platelet counts, serum clinical chemistry parameters and histological examination of tissues. Only the 1,000 kBq/kg dosage resulted in decreased body weight of the BALB/c mice. There was a significant but temporary decrease in WBC and platelet count in mice treated with 400 and 1,000 kBq/kg {sup 227}Th-rituximab. Therefore, the no-observed-adverse-effect level (NOAEL) was 200 kBq/kg. The maximum tolerated activity was between 600 and 1,000 kBq/kg. No significant signs of toxicity were observed in histological sections in any examined tissue. There were significantly (p < 0.05), but transiently, higher concentrations of serum bile acids and aspartate aminotransferase in mice treated with either {sup 227}Th-rituximab or non-labelled antibody when compared with control mice. The maximum tolerated dose to bone marrow was between 2.1 and 3.5 Gy. Therapeutically relevant dose levels of {sup 227}Th-rituximab were well tolerated in mice. Bone marrow suppression, as indicated by decrease in WBC count, was the dose-limiting radiotoxicity. These toxicity data together with anti-tumour activity data in a CD20-positive xenograft mouse model indicate that therapeutic effects could be

  6. Rituximab Treatment Strategy for Patients with Diffuse Large B-Cell Lymphoma after First-Line Therapy: A Systematic Review and Meta-Analysis

    Institute of Scientific and Technical Information of China (English)

    Yuan-Rong Ren; Yong-Dong Jin; Zhi-Hui Zhang; Li Li; Ping Wu

    2015-01-01

    Background:Rituximab in combination with cyclophosphamide,doxorubicin,vincristine,and prednisone (CHOP) significantly prolonged event-free survival in first-line chemotherapy for patients with diffuse large B-cell lymphoma (DLBCL).But relapse and refractory DLBCL occur frequently.Although rituximab is effective,its role in salvage therapy after autologous transplant remains unclear.Maintenance therapy with rituximab in responding patients after first line chemotherapy may be a useful novel approach capable of eradicating minimal residual disease and to bring survival benefit.This systematic review and meta-analysis evaluated the effects of rituximab maintenance treatment and salvage therapy of patients with DLBCL.Methods:We performed a systematic review and meta-analysis of randomized controlled trials and compared rituximab maintenance or salvage therapy at relapse with observation.We searched the Cochrane Library,PubMed,EMBASE,conference proceedings,databases of ongoing trials,and references of published trials.Two reviewers independently assessed the quality of the trials and extracted data.Hazard ratios for time-to-event data were estimated and pooled.Results:Seven trials including 1470 DLBCL patients were included in this systematic review and meta-analysis.Patients treated with maintenance rituximab have better overall survival (OS) and event-free survival (EFS) than patients in the observation arm,but there was no statistical significance.Patients who received rituximab salvage therapy for relapse or refractory DLBCL have statistically significantly better OS [HR of death =0.72,95% CI (0.55-0.94),P=0.02],progression-free survival (PFS) [HR =0.61,95% CI (0.52-0.72),P< 0.05],odds ratio (OR) [RR =1.26,95% CI (1.07-1.47),P =0.004] than patients in the observation arm.The rate of infection-related adverse events was higher with rituximab treatment [RR =1.37,95% CI =(1.14-1.65) P =0.001].Conclusions:After first-line chemotherapy,the two rituximab

  7. Radioimmunotherapy with {sup 131}I-Rituximab in a Patient with Diffuse Large B-Cell Lymphoma Relapsed After Treatment with {sup 90}Y-Ibritumomab Tiuxetan

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Geon Wook; Kang, Hye Jin; Shin, Dongyeop; Gu, Ha Ra; Choi, Hong Seok; Lim, Sang Moo [Korea Cancer Center Hospital, Seoul (Korea, Republic of)

    2013-12-15

    We report a case that demonstrates the efficacy of radioimmunotherapy (RIT) with radioiodinated rituximab ({sup 131}I-rituximab) for relapsed diffuse large B-cell lymphoma (DLBCL). A 79-year-old male patient with DLBCL initially achieved a complete response (CR) after six cycles of RCHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) therapy. However, the lymphoma relapsed 20 months later. Although the patient had achieved a second and a third CR after two cycles of {sup 90}Y-ibritumomab tiuxetan, he experienced a third relapse approximately 3 years later. Between March and June 2011, the patient received three cycles of {sup 131}I-rituximab. Although he had achieved partial response after the second cycle, the disease progressed after the third cycle, and the total progression. Free survival was thus 5 months. The patient suffered only relatively mild toxicity (grade 1 thrombocytopenia) during treatment. RIT with {sup 131}I-rituximab is therefore potentially effective in patients with relapsed DLBCL, even after the failure of {sup 90}Y-ibritumomab tiuxetan therapy.

  8. The tumour microenvironment influences survival and time to transformation in follicular lymphoma in the rituximab era.

    Science.gov (United States)

    Blaker, Yngvild Nuvin; Spetalen, Signe; Brodtkorb, Marianne; Lingjaerde, Ole Christian; Beiske, Klaus; Østenstad, Bjørn; Sander, Birgitta; Wahlin, Björn Engelbrekt; Melen, Christopher Michael; Myklebust, June Helen; Holte, Harald; Delabie, Jan; Smeland, Erlend Bremertun

    2016-10-01

    The tumour microenvironment influences outcome in patients with follicular lymphoma (FL), but its impact on transformation is less studied. We investigated the prognostic significance of the tumour microenvironment on transformation and survival in FL patients treated in the rituximab era. We examined diagnostic and transformed biopsies from 52 FL patients using antibodies against CD3, CD4, CD8, CD21 (CR2), CD57 (B3GAT1), CD68, FOXP3, TIA1, PD-1 (PDCD1), PD-L1 (CD274) and PAX5. Results were compared with a second cohort of 40 FL patients without signs of transformation during a minimum of five years observation time. Cell numbers and localization were semi-quantitatively assessed. Better developed CD21+  follicular dendritic cell (FDC) meshworks at diagnosis was a negative prognostic factor for overall survival (OS), progression-free survival (PFS) and time to transformation (TTT) in patients with subsequently transformed FL. Remnants of FDC meshworks at transformation were associated with shorter OS and PFS from transformation. High degrees of intrafollicular CD68+ and PD-L1+  macrophage infiltration, high total area scores and an extrafollicular/diffuse pattern of FOXP3+  T cells and high intrafollicular scores of CD4+  T cells at diagnosis were associated with shorter TTT. Scores of several T-cell subset markers from the combined patient cohorts were predictive for transformation, especially CD4 and CD57. PMID:27341313

  9. Rituximab and Other New Anti-CD20 MAbs for Non-Hodgkin’s Lymphoma Treatment

    Directory of Open Access Journals (Sweden)

    Letizia Polito

    2013-10-01

    Full Text Available Non-Hodgkin’s lymphomas (NHLs are a heterogeneous group of different haematological cancers with a wide range of aggressiveness. NHLs represent >80% of lymphomas and the majority of NHLs involve B cells. CD20 represents a good target for NHL immunotherapy because it is largely expressed on B cell NHL and not on B cell precursors and plasma cells. The anti-CD20 monoclonal antibody (mAb rituximab (RTX was the first antibody approved by the FDA for lymphoma therapy and has revolutionised B cell lymphoma treatment. Several clinical trials have demonstrated the high efficacy of RTX, resulting in a significant improvement in overall response rates and in NHL patient survival. However, RTX, both as a single agent and in combination with chemotherapy, induces several side-effects and resistance mechanisms. Remarkable efforts have been made to improve RTX efficacy, including conjugation to an active moiety (radionuclide, toxin, enzyme, or drug and the development of new anti-CD20 mAbs. This review summarises the characteristics of RTX and other anti-CD20 mAbs for NHL treatment; the results of the main clinical trials are reported.

  10. Cladribine plus rituximab is an effective therapy for newly diagnosed mantle cell lymphoma.

    Science.gov (United States)

    Spurgeon, Stephen E; Pindyck, Talia; Okada, Craig; Chen, Yiyi; Chen, Zunqiu; Mater, Elana; Abbi, Kamal; Epner, Elliot M

    2011-08-01

    Mantle cell lymphoma (MCL) is a non-Hodgkin lymphoma that is incurable with standard chemotherapy. There is no consensus on the best initial therapy, especially for elderly patients, who are not candidates for aggressive treatment approaches. Current National Comprehensive Cancer Network (NCCN) treatment guidelines include rituximab (R) plus cladribine for the initial treatment of MCL. However, few data are available to substantiate this recommendation. Therefore, to further define the role of R-cladribine for the initial treatment of MCL, we performed a retrospective chart review of 31 patients with MCL (median age, 67) treated with R-cladribine. The majority of responding patients also received R maintenance. The overall response rate was 87%, with 61% of patients achieving a complete remission (CR/CRu). The estimated median follow-up was 32.5 months, median PFS was 37.5 months, and median OS was 85.2 months. One of 19 (5.3%) subjects in CR/CRu relapsed (median follow-up of 23 months). CR/CRu was associated with improved survival (p < 0.0001), while a high mantle cell international prognostic index (MIPI) was associated with worse survival (p = 0.05). There was one toxic death (neutropenic pseudomonal sepsis) related to treatment. R-cladribine is an effective therapy for previously untreated MCL, and these results validate the use of R-cladribine for the initial treatment of MCL. PMID:21623691

  11. Efficiency of using rituximab in a patient with generalized granulomatosis with polyangiitis: A case report

    Directory of Open Access Journals (Sweden)

    Gulazyk Malikovna Koilubaeva

    2014-01-01

    Full Text Available Systemic vasculitides (SVs are characterized by inflammation of the blood vessels wall; the spectrum of their clinical manifestations depends on the type, extent, and location of affected vessels and the activity of systemic inflammation. The etiology of most primary SVs is unknown. Antineutrophil cytoplasmic antibodies (ANCAs are implicated in its pathogenesis. The presence of ANCAa in patients' serum and the correlation of their level with the severity of clinical manifestations served as a basis for identifying a subgroup of systemic necrotizing vasculitides associated with ANCA synthesis: granulomatosis with polyangiitis (GPA, microscopic polyangiitis, and Churg – Strauss syndrome. GPA is characterized by systemic granulomatous necrotizing vasculitis involving the small vessels of the upper respiratory tract, lung, and kidney.The paper describes a case of difficult diagnosis and successful rituximab (RTM treatment of generalized GPA in a 45-year-old female patients. The disease occurred with local damage to the upper respiratory tract, granulomatous inflammation of the pulmonary vessels to form multiple infiltrates with lung tissue destruction elements and necrotizing glomerulonephritis. Despite intensive immunosuppressive treatment, there was a rapid GPA progression with the further development of respiratory failure, which had been induced by stenotic laryngitis subglottica leading to tracheostoma. Damage to the organ of vision could lead to severe complications, including amaurosis. RMT was shown to be effective in treating generalized GPA with a poor prognosis.

  12. Off-label use of rituximab for systemic lupus erythematosus in Europe

    Science.gov (United States)

    Rydén-Aulin, Monica; Boumpas, Dimitrios; Bultink, Irene; Callejas Rubio, Jose Luis; Caminal-Montero, Luis; Castro, Antoni; Colodro Ruiz, Agustín; Doria, Andrea; Dörner, Thomas; Gonzalez-Echavarri, Cristina; Gremese, Elisa; Houssiau, Frederic A; Huizinga, Tom; Inanç, Murat; Isenberg, David; Iuliano, Annamaria; Jacobsen, Søren; Jimenéz-Alonso, Juan; Kovács, Lászlo; Mariette, Xavier; Mosca, Marta; Nived, Ola; Oristrell, Joaquim; Ramos-Casals, Manuel; Rascón, Javier; Sáez-Comet, Luis; Salvador Cervelló, Gonzalo; Sebastiani, Gian Domenico; Squatrito, Danilo; Szücs, Gabriella; Voskuyl, Alexandre; van Vollenhoven, Ronald

    2016-01-01

    Objectives Rituximab (RTX) is a biological treatment used off-label in patients with systemic lupus erythematosus (SLE). This survey aimed to investigate the off-label use of RTX in Europe and compare the characteristics of patients receiving RTX with those receiving conventional therapy. Methods Data on patients with SLE receiving RTX were taken from the International Registry for Biologics in SLE retrospective registry and complemented with data on patients with SLE treated with conventional therapy. For nationwide estimates of RTX use in patients with SLE, investigators were asked to provide data through case report forms (CRFs). Countries for which no data were submitted through CRFs, published literature and/or personal communication were used, and for European countries where no data were available, estimates were made on the assumption of similarities with neighbouring countries. Results The estimated off-label use of RTX in Europe was 0.5%–1.5% of all patients with SLE. In comparison with patients with SLE on conventional therapy, patients treated with RTX had longer disease duration, higher disease activity and were more often treated with immunosuppressives. The most frequent organ manifestations for which either RTX or conventional therapy was initiated were lupus nephritis followed by musculoskeletal and haematological. The reason for treatment was, besides disease control, corticosteroid-sparing for patients treated with conventional therapy. Conclusions RTX use for SLE in Europe is restrictive and appears to be used as a last resort in patients for whom other reasonable options have been exhausted.

  13. [Rituximab (MabThera)--a new biological medicine in rheumatoid arthritis therapy].

    Science.gov (United States)

    Nemec, P

    2007-11-01

    Rheumatoid arthritis (RA) is a serious, chronic, inflammatory disorder that damages the joints. The chronic destructive process causes pain to patients with RA and leads to the development of permanent disability. At present, great emphasis is placed on timely and effective therapy for RA, which is able to halt or slow the development of the disorder. At present we do not have any means of curing RA, the main objective for treatment is to induce remission of the disorder and prevent structural damage to the joints and the development of permanent disability. The relatively frequent failure of disease modifying medications (DMARDs) lead to efforts to find new resources for the treatment of RA. So called biological medicines were recently introduced into therapeutic use. These were mainly TNFalpha blockers. Experience has shown that approximately a third of patients with RA do not respond even to treatment with such medicines. Rituximab (MabThera), a monoclonal antibody against CD20 positive B-lymphocytes, is a new biological medicine approved for RA therapy. It represents a new hope for patients with active RA, for whom earlier therapy with TNFa blockers has failed.

  14. [Rituximab (MabThera)--a new biological medicine in rheumatoid arthritis therapy].

    Science.gov (United States)

    Nemec, P

    2007-11-01

    Rheumatoid arthritis (RA) is a serious, chronic, inflammatory disorder that damages the joints. The chronic destructive process causes pain to patients with RA and leads to the development of permanent disability. At present, great emphasis is placed on timely and effective therapy for RA, which is able to halt or slow the development of the disorder. At present we do not have any means of curing RA, the main objective for treatment is to induce remission of the disorder and prevent structural damage to the joints and the development of permanent disability. The relatively frequent failure of disease modifying medications (DMARDs) lead to efforts to find new resources for the treatment of RA. So called biological medicines were recently introduced into therapeutic use. These were mainly TNFalpha blockers. Experience has shown that approximately a third of patients with RA do not respond even to treatment with such medicines. Rituximab (MabThera), a monoclonal antibody against CD20 positive B-lymphocytes, is a new biological medicine approved for RA therapy. It represents a new hope for patients with active RA, for whom earlier therapy with TNFa blockers has failed. PMID:18277630

  15. Off-label use of rituximab for systemic lupus erythematosus in Europe

    Science.gov (United States)

    Rydén-Aulin, Monica; Boumpas, Dimitrios; Bultink, Irene; Callejas Rubio, Jose Luis; Caminal-Montero, Luis; Castro, Antoni; Colodro Ruiz, Agustín; Doria, Andrea; Dörner, Thomas; Gonzalez-Echavarri, Cristina; Gremese, Elisa; Houssiau, Frederic A; Huizinga, Tom; Inanç, Murat; Isenberg, David; Iuliano, Annamaria; Jacobsen, Søren; Jimenéz-Alonso, Juan; Kovács, Lászlo; Mariette, Xavier; Mosca, Marta; Nived, Ola; Oristrell, Joaquim; Ramos-Casals, Manuel; Rascón, Javier; Sáez-Comet, Luis; Salvador Cervelló, Gonzalo; Sebastiani, Gian Domenico; Squatrito, Danilo; Szücs, Gabriella; Voskuyl, Alexandre; van Vollenhoven, Ronald

    2016-01-01

    Objectives Rituximab (RTX) is a biological treatment used off-label in patients with systemic lupus erythematosus (SLE). This survey aimed to investigate the off-label use of RTX in Europe and compare the characteristics of patients receiving RTX with those receiving conventional therapy. Methods Data on patients with SLE receiving RTX were taken from the International Registry for Biologics in SLE retrospective registry and complemented with data on patients with SLE treated with conventional therapy. For nationwide estimates of RTX use in patients with SLE, investigators were asked to provide data through case report forms (CRFs). Countries for which no data were submitted through CRFs, published literature and/or personal communication were used, and for European countries where no data were available, estimates were made on the assumption of similarities with neighbouring countries. Results The estimated off-label use of RTX in Europe was 0.5%–1.5% of all patients with SLE. In comparison with patients with SLE on conventional therapy, patients treated with RTX had longer disease duration, higher disease activity and were more often treated with immunosuppressives. The most frequent organ manifestations for which either RTX or conventional therapy was initiated were lupus nephritis followed by musculoskeletal and haematological. The reason for treatment was, besides disease control, corticosteroid-sparing for patients treated with conventional therapy. Conclusions RTX use for SLE in Europe is restrictive and appears to be used as a last resort in patients for whom other reasonable options have been exhausted. PMID:27651920

  16. Effectiveness of disease-modifying antirheumatic drug co-therapy with methotrexate and leflunomide in rituximab-treated rheumatoid arthritis patients: results of a 1-year follow-up study from the CERERRA collaboration.

    NARCIS (Netherlands)

    Chatzidionysiou, K.; Lie, E.; Nasonov, E.; Lukina, G.; Hetland, M.L.; Tarp, U.; Riel, P.L.C.M. van; Nordstrom, D.C.; Gomez-Reino, J.; Pavelka, K.; Tomsic, M.; Kvien, T.K.; Vollenhoven, R.F. van; Gabay, C.

    2012-01-01

    OBJECTIVES: To compare the effectiveness and safety of rituximab alone or in combination with either methotrexate or leflunomide. METHODS: 10 European registries submitted anonymised datasets with baseline, 3, 6, 9 and 12-month clinical data from patients who started rituximab. RESULTS: 1195 patient

  17. Effectiveness of disease-modifying antirheumatic drug co-therapy with methotrexate and leflunomide in rituximab-treated rheumatoid arthritis patients : results of a 1-year follow-up study from the CERERRA collaboration

    NARCIS (Netherlands)

    Chatzidionysiou, Katerina; Lie, Elisabeth; Nasonov, Evgeny; Lukina, Galina; Hetland, Merete Lund; Tarp, Ulrik; van Riel, Piet L. C. M.; Nordstrom, Dan C.; Gomez-Reino, Juan; Pavelka, Karel; Tomsic, Matija; Kvien, Tore K.; van Vollenhoven, Ronald F.; Gabay, Cem

    2012-01-01

    Objectives To compare the effectiveness and safety of rituximab alone or in combination with either methotrexate or leflunomide. Methods 10 European registries submitted anonymised datasets with baseline, 3, 6, 9 and 12-month clinical data from patients who started rituximab. Results 1195 patients w

  18. Cyclophosphamide-refractory scleroderma-associated interstitial lung disease: remarkable clinical and radiological response to a single course of rituximab combined with high-dose corticosteroids.

    LENUS (Irish Health Repository)

    Haroon, Muhammad

    2011-10-01

    We would like to report our experience of using rituximab in cyclophosphamide refractory, rapidly progressive interstitial lung disease (ILD) in a patient with limited scleroderma. A 40-year-old man presented with 10-week history of inflammatory polyarthritis, which responded to a short course of oral corticosteroids. However, 3 weeks later, he developed new onset of exertional dyspnoea. High-resolution CT of the thorax was suggestive of early ILD. Surgical lung biopsy showed features of fibrotic non-specific interstitial pneumonia. He was diagnosed with scleroderma on the basis of: presence of anticentromere antibodies, Raynaud\\'s phenomenon, pulmonary fibrosis, digital oedema and hypomotility along with a dilated oesophagus. He was treated aggressively with pulse doses of corticosteroids and cyclophosphamide; however, his ILD continued to deteriorate. At this stage, he received rituximab (two pulses of 1 g each), which led to a gradual clinical improvement. Now, 12 months since his rituximab infusion, he walks 2 miles daily without any exertional dyspnoea.

  19. Loss of CD20 expression in relapsed diffuse large B cell lymphoma after rituximab therapy: a case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    Yao Jiang; Yingchao Zhao; Xiaorong Dong; Sheng Zhang; Yan Li; Gang Wu

    2013-01-01

    Nowadays, resistance to rituximab has become a major issue in clinical practice. And loss of CD20 may contribute to it. Here we presented a case of loss of CD20 expression in relapsed diffuse large B cell lymphoma treated with rituximab and discuss the incidence, mechanism, influence factors, specific markers, prognosis and treatment of this disease. These results suggested that a post-relapse biopsy after rituximab treatment should be performed. CD79a and Pax-5 should be used as the first-line B lineage-specific markers for these patients. Though mechanisms of CD20 decrement are not fully elucidated, the down-regulation of CD20 mRNA is the most probable hypothesis. Recently various new agents are developed, but the prognosis is still poor. Further studies for new treatments are needed.

  20. Evaluation of non-radioactive lutetium- and yttrium-labeled immunoconjugates of rituximab - a vibrational spectroscopy study

    OpenAIRE

    Gjorgieva Ackova, Darinka; Smilkov, Katarina; Janevik-Ivanovska, Emilija; Stafilov, Trajče; Arsova-Sarafinovska, Zorica; Makreski, Petre

    2015-01-01

    Fourier Transform Infrared (FT-IR) and Raman Spectroscopy were used to study the molecular structure of the recombinant monoclonal antibody and anti-CD20-conjugates which are intended to be used as anti-cancer therapeutic agents. We characterized the secondary structure of a therapeutic immunoconjugates of rituximab, formulated with three different bifunctional chelating agents (p-SCN-Bn-DOTA, p-SCN-Bn-DTPA, 1B4M-DTPA) and labeled with non-radioactive lutetium and yttrium. The secondary struc...

  1. 非霍奇金淋巴瘤的Rituximab治疗%Rituximab-the drug for non-Hodgkin's lymphoma

    Institute of Scientific and Technical Information of China (English)

    师明磊; 胡显文; 陈惠鹏

    2004-01-01

    Rituximab是用于治疗非霍奇金淋巴瘤(NHL)的单抗药物.Rituximab单独使用对B细胞NHL总有效率为40%~50%;和化疗药物联用有效率达90%以上.毒性作用轻微,是临床治疗B细胞NHL的安全有效的新药.现综述Rituximab用于治疗各种类型NHL的临床试验以及与其他药物联用的临床试验.

  2. Salmonella Enteritidis Empyema Preceding the Diagnosis of Non-Hodgkin’s Lymphoma and Subsequent Contralateral Chylothorax Treated with Radiolabeled Rituximab

    Directory of Open Access Journals (Sweden)

    Syed Ali

    2015-12-01

    Full Text Available Salmonella infection is common, but pleural involvement has rarely been reported. Only seven cases of Salmonella enteritidis pleural empyema have been reported; all had an associated preexisting underlying immunosuppresion or malignancy. We report the case of an apparently healthy man who developed S. enteritidis empyema. On further follow-up and surveillance, he eventually presented with non-Hodgkin’s lymphoma and a contralateral recurrent chylothorax. The latter was successfully controlled with radiolabeled rituximab, which has never been described for the above purpose in literature before.

  3. Standard Operating Procedure for Prospective Individualised Dosimetry for [131]I-rituximab Radioimmunotherapy of Non-Hodgkin's Lymphoma

    OpenAIRE

    Calais, Phillipe J.; Turner, J. Harvey

    2012-01-01

    Radioimmunotherapy (RIT) is an attractive therapy for non-Hodgkin's lymphoma (NHL) as it allows targeted tumor irradiation which provides a cytotoxic effect significantly greater than that of the immune-mediated effects of a non-radioactive, or ‘cold’, antibody alone. Anti-CD20 antibodies such as rituximab are ideal for RIT, as not only is it easily iodinated, but the CD20 antigen is found on more than 95% of B-cell NHL. A standard operating procedure (SOP) has been formulated for personalize...

  4. Protein A immunoadsorption combined with rituximab in highly sensitized kidney transplant recipients

    Institute of Scientific and Technical Information of China (English)

    YIN Hang; HU Xiao-peng; LI Xiao-bei; LIU Hang; WANG Wei; REN Liang; WANG Yong; ZHANG Xiao-dong

    2009-01-01

    Background The number of highly sensitized patients is rising, and sensitization can lead to renal transplant failure.The present study aimed to investigate the safety and efficacy of protein A immunoadsorption combined with rituximab (RTX) in highly sensitized recipients of kidney transplants.Methods Seven highly sensitized recipients of living-related renal transplants (4 men and 3 women, mean aged 42.5 years old (range 33-51)) were pretreated with this combination. Human leukocyte antigen (HLA) mismatch number was 2-5. Panel reactive antibody (PRA) of class 1 was high in 2 cases and that of class Ⅱ was high in 1 case. All patients were pretreated with immunoadsorption 2-10 times. Immunoglobulin and PRA changes were monitored before and after absorption. The operation was conducted when PRA or immunoglobulin levels were at or below normal levels.Immunosuppressive drugs were provided 3-5 days before the operation, and one dose of RTX (375 mg/m~2) was infused with polyclonal antibody on the day of operation. Postoperative creatinine (Cr), creatinine clearance rate (Ccr), PRA ratio,and immunoglobulin changes were monitored.Results All 7 patients had good recovery without delayed graft function. Acute rejection occurred in 3 cases at postoperative days 8, 10, and 14, respectively. The Banff 07 biopsy grades were la in 1 case and lla C4d0 in 2 cases.Successful reversion was achieved after giving methylprednisolone or antithymocyte immunoglobulin + cyclophosphamide. All patients were discharged with normal renal function, mean class 1 PRA was 14% and mean class Ⅱ PRA was 35%. PRA was completely negative in 3 cases.Conclusion Protein A immunoadsorption combined with RTX can safely reduce the occurrence of humoral rejection in highly sensitized renal transplant recipients.

  5. Clinical scale preparation and evaluation of {sup 131}I-Rituximab for Non-Hodgkin's lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Kameswaran, Mythili; Vimalnath, K. Viswanathan; Rajeswari, Ardhi; Joshi, Prahlad Vasudeo; Samuel, Grace [Bhabha Atomic Research Centre, Mumbai (India). Radiopharmaceuticals Div.; Sarma, H.D. [Bhabha Atomic Research Centre, Mumbai (India). Radiation Biology and Health Sciences Div.

    2014-09-01

    Radioimmunotherapy (RIT) with anti CD20 MoAb conjugated to a β{sup -} emitting radioisotope like {sup 131}I or {sup 90}Y has the added advantage of delivering radiation not only to tumor cells that bind the antibody but also due to a crossfire effect, to neighboring tumor cells inaccessible to the antibody. In order to make available an indigenous radioimmunotherapeutic agent for Non Hodgkin's Lymphoma (NHL), radioiodinated Rituximab has been prepared and evaluated at a clinical scale. Radioiodination of Rituximab was performed by the conventional Chloramine T method using 7.4 GBq Na{sup 131}I in a lead shielded plant. Six batches of radioiodination were prepared and characterized by electrophoresis and HPLC to evaluate the reproducibility of the product. The product remained stable retaining the radiochemical purity > 95% upto 5 days after radioiodination. In vitro cell binding studies and biodistribution studies in normal Swiss mice have indicated the potential of this molecule as a radioimmunotherapeutic agent for NHL. (orig.)

  6. Targeted alpha therapy in vivo: direct evidence for single cancer cell kill using {sup 149}Tb-rituximab

    Energy Technology Data Exchange (ETDEWEB)

    Beyer, G.J.; Soloviev, D.; Buchegger, F. [Division of Nuclear Medicine, University Hospital of Geneva, 24 Rue Micheli du Crest, 1211, Geneva 14 (Switzerland); Miederer, M. [Department of Molecular Pharmacology and Chemistry, Memorial Sloan-Kettering Cancer Center, New York (United States); Vranjes-Duric, S. [Laboratory of Radioisotopes, Vinca Institute of Nuclear Sciences, Belgrade (Czechoslovakia); Comor, J.J. [Laboratory of Physics, Vinca Institute of Nuclear Sciences, Belgrade (Czechoslovakia); Kuenzi, G.; Hartley, O. [Department of Medical Biochemistry, University Medical Center, Geneva (Switzerland); Senekowitsch-Schmidtke, R. [Clinic of Nuclear Medicine, Technical University of Munich, Munich (Germany)

    2004-04-01

    This study demonstrates high-efficiency sterilisation of single cancer cells in a SCID mouse model of leukaemia using rituximab, a monoclonal antibody that targets CD20, labelled with terbium-149, an alpha-emitting radionuclide. Radio-immunotherapy with 5.5 MBq labelled antibody conjugate (1.11 GBq/mg) 2 days after an intravenous graft of 5.10{sup 6} Daudi cells resulted in tumour-free survival for >120 days in 89% of treated animals. In contrast, all control mice (no treatment or treated with 5 or 300 {mu}g unlabelled rituximab) developed lymphoma disease. At the end of the study period, 28.4%{+-}4% of the long-lived daughter activity remained in the body, of which 91.1% was located in bone tissue and 6.3% in the liver. A relatively high daughter radioactivity concentration was found in the spleen (12%{+-}2%/g), suggesting that the killed cancer cells are mainly eliminated through the spleen. This promising preliminary in vivo study suggests that targeted alpha therapy with {sup 149}Tb is worthy of consideration as a new-generation radio-immunotherapeutic approach. (orig.)

  7. A multicenter phase II study of sepantronium bromide (YM155) plus rituximab in patients with relapsed aggressive B-cell Non-Hodgkin lymphoma.

    Science.gov (United States)

    Papadopoulos, Kyriakos P; Lopez-Jimenez, Javier; Smith, Scott E; Steinberg, Joyce; Keating, Anne; Sasse, Carolyn; Jie, Fei; Thyss, Antoine

    2016-08-01

    This phase II study evaluated YM155, a novel small-molecule survivin suppressant, in combination with rituximab in patients with relapsed aggressive B-cell non-Hodgkin lymphoma (NHL) who failed or were not candidates for autologous stem cell transplant (ASCT). During 14-day cycles, 41 patients received YM155 (5mg/m(2)/d) by continuous intravenous (IV) infusion for 168 hours (day 1-7), and rituximab (375mg/m(2)) IV on days 1 and 8 during cycles 1-4 and repeated for 4 cycles every 10 cycles. Forty patients (97.6%) had prior rituximab and 15 patients (36.6%) prior ASCT. Most frequent grade 3-4 adverse events were neutropenia (19.5%) and thrombocytopenia (12.2%). In the per-protocol set (n = 34), objective response rate was 50% and median progression-free survival 17.9 months. Median overall survival was not reached at study termination (median follow-up, 23 months). YM155 in combination with rituximab was tolerable with encouraging antitumor activity and durable responses in relapsed aggressive B-cell NHL patients. PMID:26857688

  8. [Development of syndrome of inappropriate secretion of ADH and reversible posterior leukoencephalopathy during initial rituximab-CHOP therapy in a patient with diffuse large B-cell lymphoma].

    Science.gov (United States)

    Mizutani, Minoru; Nakamori, Yoshiki; Sakaguchi, Haruna; Kageyama, Yuki; Oya, Eiko; Ino, Kazuko; Suzuki, Kei; Sekine, Takao

    2013-03-01

    A 61-year-old woman presented with a right mandibular tumor and was diagnosed with DLBCL clinical stage IIIA from the biopsy results of the tumor and CT examination. An initial rituximab was administrated a week after the first CHOP treatment. During the infusion of rituximab, she exhibited disorientation, seizure, and consciousness disturbance. Hyponatremia due to SIADH and hypertension were coincidentally observed. MRI revealed T2 and FLAIR hyperintense signals involving the bilateral occipital, parietal, frontal lobes and the cerebellum that were consistent with reversible posterior leukoencephalopathy syndrome (RPLS). Her consciousness level recovered in parallel with corrections in serum sodium levels and blood pressure. Although she presented with transient cortical blindness, all neurological abnormalities disappeared 40 hours after the occurrence of seizure. She received a further 7 cycles of CHOP followed by 7 cycles of rituximab treatment with no relapse of RPLS. After irradiation for a residual abdominal tumor, she has maintained complete remission for 2 years. Although RPLS is a rare complication of rituximab-CHOP chemotherapy, it should be considered in patients with DLBCL who present with acute neurological deterioration.

  9. Addition of rituximab to chemotherapy overcomes the negative prognostic impact of cyclin E expression in diffuse large B-cell lymphoma

    DEFF Research Database (Denmark)

    Frei, E; Visco, C; Xu-Monette, Z Y;

    2013-01-01

    High levels of cyclin E (CCNE) are accompanied by shorter survival in cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone (CHOP)-treated diffuse large B-cell lymphomas (DLBCL), independent of the international prognostic index (IPI). Data on the prognostic role of CCNE in the 'rituximab...

  10. Rituximab plus fludarabine and cyclophosphamide prolongs progression-free survival compared with fludarabine and cyclophosphamide alone in previously treated chronic lymphocytic leukemia

    DEFF Research Database (Denmark)

    Robak, Tadeusz; Dmoszynska, Anna; Solal-Céligny, Philippe;

    2010-01-01

    Rituximab, a monoclonal antibody that targets the CD20 cell surface antigen, has clinical activity in patients with non-Hodgkin's lymphoma and other B-lymphocyte disorders when administered alone or in combination with chemotherapy. Promising results have previously been reported in nonrandomized...

  11. Rituximab Maintenance Treatment of Relapsed/Resistant Follicular Non-Hodgkin's Lymphoma: Long-Term Outcome of the EORTC 20981 Phase III Randomized Intergroup Study

    NARCIS (Netherlands)

    M.H.J. van Oers; M. van Glabbeke; L. Giurgea; R. Klasa; R.E. Marcus; M. Wolf; E. Kimby; M. van't Veer; A. Vranovsky; H. Holte; A. Hagenbeek

    2010-01-01

    Purpose In 2006, we published the results of the European Organisation for Research and Treatment of Cancer phase III trial EORTC 20981 on the role of rituximab in remission induction and maintenance treatment of relapsed/resistant follicular lymphoma (FL). At that time, the median follow-up for the

  12. Combination of rituximab with autologous peripheral blood stem cell transplantation for treatment of diffuse large B-cell lymphoma:a single-center experience

    Institute of Scientific and Technical Information of China (English)

    梁赜隐

    2013-01-01

    Objective To investigate whether incorporation of rituximab into high-dose chemotherapy with autologous peripheral blood stem cell transplantation(auto-PBSCT) could improve the survival of patients with diffuse large B-cell lymphoma(DLBCL),and evaluate the safety of

  13. Dynamic contrast-enhanced, extremity-dedicated MRI identifies synovitis changes in the follow-up of rheumatoid arthritis patients treated with rituximab

    DEFF Research Database (Denmark)

    Cimmino, Marco A; Parodi, Massimiliano; Zampogna, Giuseppe;

    2014-01-01

    OBJECTIVES: The aim of this study is to assess prospectively the effect of rituximab (RTX) on MRI features of wrist joint disease in patients affected by rheumatoid arthritis (RA). METHODS: Ten patients (6F/4M, mean age 52.9±15.5 years) diagnosed with IgM rheumatoid factor, anti-CCP positive, RA ...

  14. Neutralization of (NK-cell-derived) B-cell activating factor by Belimumab restores sensitivity of chronic lymphoid leukemia cells to direct and Rituximab-induced NK lysis.

    Science.gov (United States)

    Wild, J; Schmiedel, B J; Maurer, A; Raab, S; Prokop, L; Stevanović, S; Dörfel, D; Schneider, P; Salih, H R

    2015-08-01

    Natural killer (NK) cells are cytotoxic lymphocytes that substantially contribute to the therapeutic benefit of antitumor antibodies like Rituximab, a crucial component in the treatment of B-cell malignancies. In chronic lymphocytic leukemia (CLL), the ability of NK cells to lyse the malignant cells and to mediate antibody-dependent cellular cytotoxicity upon Fc receptor stimulation is compromised, but the underlying mechanisms are largely unclear. We report here that NK-cells activation-dependently produce the tumor necrosis factor family member 'B-cell activating factor' (BAFF) in soluble form with no detectable surface expression, also in response to Fc receptor triggering by therapeutic CD20-antibodies. BAFF in turn enhanced the metabolic activity of primary CLL cells and impaired direct and Rituximab-induced lysis of CLL cells without affecting NK reactivity per se. The neutralizing BAFF antibody Belimumab, which is approved for treatment of systemic lupus erythematosus, prevented the effects of BAFF on the metabolism of CLL cells and restored their susceptibility to direct and Rituximab-induced NK-cell killing in allogeneic and autologous experimental systems. Our findings unravel the involvement of BAFF in the resistance of CLL cells to NK-cell antitumor immunity and Rituximab treatment and point to a benefit of combinatory approaches employing BAFF-neutralizing drugs in B-cell malignancies.

  15. Rituximab improves the treatment results of DHAP-VIM-DHAP and ASCT in relapsed/progressive aggressive CD20+ NHL: A prospective randomized HOVON trial

    NARCIS (Netherlands)

    E. Vellenga (Edo); W.L.J. van Putten (Wim); M.B. van 't Veer (Mars); J.M. Zijlstra (Josée); W.E. Fibbe (Willem); M.H.J. van Oers (Marinus); L.F. Verdonck (Leo); P.W. Wijermans (Pierre); G. van Imhoff (Gustaaf); P.J. Lugtenburg (Pieternella); P.C. Huijgens (Peter)

    2008-01-01

    textabstractWe evaluated the role of rituximab during remission induction chemotherapy in relapsed aggressive CD20+non-Hodgkin lymphoma. Of 239 patients, 225 were evaluable for analysis. Randomized to DHAP (cisplatin-cytarabine- dexamethasone)-VIM (etoposide-ifosfamide-methotrexate)-DHAP (cisplatin-

  16. Rituximab improves the treatment results of DHAP-VIM-DHAP and ASCT in relapsed/progressive aggressive CD20(+) NHL : a prospective randomized HOVON trial

    NARCIS (Netherlands)

    Vellenga, Edo; van Putten, Wim L. J.; van't Veer, Mars B.; Zijlstra, Josee M.; Fibbe, Willem E.; van Oers, Marinus H. J.; Verdonck, Leo F.; Wijermans, Pierre W.; van Imhoff, Gustaaf W.; Lugtenburg, Pieternella J.; Huijgens, Peter C.

    2008-01-01

    We evaluated the role of rituximab during remission induction chemotherapy in relapsed aggressive CD20(+) non-Hodgkin lymphoma. Of 239 patients, 225 were evaluable for analysis. Randomized to DHAP (cisplatin-cytarabine-dexamethasone)-VIM (etoposide-ifosfamide-methotrexate)-DHAP (cisplatin-cytarabine

  17. Phase III study of ACVBP versus ACVBP plus rituximab for patients with localized low-risk diffuse large B-cell lymphoma (LNH03-1b)

    OpenAIRE

    Ketterer, N; Coiffier, B.; Thieblemont, C.; Fermé, C.; Brière, J; Casasnovas, O.; Bologna, S.; Christian, B.; Connerotte, T.; Récher, C; Bordessoule, D; Fruchart, C.; Delarue, R.; Bonnet, Christophe; Morschhauser, F.

    2013-01-01

    Background The superiority of a chemotherapy with doxorubicin, cyclophosphamide, vindesine, bleomycin and prednisone (ACVBP) in comparaison with cyclophosphamide, doxorubicin, vincristin and prednisone plus radiotherapy for Young patients with localized diffuse large B-cell lymphoma (DLBCL) was previously demonstrated. We report the results of a trial which évaluâtes the role of rituximab combined with ACVBP (R- ACVBP) in these patients. ...

  18. Combination therapy with rituximab and cyclophosphamide in the treatment of anti-neutrophil cytoplasmic antibodies (ANCA) positive pulmonary hemorrhage: case report

    OpenAIRE

    Lehman Thomas JA; Baird Emily M; Worgall Stefan

    2011-01-01

    Abstract Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with pulmonary hemorrhage is rare in childhood. Standard treatment includes corticosteroids and cyclophosphamide (CYC), which is associated with a high level of toxicity. We report a white female with ANCA positive pulmonary hemorrhage who was treated with cyclophosphamide (CYC) and rituximab (RTX) combination therapy.

  19. An approach for conjugation of 177 Lu- DOTA-SCN- Rituximab (BioSim & its evaluation for radioimmunotherapy of relapsed & refractory B-cell non Hodgkins lymphoma patients

    Directory of Open Access Journals (Sweden)

    Parul Thakral

    2014-01-01

    Interpretation & conclusions: A favourable radiochemical purity, stability and biodistribution of the radiolabelled immunoconjugate indicate that clinical trials for evaluation of toxicity and efficacy of 177 Lu-DOTA-antiCD20 antibody-Rituximab (BioSim in patients of relapsed and refractory non Hodgkin′s lymphoma can be considered.

  20. High treatment efficacy by dual targeting of Burkitt's lymphoma xenografted mice with a {sup 177}Lu-based CD22-specific radioimmunoconjugate and rituximab

    Energy Technology Data Exchange (ETDEWEB)

    Weber, Tobias; Boetticher, Benedikt; Keller, Armin; Schlegelmilch, Anne; Jaeger, Dirk; Krauss, Juergen [Heidelberg University Hospital, Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg (Germany); Mier, Walter; Kraemer, Susanne; Leotta, Karin [Heidelberg University Hospital, Department of Nuclear Medicine, Heidelberg (Germany); Sauter, Max; Haberkorn, Uwe [Heidelberg University Hospital, Department of Nuclear Medicine, Heidelberg (Germany); German Cancer Research Center (DKFZ), Clinical Cooperation Unit Nuclear Medicine, Heidelberg (Germany); Grosse-Hovest, Ludger [University of Tuebingen, Department of Immunology, Tuebingen (Germany); Arndt, Michaela A.E. [Heidelberg University Hospital, Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg (Germany); German Cancer Research Center (DKFZ), Immunotherapy Program, National Center for Tumor Diseases, Heidelberg (Germany)

    2016-03-15

    Dual-targeted therapy has been shown to be a promising treatment option in recurrent and/or refractory B-cell non-Hodgkin's lymphoma (B-NHL). We generated radioimmunoconjugates (RICs) comprising either a novel humanized anti-CD22 monoclonal antibody, huRFB4, or rituximab, and the low-energy β-emitter {sup 177}Lu. Both RICs were evaluated as single agents in a human Burkitt's lymphoma xenograft mouse model. To increase the therapeutic efficacy of the anti-CD22 RIC, combination therapy with unlabelled anti-CD20 rituximab was explored. The binding activity of CHX-A''-DTPA-conjugated antibodies to target cells was analysed by flow cytometry. To assess tumour targeting of {sup 177}Lu-labelled antibodies, in vivo biodistribution experiments were performed. For radioimmunotherapy (RIT) studies, non-obese diabetic recombination activating gene-1 (NOD-Rag1{sup null}) interleukin-2 receptor common gamma chain (IL2r γ {sup null}) null mice (NRG mice) were xenografted subcutaneously with Raji Burkitt's lymphoma cells. {sup 177}Lu-conjugated antibodies were administered at a single dose of 9.5 MBq per mouse. For dual-targeted therapy, rituximab was injected at weekly intervals (0.5 - 1.0 mg). Tumour accumulation of RICs was monitored by planar scintigraphy. Conjugation of CHX-A''-DTPA resulted in highly stable RICs with excellent antigen-binding properties. Biodistribution experiments revealed higher tumour uptake of the {sup 177}Lu-labelled anti-CD22 IgG than of {sup 177}Lu-labelled rituximab. Treatment with {sup 177}Lu-conjugated huRFB4 resulted in increased tumour growth inhibition and significantly longer survival than treatment with {sup 177}Lu-conjugated rituximab. The therapeutic efficacy of the anti-CD22 RIC could be markedly enhanced by combination with unlabelled rituximab. These findings suggest that dual targeting with {sup 177}Lu-based CD22-specific RIT in combination with rituximab is a promising new treatment option for

  1. High treatment efficacy by dual targeting of Burkitt's lymphoma xenografted mice with a 177Lu-based CD22-specific radioimmunoconjugate and rituximab

    International Nuclear Information System (INIS)

    Dual-targeted therapy has been shown to be a promising treatment option in recurrent and/or refractory B-cell non-Hodgkin's lymphoma (B-NHL). We generated radioimmunoconjugates (RICs) comprising either a novel humanized anti-CD22 monoclonal antibody, huRFB4, or rituximab, and the low-energy β-emitter 177Lu. Both RICs were evaluated as single agents in a human Burkitt's lymphoma xenograft mouse model. To increase the therapeutic efficacy of the anti-CD22 RIC, combination therapy with unlabelled anti-CD20 rituximab was explored. The binding activity of CHX-A''-DTPA-conjugated antibodies to target cells was analysed by flow cytometry. To assess tumour targeting of 177Lu-labelled antibodies, in vivo biodistribution experiments were performed. For radioimmunotherapy (RIT) studies, non-obese diabetic recombination activating gene-1 (NOD-Rag1null) interleukin-2 receptor common gamma chain (IL2r γ null) null mice (NRG mice) were xenografted subcutaneously with Raji Burkitt's lymphoma cells. 177Lu-conjugated antibodies were administered at a single dose of 9.5 MBq per mouse. For dual-targeted therapy, rituximab was injected at weekly intervals (0.5 - 1.0 mg). Tumour accumulation of RICs was monitored by planar scintigraphy. Conjugation of CHX-A''-DTPA resulted in highly stable RICs with excellent antigen-binding properties. Biodistribution experiments revealed higher tumour uptake of the 177Lu-labelled anti-CD22 IgG than of 177Lu-labelled rituximab. Treatment with 177Lu-conjugated huRFB4 resulted in increased tumour growth inhibition and significantly longer survival than treatment with 177Lu-conjugated rituximab. The therapeutic efficacy of the anti-CD22 RIC could be markedly enhanced by combination with unlabelled rituximab. These findings suggest that dual targeting with 177Lu-based CD22-specific RIT in combination with rituximab is a promising new treatment option for refractory B-NHL. (orig.)

  2. Budget impact analysis of the use of rituximab in the treatment of rheumatoid arthritis in Italy

    Directory of Open Access Journals (Sweden)

    Maurizio Benucci

    2009-01-01

    Full Text Available Objective: a Budget Impact analysis was performed to evaluate cost implications for the Italian National Health Service (NHS of the introduction of rituximab (RTX in the treatment of rheumatoid arthritis (RA. Methods: RA patients eligible to treatment with a second-line biologic DMARD (Disease Modifying Antirheumatic Drugs were identified and quantified and available strategies for their management were explored. Costs associated with the different alternatives were estimated, and the impact on the NHS budget was estimated using a cohort simulation based on a Markov chain with a time horizon of 5 years and 1-year cycles. Seven alternative strategies were analyzed, each of them starting after the failure of a first anti-TNFα: 1 the use of a second and a third anti-TNFα; 2 the use of a second anti-TNFα followed by RTX; 3 the use of a second anti-TNFα followed by abatacept (ABAT; 4 the use of RTX as a second biological line, followed by an anti-TNFα; 5 the use of ABAT as a second biological line, followed by an anti-TNFα; 6 the use of RTX as a second biological line, followed by ABAT; 7 the use of ABAT as a second biological line, followed by RTX. Only direct medical costs were considered: drug acquisition, administration, incidental premedication and monitoring exams. Results: Italian patients eligible to second biological line therapies (RA patients refractory or intolerant to at least one anti-TNFα therapy were estimated in about 650 per year. The adoption of RTX as a second line therapy produced a substantial saving in total costs (-33% at the fifth year with respect to the strategy with RTX as third line and the one with only anti-TNFα (the last two resulting substantially cost-equivalent. The number of patients in active treatment (biologic DMARD per unit cost resulted of about 8.1 patient-years/100,000 € with the strategy based only on anti-TNFα and increased of 10% with RTX as a third line. The strategy of RTX as a second line

  3. Rituximab as first choice for patients with refractory rheumatoid arthritis: cost-effectiveness analysis in Iran based on a systematic review and meta-analysis.

    Science.gov (United States)

    Ahmadiani, Saeed; Nikfar, Shekoufeh; Karimi, Somayeh; Jamshidi, Ahmad Reza; Akbari-Sari, Ali; Kebriaeezadeh, Abbas

    2016-09-01

    The aim of this study was to evaluate the effectiveness and cost-effectiveness of using rituximab as first line for patients with refractory rheumatoid arthritis in comparison with continuing conventional DMARDs, from a perspective of health service governors. A systematic review was implemented through searching PubMed, Scopus and Cochrane Library. Quality assessment was performed by Jadad scale. After meta-analysis of ACR index results, QALY gain was calculated through mapping ACR index to HAQ and utility index. To measure the direct and indirect medical costs, a set of interviews with patients were applied. Thirty-two patients were selected from three referral rheumatology clinics in Tehran with definite diagnosis of refractory rheumatoid arthritis in the year before and treatment regimen of either rituximab or DMARDs within last year. Incremental cost-effectiveness ratio was calculated for base case and scenario of generic rituximab. Threefold of GDP per capita was considered as threshold of cost-effectiveness. Four studies were eligible to be considered in this systematic review. Total risk differences of 0.3 for achieving ACR20 criteria, 0.21 for ACR50 and 0.1 for ACR70 were calculated. Also mean of total medical costs of patients for 24 weeks were $3985 in rituximab group and $932 for DMARDs group. Thus, the incremental cost per QALY ratio will be $45,900-$70,223 in base case and $32,386-$49,550 for generic scenario. Rituximab for treatment of patients with refractory rheumatoid arthritis is not considered as cost-effective in Iran in none of the scenarios. PMID:27136919

  4. Validation of 64Cu-DOTA-rituximab injection preparation under good manufacturing practices: a PET tracer for imaging of B-cell non-Hodgkin lymphoma.

    Science.gov (United States)

    Natarajan, Arutselvan; Arksey, Natasha; Iagaru, Andrei; Chin, Frederick T; Gambhir, Sanjiv Sam

    2015-01-01

    Manufacturing of 64Cu-1,4,7,10-tetraazacyclododecane-N,N',N'',N'''-tetraacetic acid (DOTA)-rituximab injection under good manufacturing practices (GMP) was validated for imaging of patients with CD20+ B-cell non-Hodgkin lymphoma. Rituximab was purified by size exclusion high performance liquid chromatography (HPLC) and conjugated to DOTA-mono-(N-hydroxysuccinimidyl) ester. 64CuCl2, buffers, reagents, and other raw materials were obtained as high-grade quality. Following a semi-automated synthesis of 64Cu-DOTA-rituximab, a series of quality control tests was performed. The product was further tested in vivo using micro-positron emission tomography/computed tomography (PET/CT) to assess targeting ability towards human CD20 in transgenic mice. Three batches of 64Cu-DOTA-rituximab final product were prepared as per GMP specifications. The radiolabeling yield from these batches was 93.1 ± 5.8%; these provided final product with radiopharmaceutical yield, purity, and specific activity of 59.2 ± 5.1% (0.9 ± 0.1 GBq of 64Cu), > 95% (by HPLC and radio-thin layer chromatography), and 229.4 ± 43.3 GBq/µmol (or 1.5 ± 0.3 MBq/µg), respectively. The doses passed apyrogenicity and human serum stability specifications, were sterile up to 14 days, and retained > 60% immunoreactivity. In vivo micro-PET/CT mouse images at 24 hours postinjection showed that the tracer targeted the intended sites of human CD20 expression. Thus, we have validated the manufacturing of GMP grade 64Cu-DOTA-rituximab for injection in the clinical setting. PMID:25762106

  5. Preparation and quality control of 177Lu-DOTA-Rituximab for radioimmunotherapy of relapsed and refractory B-cell NHL patients

    International Nuclear Information System (INIS)

    Full text of publication follows. Background: the prerequisite of radioimmunotherapy is stable binding of a radionuclide to monoclonal antibodies, which are specific to the tumor-associated antigen. Most B-cell lymphomas express CD20 antigen on the surface of the tumor cells, making it a suitable target for therapeutic radioactive monoclonal antibodies. In the present study, the immuno-conjugate of Rituximab and macrocyclic chelator, p-SCN-Bz-DOTA, was prepared and radiolabelled with Lutetium-177 followed by quality control procedures. Methods: Rituximab was desalted with sodium bi-carbonate (0.1 M, pH 9.0) and incubated with DOTA-SCN (1:50). The effectiveness of the conjugation was evaluated by determining the number of chelators per antibody molecule. This conjugate was radiolabelled with Lutetium-177 and purified using PD10 column. The quality control parameters like pH, clarity, radiochemical purity, in-vitro stability and pyrogenicity were studied. Immunoreactivity of 177Lu-DOTA-Rituximab was assessed using RAMOS cells. The radio-immuno-conjugate (RIC) after stringent quality assurance was injected in three patients and the biodistribution profile was analysed. Results: an average of 4.02 ± 1.04 p-SCN-Bz-DOTA molecules could be randomly conjugated to a single Rituximab antibody. The radiochemical purity of the labelled antibody was >95 % with preserved affinity for CD20 antigen. The final preparation was stable up to ∼120 hours when tested under different conditions. Bacterial endotoxin level in the sample was less than the permissible levels(<0.2 EU/ml). A favourable biodistribution profile was observed with liver showing the maximum uptake of the RIC. Conclusion: a favorable radiochemical purity, stability and biodistribution of the radiolabelled immuno-conjugate indicated that 177Lu-DOTA-antiCD20 antibody-Rituximab might be a promising therapeutic agent for the treatment of relapsed and refractory Non Hodgkin's Lymphoma. (authors)

  6. Rituximab Effectiveness and Safety for Treating Primary Sjogren's Syndrome (pSS: Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Francine Bertolais do Valle Souza

    Full Text Available Primary Sjögren's Syndrome (pSS is a systemic autoimmune disease that involves the exocrine glands and internal organs. pSS leads to destruction and loss of secretory function due to intense lymphoplasmacytic infiltration. Therapeutic options include mainly symptomatic and supportive measures, and traditional immunosuppressant drugs have shown no effectiveness in randomized trials. Rituximab (RTX is a chimeric antibody anti-CD20 that leads to B cell depletion by diverse mechanisms. There is evidence that this drug may be effective for treating pSS. The objective of this systematic review was to evaluate Rituximab effectiveness and safety for treating pSS.We conducted a systematic review of RCTs published until December 2015, with no language restriction. We registered a protocol on Plataforma Brasil (40654814.6.0000.5505 and developed search strategies for the following scientific databases: MEDLINE, EMBASE, CENTRAL and LILACS. We included adults with established pSS diagnosis and considered the use of Rituximab as intervention and the use of other drugs or placebo as control. Four studies met our eligibility criteria: three with low risk of bias and one with uncertain risk of bias. The total number of participants was 276 (145 RTX, 131 placebo. We assessed the risk of bias of each included study and evaluated the following as primary outcomes: lacrimal gland function, salivary gland function, fatigue improvement and adverse events. We found no significant differences between the groups in the Schirmer test at week 24 meta-analysis (MD 3.59, 95% CI -2.89 to 10.07. Only one study evaluated the lissamine green test and reported a statistically significant difference between the groups at week 24 (MD -2.00, 95% CI -3.52 to -0.48. There was a significant difference between the groups regarding salivary flow rate (MD 0.09, 95% CI 0.02 to 0.16 and improvement in fatigue VAS at weeks 6 (RR 3.98, 95% CI 1.61 to 9.82 and week 16 (RR 3.08, 95% CI 1.21 to

  7. Macroglobulinemia de Waldenström - remissão completa após tratamento com rituximabe Successful outcome in Waldenström's macroglobulinemia treated with rituximab

    Directory of Open Access Journals (Sweden)

    Flavia C. F. Pimenta

    2008-10-01

    Full Text Available A macroglobulinemia de Waldenström (MW é uma patologia rara dos linfócitos B caracterizada pela produção monoclonal de IgM, e que pode manifestar-se clinicamente com fadiga, astenia, perda de peso, sangramento de mucosas e do trato gastrintestinal, lifonodonomegalias, hepatoesplenomegalia e alterações neurológicas. A doença é mais comum em pacientes idosos, e seus sintomas são decorrentes da hiperviscosidade sangüínea. Na MW observa-se hipergamaglobulinemia com pico monoclonal na eletroforese de proteínas séricas, níveis elevados de IgM e demais imunoglobulinas normais ou diminuídas, imunofenotipagem com linfócitos B CD19+, CD20+ e CD24+, aspirado de medula óssea hipercelular, e biópsia de medula óssea hipercelular com infiltração difusa de linfócitos, linfócitos plasmocitóides e plasmócitos. Atualmente, anticorpos monoclonais estão sendo usados na terapêutica da MW com grande sucesso. O rituximabe, anticorpo monoclonal anti -CD20, tem mostrado excelentes resultados no tratamento da MW, inclusive naqueles indivíduos que não obtiveram resposta adequada ao tratamento convencional. Nós reportamos o caso de uma mulher de 78 anos de idade com história de fadiga, astenia, anorexia, sonolência, inquietação, urticária, dificuldade para deambular e perda excessiva de peso, aproximadamente 22 kg em um período de cinco meses, cujo tratamento foi realizado com rituximabe. O objetivo deste relato é apresentar uma paciente com diagnóstico de MW e revisar aspectos clínicos e terapêutico atual da doença.Waldenström's macroglobulinemia is a rare pathology of B lymphocytes characterized by the production of monoclonal IgM, causing clinical manifestations which may include fatigue, asthenia, weight loss, bleeding of the mucosa and intestinal tract, lymphadenomegaly, hepatosplenomegaly and neurological alterations. The disease is more frequent among elderly patients and its symptoms are a result of the hyperviscosity of

  8. Hyperinfection by Strongyloides stercoralis probably associated with Rituximab in a patient with mantle cell lymphoma and hyper eosinophilia Hiperinfección por Strongyloides stercoralis probablemente asociada con Rituximab en una paciente con linfoma e hipereosinofilia

    Directory of Open Access Journals (Sweden)

    Renzo Nino Incani

    2010-08-01

    Full Text Available The first report to our knowledge, of hyperinfection by Strongyloides stercoralis (HS and hypereosinophilia, associated to immune suppression by Rituximab (the only drug received for the last one year and 10 months, in a patient with mantle-cell lymphoma (MCL, is presented. The patient has a 3-year history of MCL, and developed two accesses of HS during 2008, including meningitis, pneumonia and presence of larvae of S. stercoralis in the lungs. We had a unique chance to look at cytotoxicity of filariform larvae in the expectoration after Ivermectin treatment, showing immobilization and death of larvae, associated with eosinophils attached to the cuticle of the parasite.Se presenta el primer reporte, hasta donde tengamos información, de hiperinfección por Strongyloides stercoralis (HS e hipereosinofilia asociados a inmunosupresión por Rituximab (el único medicamento recibido durante 1 año y 10 meses, en un paciente con linfoma de células del manto (LCM. La paciente tuvo una historia de 3 años con LCM, y desarrolló 2 accesos de HS durante el 2008, incluyendo meningitis, neumonía y presencia de larvas de S. stercoralis en los pulmones. Se tuvo la oportunidad única de observar la citotoxicidad contra las larvas filariformes en la expectoración, luego del tratamiento con Ivermectina, mostrando la inmovilización y muerte de las larvas, asociada a la presencia de eosinófilos adheridos a la cutícula del parásito.

  9. Effective Treatment of Rheumatoid Arthritis-Associated Interstitial Lung Disease by B-Cell Targeted Therapy with Rituximab

    Directory of Open Access Journals (Sweden)

    Wolfgang Hartung

    2012-01-01

    Full Text Available Rheumatoid arthritis- (RA- associated interstitial lung disease (RA-ILD is the extra-articular complication with most adverse impact on the quality of life and survival in RA patients. However, treatment options are limited and controlled studies are lacking. Here, we present the case of a 66-year-old patient suffering from severe RA-ILD, which has been successfully treated with Rituximab (RTX. After failure of conventional DMARD therapy, our patient showed sustained improvement of clinical pulmonary parameters as well as joint inflammation following B-cell depletion with RTX. The six-minute-walk test improved from 380 meters to 536 meters and the forced vital capacity from 2.49 liters to 3.49. The disease activity score could be reduced from 7.7 to 2.8. Therefore, RTX might be considered as an alternative treatment for RA-ILD in patients not responding to conventional DMARD therapy.

  10. Successful experience of rituximab therapy for systemic sclerosis-associated interstitial lung disease with concomitant systemic lupus erythematosus.

    Science.gov (United States)

    Sumida, Hayakazu; Asano, Yoshihide; Tamaki, Zenshiro; Aozasa, Naohiko; Taniguchi, Takashi; Takahashi, Takehiro; Toyama, Tetsuo; Ichimura, Yohei; Noda, Shinji; Akamata, Kaname; Miyazaki, Miki; Kuwano, Yoshihiro; Yanaba, Koichi; Sato, Shinichi

    2014-05-01

    Previous studies have demonstrated that B cells play critical roles in autoimmune disorders including systemic sclerosis (SSc) and systemic lupus erythematosus (SLE). However, the effectiveness of rituximab (RTX), a chimeric anti-CD20 antibody, for SSc-associated interstitial lung disease (ILD) or SLE disease activity remains controversial. We herein report an SSc patient with severely progressed ILD and concomitant SLE treated by two cycles of RTX at baseline and half a year later. This treatment improved ILD and SLE activities, along with reduction of dermal sclerosis and serum anti-topoisomerase I antibody levels. In addition, our detailed time-course data indicate that half a year may be appropriate as an interval between each cycle of RTX therapy aimed at SSc-associated ILD or SLE. Overall, the current report could pave the way to establish RTX as a disease-modifying drug for patients with SSc and/or SLE showing resistance to other already approved medications.

  11. Rituximab in Combination with CHOP, an Effective and Well-tolerated Salvage Regimen for Diffuse Large B-Cell Lymphoma

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    OBJECTIVE To evaluate the clinical effect of the R-CHOP regimen (rituximab in combination with cyclophosphamide, epirubicin, vincristine and prednisone) in treating refractory or relapsed diffuse large B-cell lymphoma (DLBCL), as a salvage therapy for DLBCL.METHODS Eighteen patients with refractory or relapsed DLBCL who were treated with the R-CHOP regimen from 2001 to 2006 in hospitals in Jilin Province were analyzed retrospectively. The response rate, change of serum lactate dehydrogenase (LDH), time to progression (TTP) and toxicity were observed.RESULTS The R-CHOP regimen can achieve a higher response rate, decrease serum LDH to a larger extent and obtain longer TTP than a conventional secondary regimen. The main adverse effects were similar to conventional chemotherapy.CONCLUSION The R-CHOP regimen is one of the most effective secondary therapies for DLBCL.

  12. Radiolabeling of rituximab with {sup 188}Re and {sup 99m}Tc using the tricarbonyl technology

    Energy Technology Data Exchange (ETDEWEB)

    Dias, Carla Roberta [Instituto de Pesquisas Energeticas e Nucleares, Av. Professor Lineu Prestes 2242, 05508-000 Sao Paulo (Brazil); Jeger, Simone [Center for Radiopharmaceutical Sciences ETH-PSI-USZ, Paul Scherrer Institute, 5232 Villigen-PSI (Switzerland); Osso, Joao Alberto [Instituto de Pesquisas Energeticas e Nucleares, Av. Professor Lineu Prestes 2242, 05508-000 Sao Paulo (Brazil); Mueller, Cristina; De Pasquale, Christine; Hohn, Alexander; Waibel, Robert [Center for Radiopharmaceutical Sciences ETH-PSI-USZ, Paul Scherrer Institute, 5232 Villigen-PSI (Switzerland); Schibli, Roger, E-mail: roger.schibli@psi.c [Center for Radiopharmaceutical Sciences ETH-PSI-USZ, Paul Scherrer Institute, 5232 Villigen-PSI (Switzerland); Department of Chemistry and Applied Biosciences of the ETH, 8093 Zurich (Switzerland)

    2011-01-15

    Introduction: The most successful clinical studies of immunotherapy in patients with non-Hodgkin's lymphoma (NHL) use the antibody rituximab (RTX) targeting CD20{sup +} B-cell tumors. Rituximab radiolabeled with {beta}{sup -} emitters could potentiate the therapeutic efficacy of the antibody by virtue of the particle radiation. Here, we report on a direct radiolabeling approach of rituximab with the {sup 99m}Tc- and {sup 188}Re-tricarbonyl core (IsoLink technology). Methods: The native format of the antibody (RTX{sub wt}) as well as a reduced form (RTX{sub red}) was labeled with {sup 99m}Tc/{sup 188}Re(CO){sub 3}. The partial reduction of the disulfide bonds to produce free sulfhydryl groups (-SH) was achieved with 2-mercaptoethanol. Radiolabeling efficiency, in vitro human plasma stability as well as transchelation toward cysteine and histidine was investigated. The immunoreactivity and binding affinity were determined on Ramos and/or Raji cells expressing CD20. Biodistribution was performed in mice bearing subcutaneous Ramos lymphoma xenografts. Results: The radiolabeling efficiency and kinetics of RTX{sub red} were superior to that of RTX{sub wt} ({sup 99m}Tc: 98% after 3 h for RTX{sub red} vs. 70% after 24 h for RTX{sub wt}). {sup 99m}Tc(CO){sub 3}-RTX{sub red} was used without purification for in vitro and in vivo studies whereas {sup 188}Re(CO){sub 3}-RTX{sub red} was purified to eliminate free {sup 188}Re-precursor. Both radioimmunoconjugates were stable in human plasma for 24 h at 37{sup o}C. In contrast, displacement experiments with excess cysteine/histidine showed significant transchelation in the case of {sup 99m}Tc(CO){sub 3}-RTX{sub red} but not with pre-purified {sup 188}Re(CO){sub 3}-RTX{sub red}. Both conjugates revealed high binding affinity to the CD20 antigen (K{sub d}=5-6 nM). Tumor uptake of {sup 188}Re(CO){sub 3}-RTX{sub red} was 2.5 %ID/g and 0.8 %ID/g for {sup 99m}Tc(CO){sub 3}-RTX{sub red} 48 h after injection. The values for other

  13. Multicenter Retrospective Analysis of the Effectiveness and Safety of Rituximab in Korean Patients with Refractory Systemic Lupus Erythematosus

    Directory of Open Access Journals (Sweden)

    So-Young Bang

    2012-01-01

    Full Text Available Objective. Although two recent randomized placebo-controlled trials of rituximab (RTX failed to demonstrate efficacy in systemic lupus erythematosus (SLE, clinicians continue to use off-label RTX for cases refractory to current treatments. We evaluated the effectiveness and safety of rituximab for patients with refractory SLE in Korea. Methods. We retrospectively analyzed multicenter patients treated with RTX in Korea. Results. 39 SLE patients treated with RTX were included in the following manner: lupus nephritis 43.6%, hematologic 33.3%, arthritis 7.8%, myositis 7.8%, and others 7.7%. All patients had responded poorly to at least one conventional immunosuppressive agent (mean 2.5 ± 1.1, cyclophosphamide 43.6%, mycophenolate mofetil 48.7%, and other drugs before RTX. Clinical improvements (complete or partial remission occurred in patients with renal disease, hematologic disease, arthritis, myositis, and other manifestations at 6 months after RTX. The SLEDAI score was significantly decreased from 10.8±7.1 at baseline to 6.7±4.0 at 6 months, 6.2±4.1 at 12 months, and 5.5±3.6 at 24 months after RTX (P<0.05. Among 28 clinical responders, 4 patients experienced a relapse of disease at 25±4 months. Infections were noted in 3 patients (7.7%. Conclusion. RTX could be an effective and relatively safe therapeutic option in patients with severe refractory SLE until novel B-cell depletion therapy is available.

  14. Discrepancy of B cell frequency between periphery and spleen after rituximab treatment in ABO-incompatible liver transplantation.

    Science.gov (United States)

    Iso, Yukihiro; Sawada, Tokihiko; Kita, Junji; Shiraki, Takayuki; Sakuraoka, Yuki; Kato, Masato; Shimoda, Mitsugi; Kubota, Keiichi

    2013-10-01

    ABO-incompatible living-donor liver transplantation (ABO-LDLT) is generally more difficult to perform than ABO-incompatible kidney transplantation. Despite introduction of rituximab, ABO-LDLT in non-responders is a still difficult issue. A 23-year-old woman with primary sclerosing cholangitis underwent LDLT. The recipient's blood type was 0(+) and the donor's was B(+). Rituximab was infused twice on preoperative day (POD) 14 and 7. Plasma exchange (PE) was performed on PODs 5, 3, 2, and 1. However, repeated PE failed to decrease the anti-B antibody titer. On the other hand, preoperative esophagogastroscopy revealed esophageal varices with red color sign. Therefore, simultaneous liver transplantation and Hassab operation were performed. The donor left lobe of the liver was orthotopically transplanted into the recipient following Hassab operation. Flow cytometry on the day of surgery showed that the frequencies of B cells (CD20+) and memory B cells (CD20+/CD27+) in the peripheral blood were 0.9% and 0.3%, respectively; flow cytometry of cells recovered from the spleen revealed that the frequencies of B cells and memory B cells were 2.5% and 2.4%, respectively. Acute cellular rejection occurred on POD 15, and was treated by steroid pulse therapy, leading to a decrease in the anti-B antibody titer. The liver was functioning well on POD 390 (AST 19, ALT 34). In non-responders to ABO-LDLT, anti-donor blood type antibody-producing cells remains in the spleen after the conventional preoperative regimen. Splenectomy is an option for ABO-LDLT non-responders.

  15. Impact on Medical Cost, Cumulative Survival, and Cost-Effectiveness of Adding Rituximab to First-Line Chemotherapy for Follicular Lymphoma in Elderly Patients: An Observational Cohort Study Based on SEER-Medicare

    Directory of Open Access Journals (Sweden)

    Robert I. Griffiths

    2012-01-01

    Full Text Available Rituximab improves survival in follicular lymphoma (FL, but is considerably more expensive than conventional chemotherapy. We estimated the total direct medical costs, cumulative survival, and cost-effectiveness of adding rituximab to first-line chemotherapy for FL, based on a single source of data representing routine practice in the elderly. Using surveillance, epidemiology, and end results (SEER registry data plus Medicare claims, we identified 1,117 FL patients who received first-line CHOP (cyclophosphamide (C, doxorubicin, vincristine (V, and prednisone (P or CVP +/− rituximab. Multivariate regression was used to estimate adjusted cumulative cost and survival differences between the two groups over four years after beginning treatment. The median age was 73 years (minimum 66 years, 56% had stage III-IV disease, and 67% received rituximab. Adding rituximab to first-line chemotherapy was associated with higher adjusted incremental total cost ($18,695; 95% Confidence Interval (CI $9,302–$28,643 and longer adjusted cumulative survival (0.18 years; 95% CI 0.10–0.27 over four years of followup. The expected cost-effectiveness was $102,142 (95% CI $34,531–296,337 per life-year gained. In routine clinical practice, adding rituximab to first-line chemotherapy for elderly patients with FL results in higher direct medical costs to Medicare and longer cumulative survival after four years.

  16. Safety of infusing rituximab at a more rapid rate in patients with rheumatoid arthritis: results from the RATE-RA study

    Science.gov (United States)

    2014-01-01

    Background As recommended in the current prescribing information, rituximab infusions in patients with rheumatoid arthritis (RA) take 4.25 hours for the first infusion and 3.25 hours for subsequent infusions, which is a burden on patients and the health care system. We therefore evaluated the safety of infusing rituximab at a faster rate for an infusion period of 2 hours in patients with RA. Methods Patients with an inadequate response to anti-TNF who were rituximab-naive or -experienced received 2 courses of rituximab: Infusion 1 (Day 1) was administered over the standard 4.25 hours, and Infusions 2 (Day 15), 3 (Day 168) and 4 (Day 182) were administered over a faster 2-hour period. The primary endpoint was incidence of infusion-related reactions (IRRs) associated with Infusion 2. Results Of the 351 patients enrolled, 87% and 13% were rituximab-naive and -experienced, respectively. The incidence (95% CI) of IRRs associated with Infusion 1 was 16.2% (12.5%, 20.5%) and consistent with weighted historical incidence of 20.7% (19.4%, 22.1%). The incidence (95% CI) of IRRs associated with Infusions 2, 3, and 4 compared with respective weighted historical incidences at the standard infusion rate was 6.5% (4.1%, 9.7%) vs 8.1% (7.2%, 9.1%); 5.9% (3.5%, 9.3%) vs 11.5% (10.3%, 12.8%); and 0.7 (0.1%, 2.6%) vs 5.0% (4.2%, 6.0%), respectively. All IRRs were grade 1 or 2, except for 3 grade 3 IRRs associated with Infusion 1 and 2 grade 3 IRRs associated with Infusion 2. Four patients experienced a total of 5 grade 3 IRRs; 3 of these patients continued on to received subsequent infusions at the faster rate. There were no serious IRRs. Conclusion This study demonstrated that rituximab can be administered at the faster infusion rate at the second and subsequent infusions without increasing the rate or severity of IRRs. PMID:24884454

  17. Disseminated juvenile xanthogranuloma associated with follicular lymphoma in an adult: successful treatment with chemotherapy and rituximab. A review of the literature.

    Science.gov (United States)

    Narváez-Moreno, B; Pulpillo-Ruiz, Á; De Zulueta-Dorado, T; Conejo-Mir, J

    2013-04-01

    Juvenile xanthogranuloma is a non-Langerhans cell histiocytosis that typically affects children, but several cases have been reported in adults, some in connection with hematologic malignancies. We present the case of a 61-year-old woman with multiple xanthogranulomas who developed a follicular lymphoma after 4 years of follow-up. After 6 months of treatment with chemotherapy and rituximab, the cutaneous lesions disappeared and the patient achieved remission from lymphoma. We highlight this case because xanthogranuloma is a rare disorder that is difficult to diagnose in adults and also because this is the first report of an association between xanthogranuloma and follicular lymphoma. Excellent response was achieved with chemotherapy and rituximab. Finally, given the possible association between xanthogranulomas and hematologic diseases, these lesions may be a cutaneous manifestation of an occult malignancy. PMID:22681714

  18. Retrospective analysis of a B cell depletion therapy with rituximab in patients with systemic rheumatic autoimmune diseases refractory to standard therapy

    OpenAIRE

    Haasler, Nadja

    2016-01-01

    Objective: To assess the efficacy of rituximab (a chimeric monoclonal anti-CD20 antibody, RTX) in patients with 3 different rheumatic diseases: systemic lupus erythematodes (SLE), granulomatosis with polyangiitis (GPA, Wegener granulomatosis), scleroderma/polymyositis overlap syndrome. Methods: This is a retrospective study of case series of patients and the effects of RTX on clinical, serological and immunological parameters. Therefore we analysed data from 21 patients who had been treate...

  19. Molecular characterization of a variant virus that caused de novo hepatitis B without elevation of hepatitis B surface antigen after chemotherapy with rituximab.

    Science.gov (United States)

    Miyagawa, Masami; Minami, Masahito; Fujii, Kota; Sendo, Rei; Mori, Kojiro; Shimizu, Daisuke; Nakajima, Tomoaki; Yasui, Kohichiroh; Itoh, Yoshito; Taniwaki, Masafumi; Okanoue, Takeshi; Yoshikawa, Toshikazu

    2008-12-01

    Hepatitis B virus (HBV) reactivation in hepatitis B surface antigen (HBsAg)-negative patients following treatment with rituximab has been reported increasingly. The aim of this study was to investigate the molecular mechanisms underlying HBV reactivation in an HBsAg-negative patient. HBV was reactivated in a 75-year-old man following chemotherapy with rituximab, without elevation of HBsAg. The patient's full-length HBV genome was cloned and the entire sequence was determined. Transfection studies were performed in vitro using recombinant wild-type HBV (wild-type), the patient's HBV (patient), and two chimeric HBV constructs, in which the preS/S region of the patient and wild-type virus had been exchanged with one another. Secreted HBsAg and intra- and extra-cellular HBV DNA were measured. The number of amino acid substitutions in HBV from this patient was much higher than in previous reports of HBV mutants, such as occult HBV and vaccine escape HBV mutants. Levels of HBsAg and HBV DNA production in vitro were significantly lower in the patient compared to wild-type transfections. From analyses of the chimeric constructs, the altered preS/S region was responsible mainly for this impairment. These results show that highly mutated HBV can reactivate after chemotherapy with rituximab, despite an unusually large number of mutations, resulting in impaired viral replication in vitro. Severe immune suppression, probably caused by rituximab, may permit reactivation of highly mutated HBV. These findings have important clinical implications for the prevention and management of HBV reactivation and may explain partially the mechanism of recent, unusual cases of HBV reactivation. PMID:19040281

  20. Efficacy of Rituximab in Refractory Inflammatory Myopathies Associated with Anti- Synthetase Auto-Antibodies: An Open-Label, Phase II Trial.

    Directory of Open Access Journals (Sweden)

    Yves Allenbach

    Full Text Available Anti-synthetase syndrome (anti-SS is frequently associated with myositis and interstitial lung disease (ILD. We evaluated prospectively, in a multicenter, open-label, phase II study, the efficacy of rituximab on muscle and lung outcomes.Patients were enrolled if they were refractory to conventional treatments (prednisone and at least 2 immunosuppressants. They received 1 g of rituximab at D0, D15, and M6. The primary endpoint was muscular improvement based on manual muscular testing (MMT10, Kendall score in 10 muscles at M12. Secondary endpoints were normalization of creatine kinase (CK level, ILD improvement based on forced vital capacity and/or diffuse capacity for carbon monoxide, and number and/or doses of associated immunosuppressants.Twelve patients were enrolled, and 10 completed the study. Only 2 patients presented an improvement of at least 4 points on at least two muscle groups (primary end-point. Overall, seven patients had an increase of at least 4 points on MMT10. CK level decreased from 399 IU/L (range, 48-11,718 to 74.5 IU/L (range, 40-47,857. Corticosteroid doses decreased from 52.5 mg/d (range, 10-70 to 9 mg/d (range, 7-65 and six patients had a decrease in the burden of their associated immunosuppressants. At baseline, all 10 patients presented with ILD. At M12, improvement of ILD was observed in 5 out of the 10 patients, stabilization in 4, and worsening in 1.This pilot study of rituximab treatment in patients with refractory anti-SS provided data on evolution of muscular and pulmonary parameters. Rituximab should now be evaluated in a larger, controlled study for this homogenous group of patients.Clinicaltrials.gov NCT00774462.

  1. RITUXIMAB TREATMENT EFFICACY IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS REFRACTORY TO STANDARD THERAPY IN THE LONG-TERM FOLLOW-UP

    OpenAIRE

    M. E. Tsanyan; S K Soloviev; A. V. Torgashina; E N Aleksandrova; S G Radenska-Lopovok; E. V. Nikolaeva; E L Nasonov

    2014-01-01

    Objective. To evaluate the efficacy and safety of rituximab (RTM) treatment in the long-term follow-up of patients with systemic lupus erythematosus (SLE) refractory to standard therapy. Material and methods. RTM therapy was prescribed to 97 SLE patients with high disease activity and insufficient effica- cy of using high doses of glucocorticoids (GC) and cytostatics. The median follow-up time (25th; 75th percentiles) was 18 [12; 36] months. The most common clinical manifestations of SLE incl...

  2. Progressive multifocal leukoencephalopathy secondary to rituximab-induced immunosuppression and the presence of John Cunningham virus: a case report and literature review.

    Science.gov (United States)

    Kelly, Deirdre; Monaghan, Bernadette; McMahon, Eileen; Watson, Geoffrey; Kavanagh, Eoin; O'Rourke, Killian; McCaffrey, John; Carney, Desmond

    2016-09-01

    We present the case of a 60-year-old man who developed subacute neurologic changes, in the setting of stage III non-Hodgkin's follicular lymphoma, and was treated with induction chemotherapy, followed by a year of maintenance rituximab. Magnetic resonance imaging of the brain with gadolinium was pathognomonic for progressive multifocal leukoencephalopathy (PML). He was treated with sequential plasmapheresis and intravenous immunoglobulin with clinical improvement. A literature review of the diagnostic workup of rituximab-induced PML was undertaken. This case and the literature review demonstrate the important role of magnetic resonance imaging of the brain in diagnosis and follow-up of rituximab-induced PML. Specific radiologic features in combination with cerebrospinal fluid can be diagnostic and avoid the morbidity and mortality of a diagnostic brain biopsy. Plasmapheresis and intravenous immunoglobulin have a therapeutic role and demonstrate symptom improvement and disease control. Follow-up imaging in combination with clinical response is important in demonstrating a treatment response. PMID:27594961

  3. The results of sentinel lymph node imaging and biopsy with a novel lymphoscintigraphy agent 99Tcm-Rituximab in 247 breast cancer patients

    International Nuclear Information System (INIS)

    Objective: The feasibility, reliability and influence factors of sentinel lymph node (SLN) imaging and biopsy with a new imaging agent 99Tcm-Rituximab were investigated in 467 breast cancer patients. Methods: The SLN imaging was taken after peritumoral and subdermal injection of 99Tcm-Rituximab guided by ultrasound. Based on the image, the SLN were identified by a gamma probe and removed, the resected SLN were examined pathologically with both HE and immunohistochemical staining. Results: The success rate of SLN imaging was 99.14% (463/467). A total 837 SLN (1.79 per case) were visualized, which located in axilla, internal mammary, subraclavicular and breast region. The success rate of SLN biopsy (SLNB) was 99.57% (465/467), a total 1182 SLN (2.53 per case) were identified. Pathological examination showed that there were 131 patients with 194 metastatic axillary SLN; one case of micrometastases was confirmed by immunohistochemical staining, whose result of HE staining was negative. The following factors, such as age, image time, biopsy history, pathologic type and clinical stage, had no effect on the results of SLN imaging and SLNB. But the SLN metastasis rates were different in patients with different pathologic type and clinical stage(χ2=14.134, 29.184, all P99Tcm-Rituximab showed potential in both SLN imaging and identification in breast cancer patients. (authors)

  4. Successful treatment of HIV-associated multicentric Castleman's disease and multiple organ failure with rituximab and supportive care: a case report

    Directory of Open Access Journals (Sweden)

    Isaacson Peter G

    2010-01-01

    Full Text Available Abstract Introduction Multicentric Castleman's Disease (MCD, a lymphoproliferative disorder associated with Human Herpes Virus-8 (HHV-8 infection, is increasing in incidence amongst HIV patients. This condition is associated with lymphadenopathy, polyclonal gammopathy, hepato-splenomegaly and systemic symptoms. A number of small studies have demonstrated the efficacy of the anti-CD20 monoclonal antibody, rituximab, in treating this condition. Case presentation We report the case of a 46 year old Zambian woman who presented with pyrexia, diarrhoea and vomiting, confusion, lymphadenopathy, and renal failure. She rapidly developed multiple organ failure following the initiation of treatment of MCD with rituximab. Following admission to intensive care (ICU, she received prompt multi-organ support. After 21 days on the ICU she returned to the haematology medical ward, and was discharged in remission from her disease after 149 days in hospital. Conclusion Rituximab, the efficacy of which has thus far been examined predominantly in patients outside the ICU, in conjunction with extensive organ support was effective treatment for MCD with associated multiple organ failure. There is, to our knowledge, only one other published report of its successful use in an ICU setting, where it was combined with cyclophosphamide, adriamycin and prednisolone. Reports such as ours support the notion that critically unwell patients with HIV and haematological disease can benefit from intensive care.

  5. Development of [{sup 62}Zn/{sup 62}Cu]-DOTA-rituximab as a possible novel in vivo PET generator for anti-CD20 antigen imaging

    Energy Technology Data Exchange (ETDEWEB)

    Gholipour, Nazila [Tehran University of Medical Sciences, Tehran (Iran, Islamic Republic of). Dept. of Radiopharmacy; Jalilian, Amir R.; Fazaeli, Yousef; Moradkhani, Sedigheh; Bolourinovin, Fateme [Nuclear Science and Technology Research Institute (NSTRI), Tehran (Iran, Islamic Republic of); Sabzevari, Omid [Tehran University of Medical Sciences, Tehran (Iran, Islamic Republic of). Dept. of Toxicology and Pharmacology; Khalaj, Ali [Tehran University of Medical Sciences, Tehran (Iran, Islamic Republic of). Dept. of Medical Chemistry

    2014-07-01

    In this study, zinc-62 was prepared at radiopharmaceutical grade (for {sup 62}Zn/{sup 62}Cu generator production) using {sup nat}Cu(p, xn) reaction with the production yield of 5.9 mCi/μAh at 30 MeV proton energy (radiochemical separation yield >95%, radionuclidic purity >99% and radiochemical purity >99%). In the next step, rituximab was successively labeled with [{sup 62}Zn]-ZnCl{sub 2} after conjugation with p-SCN-Bz-DOTA followed by molecular filtration and determination of the average number of DOTA conjugated per mAb (6:1) by spectrophotometric method. Radiochemical purity (>97%, measured by ITLC and HPLC), integrity of protein after radiolabeling (gel electrophoresis) and stability of [{sup 62}Zn]-DOTA-rituximab (in final formulation, and human serum) were determined 1-8 h as well as biodistribution studies in wild-type rats followed by coincidence imaging for 6 h. However, the accumulation of the radiolabeled antibody was not consistent with the former reported rituximab conjugates. [{sup 62}Zn]-labeled monoclonal antibodies and fragments can be prepared as potential in vivo PET generators for molecular imaging however, the search for application of stable zinc complexes must be continued.

  6. 利妥昔单抗在儿童血液病中的应用%Rituximab in the treatment of children's hematological disease

    Institute of Scientific and Technical Information of China (English)

    朱嘉莳; 蒋慧

    2013-01-01

    抗CD20人鼠嵌合型单克隆抗体利妥昔单抗可通过多种机制杀伤B细胞,目前广泛应用于治疗CD20阳性淋巴瘤以及某些免疫相关性疾病,如免疫性血小板减少性紫癜、自身免疫性溶血性贫血、Evans综合征、移植后淋巴增殖性疾病和系统性红斑狼疮等.本文综述利妥昔单抗在儿童血液病中的临床应用.%Rituximab is a chimeric mouse-human monoclonal antibody against the CD 20 antigen, which can kill the B cell. Rituximab is widely used in patients with CD20 positive lymphoma and some other immune related diseases, such as immune thrombocytopenic purpura, autoimmune hemolytic anemia, Evans syndrome, post transplant lymphoproliferative disease and systemic lupus erythematosus. This review summarizes the research progress of rituximab in the treatment of children with hematological disease.

  7. Impact of relative dose intensity (RDI in CHOP combined with rituximab (R-CHOP on survival in diffuse large B-cell lymphoma

    Directory of Open Access Journals (Sweden)

    Koh Ki-Ryang

    2009-08-01

    Full Text Available Abstract Background Recently, maintaining higher relative dose intensity (RDI of chemotherapeutic drugs has become a widespread practice in an attempt to achieve better outcomes in the treatment of aggressive lymphoma. The addition of rituximab to chemotherapy regimens has significantly improved outcome in diffuse large B-cell lymphoma (DLBL. However, it is unknown if higher RDI in chemotherapy when combined with rituximab leads to a better outcome in aggressive B-cell lymphoma. Methods We retrospectively evaluated the impact of the RDI of initial chemotherapy (consisting of cyclophosphamide, doxorubicin, vincristine and prednisolone with rituximab (R-CHOP on outcome in 100 newly diagnosed DLBL patients. Results A multivariate Cox regression model showed that RDI trended towards a significant association with mortality [hazard ratio per 0.1 of RDI = 0.8; 95% confidence interval 0.6–1.0; P = 0.08]. Additionally, on multivariate logistic analysis, advanced age was a significant factor for reduced RDI. Conclusion Our data suggest that in DLBL patients, mortality was affected by RDI of R-CHOP as the initial treatment, and the retention of a high RDI could therefore be crucial.

  8. Chimaeric anti-CD20 monoclonal antibody (rituximab) in post-transplant B-lymphoproliferative disorder following stem cell transplantation in children.

    Science.gov (United States)

    Faye, A; Quartier, P; Reguerre, Y; Lutz, P; Carret, A S; Dehée, A; Rohrlich, P; Peuchmaur, M; Matthieu-Boué, A; Fischer, A; Vilmer, E

    2001-10-01

    Post-transplant lymphoproliferative disorder (PTLD) after haemopoietic stem cell transplantation is a serious complication that occurs in 8-22% of patients with high-risk factors. We retrospectively investigated tolerance and efficacy of humanized anti-CD20 monoclonal antibody (rituximab) as first-line treatment in 12 children with B-cell PTLD. At diagnosis, eight patients had tumoral involvement. The other four patients had fever, associated with raised Epstein-Barr virus (EBV) viral load and monoclonal gammopathy. Rituximab was given at the dose of 375 mg/m2 once a week by intravenous infusion (1-9 infusions). Only 1/48 infusions was associated with a grade 2 clinical adverse event. Eight out of 12 (66%) patients responded to the treatment and were in complete remission. All patients without tumoral involvement responded to the treatment. A rapid decrease in fever within 1 week was observed in all responders. Non-responders did not show any clinical response during the first week. Tumoral involvement and immunodepression seemed to be more marked in non-responders. Rituximab was an effective and well-tolerated treatment of B-cell PTLD. Early treatment before tumoral involvement seemed to be the most effective approach. Lack of rapid response should lead to intensification of PTLD treatment. Pre-emptive treatment should be considered and evaluated in further longitudinal multicentre studies.

  9. Acquired haemophilia A in a patient with chronic hepatitis C virus infection receiving treatment with pegylated interferon plus ribarivin: role of rituximab.

    Science.gov (United States)

    Fernández de Palencia Espinosa, M Á; Arocas Casañ, V; Garrido Corro, B; de la Rubia Nieto, A

    2013-01-01

    Antecedentes: la hemofilia adquirida es un trastorno infrecuente causado por el desarrollo de inhibidores del factor de coagulación. Para eliminarlos, se requiere tratamiento con corticoides y fármacos citotóxicos. Métodos: describimos el caso del uso de rituximab en hemofilia adquirida refractaria al tratamiento convencional en un hombre de 63 años con infección crónica por el virus de la hepatitis C y que estaba recibiendo tratamiento con interferón pegilado a-2a y ribarivina. Resultados: tras 21 semanas de tratamiento antivírico, el paciente fue ingresado en el hospital por un gran hematoma en la musculatura abdominal. La concentración de factor VIII era nula y el título de inhibidor fue de 345 unidades Bethesda. Se administró tratamiento inmunosupresor oral con metilprednisolona y ciclofosfamida durante 1 mes, con escasa mejoría. Así pues, se sustituyó la ciclofosfamida por una dosis semanal de rituximab intravenoso. Dos meses después, la concentración de factor VIII se normalizó y el título de inhibidor era indetectable. Conclusión: Rituximab puede ser útil en el tratamiento de la hemofilia adquirida resistente al tratamiento estándar.

  10. Rituximab use in young adults diagnosed with juvenile idiopathic arthritis unresponsive to conventional treatment: report of 6 cases.

    Science.gov (United States)

    Sakamoto, Ana Paula; Pinheiro, Marcelo M; Barbosa, Cássia Maria Passarelli Lupoli; Fraga, Melissa Mariti; Len, Claudio Arnaldo; Terreri, Maria Teresa

    2015-01-01

    Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in childhood. Without an effective therapy, patients may progress quickly to functional disability. Recently, depletion of B cells emerged as a new approach for the treatment of autoimmune diseases, including JIA. We describe six cases of JIA patients followed at a referral center for Rheumatology and Pediatric Rheumatology, submitted to treatment with rituximab (RTX) after refractoriness to three anti-TNF agents. Patients received RTX cycles with two infusions every six months. Response to treatment was assessed by DAS28, HAQ/CHAQ, and an overall assessment by the doctor and the patient. Of our six patients, four were girls (mean age at onset of disease: 6.1 years; mean disease evolution time: 15.1 years; mean age upon receiving RTX: 21.6 years). Four patients belonged to polyarticular subtype (1 rheumatoid factor [RF]-negative, 3 FR-positive), a patient with systemic JIA subtype with a polyarticular course and arthritis related to enthesitis. Of our six patients, five responded to treatment; and during the course of 12 months, the clinical response was maintained, although not sustained. However, discontinuation by infusion reactions caused the withdrawal of RTX in two patients. The use of RTX in JIA is restricted to cases refractory to other biological agents and, even considering that this study was held in a small number of advanced patients, RTX proved to be an effective therapeutic option.

  11. Risk Factors and Adverse Events Poorly Predict Infections and Hypogammaglobulinemia in Granulomatosis with Polyangiitis Patients Receiving Rituximab

    Directory of Open Access Journals (Sweden)

    Emilio Besada

    2016-01-01

    Full Text Available Background. 29 GPA patients from the Northern Norway vasculitis disease registry received rituximab (RTX induction and maintenance. 24% and 31% had, respectively, severe and chronic infections while 45% had hypogammaglobulinemia and 28% discontinued RTX due to hypogammaglobulinemia. The aim of the study was to examine how known predictors and adverse events interacted with adverse events using structural statistical methods. Methods. Five predictors (age, cyclophosphamide, total Ig and CD4/CD8 ratio prior RTX, and type of RTX maintenance regimen and 4 adverse events (severe and chronic infections, hypogammaglobulinemia, and RTX discontinuation were modeled in principal component and redundancy analyses. Results. The 5 predictors explained 51% of the variance of the GPA cohort. Models including cyclophosphamide exposure and total Ig level predicted best adverse events. However total Ig level has low R squared. The 2 best combinations of adverse events explained 13% of the variance of the predictors and adverse events. Only chronic infections were associated with combination of all adverse events (P=0.014. Hypogammaglobulinemia did not seem associated with the other adverse events. Conclusions. Traditional risk factors for infections and hypogammaglobulinemia seemed to poorly predict adverse events in our GPA cohort.

  12. Combination therapy for rheumatoid arthritis with rituximab and leflunomide(preliminary results of the Russian ARBITR Registry

    Directory of Open Access Journals (Sweden)

    Evgeniy L'vovich Nasonov

    2011-01-01

    Full Text Available The paper analyzes the efficiency and tolerability of a combination of rituximab (RTM and leflunomide (LEF for the treatment of rheumatoid arthritis (RA versus the conventional combination of RTM and methotrexate (MT. The results of 24-week therapy were assessed in the RA patients included into the Russian Biological Therapy Register. A good effect of therapy was achieved in 31.8% of the patients who had received RTM+LEF (p = 0.1. The development of clinical remissions in RA was observed at a practically equal frequency of 13.6 and 11.7%, respectively. The doses of glucocorticoids and nonsteroidal anti-inflammatory drugs used in concurrent anti-inflammatory therapy could be substantially reduced in both groups. In both groups, the rate of side effects was very equal: 21.7% for the RTM+LEF group and 25.7% for the RTM+MT group. Thus, the combination therapy of RTM and LEF in real clinical practice is not considerably different from the most commonly used combination of RMT and MT in efficiency and tolerability and may be successfully used if there are any contraindications to the use of MT.

  13. The Effects of Rituximab on Lipids, Arterial Stiffness and Carotid Intima-Media Thickness in Rheumatoid Arthritis

    Science.gov (United States)

    2016-01-01

    The aim of the study was to examine lipid profiles, arterial stiffness (AS), carotid intima-media thickness (cIMT), in 55 women with RA without overt cardiovascular disease (СVD) treated with rituximab (RTX).The following parameters were recorded before and 24 weeks after RTX therapy (2 infusions of 500 or 1,000 mg RTX intravenously, fortnightly): plasma total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides, DAS 28-ESR, serum C-reactive protein (CRP), RF IgM, AS (SI - stiffness index, RI – reflection index) by digital volume pulse contour analysis (Micro Medical, UK), and common cIMT by high-resolution B-mode carotid ultrasound. Based on the European League Against Rheumatism (EULAR) criteria, patients were divided into two groups: 1) moderate/good response to RTX therapy after 24 weeks (41 patients, 75%), 2) no response to RTX therapy (14 patients, 25%). Effective RTX therapy resulted in 9% increase in TC, 23% increase in HDL-C and 14% decrease in atherogenic index, 57% decrease in SI and 24% decrease in RI. We observed a 9% decrease of cIMTmax at 24 weeks. The improvement of cardiovascular parameters was accompanied by statistically significant decreases of CRP, ESR, RF IgM and DAS 28 in group 1 (P therapy exerted favorable effects on lipid profile, AS and cIMT in women with RA without overt CVD. PMID:26839473

  14. Púrpura trombocitopênica trombótica - remissão completa em paciente com mau prognóstico após tratamento com plasmaférese terapêutica e rituximabe Successful outcome in poor-prognostic acute thrombotic thrombocytopenic purpura treated with plasma exchange and rituximab

    Directory of Open Access Journals (Sweden)

    Cesar de Almeida Neto

    2008-02-01

    Full Text Available A púrpura trombocitopênica trombótica (PTT é uma doença rara e fatal que deve ser diagnosticada e tratada prontamente a fim de se obter melhor resposta terapêutica. Apresentamos um caso de PTT aguda grave tratada com plasmaférese e rituximabe. Ao diagnóstico, a paciente apresentava anemia hemolítica microangiopática, icterícia, febre, convulsões, seguidas por coma e choque hipovolêmico. Os exames laboratoriais iniciais mostravam DHL=2.860 IU/L, contagem de plaquetas de 37 x 10(9/L, hemoglobina de 5,1 g/dL e no esfregaço de sangue periférico havia a presença de esquizócitos. Iniciado tratamento para PTT com pulsoterapia com metilprednisolona e plasmaféreses terapêuticas diárias com troca de uma volemia plasmática e substituição com plasma fresco congelado. Após cinco sessões de plasmaférese, houve piora no quadro neurológico, acompanhado por aumento importante de DHL, ALT, AST e a contagem de plaquetas era de 72 x 10(9/L. Iniciamos o uso de rituximabe na dose padrão de 375mg/m²/semana/4 semanas e passamos a utilizar plasma pobre em crioprecipitado como reposição durante as plasmaféreses. Dois dias após a mudança na conduta terapêutica, houve importante melhora do quadro neurológico, estabilização da contagem de plaquetas e queda acentuada de DHL. Após 23 procedimentos de plasmaférese e quatro doses de rituximabe, a paciente apresentou remissão completa, mantida há 34 meses. A plasmaférese terapêutica com plasma pobre em crioprecipitado e o uso concomitante de rituximabe foi uma estratégia útil no tratamento deste caso de PTT aguda grave. Porém, ensaios clínicos prospectivos e randomizados são necessários para confirmar estes achados.Thrombotic thrombocytopenic purpura (TTP is a rare severe disease that must be diagnosed and treated promptly for a successful outcome. We report a case of severe acute TTP treated with plasma exchange and rituximab. The patient presented at diagnosis with severe

  15. Feasibility and toxicity of concomitant radio/immunotherapy with MabThera (Rituximab {sup registered}) for patients with non-Hodgkin's lymphoma. Results of a prospective phase I/II study

    Energy Technology Data Exchange (ETDEWEB)

    Haidenberger, Alfred; Popper, Bela-Andre; Skvortsova, Ira; Lukas, Peter [Medical Univ. Innsbruck (Austria). Dept. of Radiotherapy/Radiooncology; Fromm-Haidenberger, Sabine [Hospital Gmunden (Austria). Inst. of Radiology; Vries, Alexander de [Hospital Feldkirch (Austria). Dept. of Radiotherapy/Radiooncology; Steurer, Michael; Kantner, Johanna; Gunsilius, Eberhard [Medical Univ. Innsbruck (Austria). Dept. of Hematology

    2011-05-15

    Purpose: Non-Hodgkin's lymphomas (NHL) have a high radio- and chemosensitivity. Although initially responsive, approximately 50% of low grade B-cell lymphomas relapse after 10-15 years. Besides chemo- and radiotherapy, rituximab, a mouse/human chimeric antibody targeting CD20 antigen on the surface of B-cell lymphoma cells, is another treatment approach. In vitro data showed potentiation of radiation-induced apoptosis by addition of rituximab. The purpose of this study was to evaluate the feasibility and toxicity of radiotherapy with concomitant application of rituximab in NHL patients. Patients and Methods: A total of 21 patients with B-cell lymphoma (stage I: n = 11; II: n = 5; III: n = 1; IV: n = 4) were included in this study, treated with radiotherapy of 30-40 Gy and weekly application of rituximab (375 mg/m{sup 2}). Nine patients had R-CHOP chemotherapy previously, 1 patient leuceran chemotherapy, and 2 patients an initial treatment with 6 cycles of rituximab. Mean time of follow-up was 41.7 months. Results: No grade 4 toxicity or treatment-related death was observed. In 1 patient, rituximab application had to be stopped after 3 cycles due to radiation-induced side effects. No late toxicities were reported. All patients were in complete remission after treatment. Progression or relapse was observed in 6 patients (28%); the mean time to progression was 27 months. The mean overall survival (OS) was 53 months. Conclusion: Combined radio/immunotherapy is feasible and safe. Treatment was well tolerated, no late toxicities were observed, and treatment outcome is promising. Randomized trials are necessary to clarify the benefit of this treatment approach and its applicability. (orig.)

  16. Feasibility and toxicity of concomitant radio/immunotherapy with MabThera (Rituximab registered) for patients with non-Hodgkin's lymphoma. Results of a prospective phase I/II study

    International Nuclear Information System (INIS)

    Purpose: Non-Hodgkin's lymphomas (NHL) have a high radio- and chemosensitivity. Although initially responsive, approximately 50% of low grade B-cell lymphomas relapse after 10-15 years. Besides chemo- and radiotherapy, rituximab, a mouse/human chimeric antibody targeting CD20 antigen on the surface of B-cell lymphoma cells, is another treatment approach. In vitro data showed potentiation of radiation-induced apoptosis by addition of rituximab. The purpose of this study was to evaluate the feasibility and toxicity of radiotherapy with concomitant application of rituximab in NHL patients. Patients and Methods: A total of 21 patients with B-cell lymphoma (stage I: n = 11; II: n = 5; III: n = 1; IV: n = 4) were included in this study, treated with radiotherapy of 30-40 Gy and weekly application of rituximab (375 mg/m2). Nine patients had R-CHOP chemotherapy previously, 1 patient leuceran chemotherapy, and 2 patients an initial treatment with 6 cycles of rituximab. Mean time of follow-up was 41.7 months. Results: No grade 4 toxicity or treatment-related death was observed. In 1 patient, rituximab application had to be stopped after 3 cycles due to radiation-induced side effects. No late toxicities were reported. All patients were in complete remission after treatment. Progression or relapse was observed in 6 patients (28%); the mean time to progression was 27 months. The mean overall survival (OS) was 53 months. Conclusion: Combined radio/immunotherapy is feasible and safe. Treatment was well tolerated, no late toxicities were observed, and treatment outcome is promising. Randomized trials are necessary to clarify the benefit of this treatment approach and its applicability. (orig.)

  17. Predictors of Local Recurrence After Rituximab-Based Chemotherapy Alone in Stage III and IV Diffuse Large B-Cell Lymphoma: Guiding Decisions for Consolidative Radiation

    Energy Technology Data Exchange (ETDEWEB)

    Jegadeesh, Naresh; Rajpara, Raj; Esiashvili, Natia; Shi, Zheng [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Liu, Yuan [Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Department of Biostatistics and Bioinformatics Shared Resource, Emory University, Atlanta, Georgia (United States); Okwan-Duodu, Derrick [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Flowers, Christopher R. [Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Department of Medical Oncology, Emory University, Atlanta, Georgia (United States); Khan, Mohammad K., E-mail: drkhurram2000@gmail.com [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States)

    2015-05-01

    Purpose: The role of consolidative radiation therapy (RT) for stage III and IV diffuse large B-cell lymphoma (DLBCL) in the era of rituximab is not well defined. There is evidence that some patients with bulky disease may benefit, but patient selection criteria are not well established. We sought to identify a subset of patients who experienced a high local failure rate after receiving rituximab-based chemotherapy alone and hence may benefit from the addition of consolidative RT. Methods and Materials: Two hundred eleven patients with stage III and IV DLBCL treated between August 1999 and January 2012 were reviewed. Of these, 89 had a complete response to systemic therapy including rituximab and received no initial RT. Kaplan-Meier analysis and Cox proportional hazards regression were performed, with local recurrence (LR) as the primary outcome. Results: The median follow-up time was 43.9 months. Fifty percent of patients experienced LR at 5 years. In multivariate analysis, tumor ≥5 cm and stage III disease were associated with increased risk of LR. The 5-year LR-free survival was 47.4% for patients with ≥5-cm lesions versus 74.7% for patients with <5-cm lesions (P=.01). In patients with <5-cm tumors, the maximum standardized uptake value (SUVmax) was ≥15 in all patients with LR. The 5-year LR-free survival was 100% in SUV<15 versus 68.8% in SUV≥15 (P=.10). Conclusions: Advanced-stage DLBCL patients with stage III disease or with disease ≥5 cm appear to be at an increased risk for LR. Patients with <5-cm disease and SUVmax ≥15 may be at higher risk for LR. These patients may benefit from consolidative RT after chemoimmunotherapy.

  18. Strikingly high false positivity of surveillance FDG-PET/CT scanning among patients with diffuse large cell lymphoma in the rituximab era.

    Science.gov (United States)

    Avivi, Irit; Zilberlicht, Ariel; Dann, Eldad J; Leiba, Ronit; Faibish, Tal; Rowe, Jacob M; Bar-Shalom, Rachel

    2013-05-01

    Predictive value (PV) of surveillance fluorodeoxyglucose positron emission tomography (FDG-PET) in patients with diffuse large B-cell lymphoma (DLBCL) treated with chemotherapy-rituximab (R) versus chemotherapy only, remains unclear. The aim of the current study was to compare the performance of surveillance PET in DLBCL patients receiving CHOP (cyclophosphamide, hydroxydaunorubicin hydrochloride, vincristine, and prednisone) alone versus CHOP-R. Institutional database was retrospectively searched for adults with newly diagnosed DLBCL, receiving CHOP or CHOP-R, who achieved complete remission and underwent surveillance PETs. Follow-up (FU) PET was considered positive for recurrence in case of an uptake unrelated to physiological or known benign process. Results were confirmed by biopsy, imaging and clinical FU. One hundred nineteen patients, 35 receiving CHOP and 84 CHOP-R, who underwent 422 FU-PETs, were analyzed. At a median PET-FU of 3.4 years, 31 patients relapsed (17 vs. 14, respectively; P = 0.02). PET detected all relapses, with no false-negative studies. Specificity and positive PV (PPV) were significantly lower for patients receiving CHOP-R vs. CHOP (84% vs. 87%, P = 0.023; 23% vs. 74%, P CHOP-R (77% vs. 26%, P < 0.001). In the latter group, FP-rate remained persistently high up to 3 years post-therapy. Multivariate analysis confirmed rituximab to be the most significant predictor for FP-PET. In conclusion, routine surveillance FDG-PET is not recommended in DLBCL treated with rituximab; strict criteria identifying patients in whom FU-PET is beneficial are required. PMID:23423884

  19. The FCGR3A polymorphism predicts the response to rituximab-based therapy in patients with non-Hodgkin lymphoma: a meta-analysis.

    Science.gov (United States)

    Liu, Duo; Tian, Yuyang; Sun, Donglin; Sun, Haiming; Jin, Yan; Dong, Mei

    2016-09-01

    Epidemiological studies have assessed the association between Fc gamma receptor IIIA (FCGR3A) 158 V/F and the response to rituximab-based therapy in patients with non-Hodgkin lymphoma (NHL), but the findings have been inconsistent. We performed this meta-analysis to obtain a better assessment of this relationship. Electronic database searches were conducted for relevant studies. A pooled odds ratio (OR) with a 95 % confidence interval (95 % CI) was used to assess the strength of the association. Analyses of the subgroup and publication bias were conducted. A total of 10 studies involving 1050 patients were analyzed. In all the genetic models, no clear relationship was found between the FCGR3A 158 V/F polymorphism and the response to rituximab-based therapy in NHL patients. When categorized by ethnicity, Asian individuals with the FCGR3A 158 V/V allele (OR = 4.37; 95 % CI = 1.07-17.73; P = 0.039) or the non-F/(FV + VV) (OR = 2.50; 95 % CI = 1.04-5.98; P = 0.040) allele have a significantly higher complete response rate (CR) compared to FF individuals. No obvious heterogeneities were observed. In addition, no statistical evidence for a publication bias was found. Our study suggested that the FCGR3A 158 V/F polymorphism can predict the treatment response to rituximab-based chemotherapy in NHL patients, especially for Asian individuals. PMID:27431582

  20. Alisertib added to rituximab and vincristine is synthetic lethal and potentially curative in mice with aggressive DLBCL co-overexpressing MYC and BCL2.

    Directory of Open Access Journals (Sweden)

    Daruka Mahadevan

    Full Text Available Pearson correlation coefficient for expression analysis of the Lymphoma/Leukemia Molecular Profiling Project (LLMPP demonstrated Aurora A and B are highly correlated with MYC in DLBCL and mantle cell lymphoma (MCL, while both Auroras correlate with BCL2 only in DLBCL. Auroras are up-regulated by MYC dysregulation with associated aneuploidy and resistance to microtubule targeted agents such as vincristine. Myc and Bcl2 are differentially expressed in U-2932, TMD-8, OCI-Ly10 and Granta-519, but only U-2932 cells over-express mutated p53. Alisertib [MLN8237 or M], a highly selective small molecule inhibitor of Aurora A kinase, was synergistic with vincristine [VCR] and rituximab [R] for inhibition of cell proliferation, abrogation of cell cycle checkpoints and enhanced apoptosis versus single agent or doublet therapy. A DLBCL (U-2932 mouse model showed tumor growth inhibition (TGI of ∼ 10-20% (p = 0.001 for M, VCR and M-VCR respectively, while R alone showed ∼ 50% TGI (p = 0.001. M-R and VCR-R led to tumor regression [TR], but relapsed 10 days after discontinuing therapy. In contrast, M-VCR-R demonstrated TR with no relapse >40 days after stopping therapy with a Kaplan-Meier survival of 100%. Genes that are modulated by M-VCR-R (CENP-C, Auroras play a role in centromere-kinetochore function in an attempt to maintain mitosis in the presence of synthetic lethality. Together, our data suggest that the interaction between alisertib plus VCR plus rituximab is synergistic and synthetic lethal in Myc and Bcl-2 co-expressing DLBCL. Alisertib plus vincristine plus rituximab [M-VCR-R] may represent a new strategy for DLBCL therapy.

  1. Rituximab for managing acquired hemophilia A in a case of chronic neutrophilic leukemia with the JAK2 kinase V617F mutation

    Directory of Open Access Journals (Sweden)

    Okuno N

    2012-12-01

    Full Text Available Shinsaku Imashuku,1 Naoko Kudo,1 Kagekatsu Kubo,1 Katsuyasu Saigo,1 Nanako Okuno,2 Kaoru Tohyama21Division of Hematology, Takasago-seibu Hospital, Takasago, Japan; 2Department of Laboratory Medicine, Kawasaki Medical School, Kurashiki, JapanBackground: Acquired hemophilia A is rarely found in association with myeloproliferative neoplasms, such as the JAK2 kinase V617F mutation-positive chronic neutrophilic leukemia (CNL.Case report: An 80-year-old Japanese male was diagnosed with acquired hemophilia A. He had compartment-like symptoms due to soft tissue hemorrhage in his left forearm and right lower extremity. A blood examination showed neutrophilia with a white blood cell count of 31,900/µL (91.9% neutrophils, an activated partial thromboplastin time of 69.0 seconds, coagulation factor VIII (FVIII < 1.0%, and anti-FVIII inhibitor, 190 BU/mL. The bleeding episodes were controlled with intravenous activated prothrombin complex concentrate (FEIBA® followed by recombinant factor VIIa (NovoSeven®. In addition, oral prednisolone (maximum dose, 30 mg/day plus four doses of rituximab effectively suppressed anti-FVIII inhibitor levels while simultaneously reducing the neutrophil count. CNL with the JAK2 kinase V617F mutation was identified as the underlying disease.Conclusion: This report describes the effectiveness of a combination of prednisolone and rituximab in managing acquired hemophilia A in an elderly man with a rare case of JAK2 kinase V617F mutation-positive CNL.Keywords: acquired hemophilia A, chronic neutrophilic leukemia, JAK2 kinase, V617 mutation, rituximab

  2. Avaliação do efeito da associação do Rituximab ao protocolo de quimioterapia ciclofosfamida, doxorrubicina, vincristina e prednisolona (CHOP) no tratamento de linfomas Não-Hodgkin

    OpenAIRE

    Fuste, P.; Pereira, C; A Reis; V. Serrano; Caetano, Liliana Aranha; Costa, Ana Margarida

    2010-01-01

    O protocolo de quimioterapia ciclofosfamida, doxorrubicina, vincristina e prednisolona (CHOP) e, posteriormente, rituximab, ciclofosfamida, doxorrubicina, vincristina e prednisolona (RCHOP) têm sido utilizados como terapêutica em Linfomas não-Hodgkin (LNH) como o Linfoma Difuso de Grandes Células B (LDGCB) e o Linfoma Folicular (LF). O LDGCB constitui o tipo de LNH mais frequente, com uma incidência de 40% e o LF representa cerca de 25% de todos os LNH-B. O anticorpo monoclonal rituximab foi ...

  3. Preparation and radiolabeling of a lyophilized (kit) formulation of DOTA-rituximab with 90Y and 111In for domestic radioimmunotherapy and radioscintigraphy of Non-Hodgkin’s Lymphoma

    OpenAIRE

    Gholipour, Nazila; Jalilian, Amir Reza; Khalaj, Ali; Johari-Daha, Fariba; Yavari, Kamal; Sabzevari, Omid; Khanchi, Ali Reza; AKHLAGHI, MEHDI

    2014-01-01

    Background On the basis of results of our previous investigations on 90Y-DTPA-rituximab and in order to fulfil national demands to radioimmunoconjugates for radioscintigraphy and radioimmunotherapy of Non-Hodgkin’s Lymphoma (NHL), preparation and radiolabeling of a lyophilized formulation (kit) of DOTA-rituximab with 111In and 90Y was investigated. Methods 111In and 90Y with high radiochemical and radionuclide purity were prepared by 112Cd (p,2n)111In nuclear reaction and a locally developed ...

  4. Diffuse Large B-Cell Lymphoma Transformed from Mucosa-Associated Lymphoid Tissue Lymphoma Arising in a Female Urethra Treated with Rituximab for the First Time

    OpenAIRE

    Zahrani, A. Al; Abdelsalam, M.; Fiaar, A. Al; Ibrahim, N.; Al-Elawi, A.; Muhammad, B

    2012-01-01

    A 30-year-old female patient presented to the gynecology clinic with a small (painless) swelling at the urethral orifice. She underwent surgical excision of the lesion. Pathological examination revealed non-Hodgkin's lymphoma of diffuse large B-cell type and mucosa-associated lymphoid tissue type, stage IE. The patient refused radiotherapy. Accordingly, we started CHOP-R chemotherapy. She received a total of 6 cycles of CHOP and 8 cycles of rituximab. Patient follow-up was done 3 months later...

  5. Serum BLyS levels increase after rituximab as initial therapy in patients with follicular grade 1 non-Hodgkin lymphoma

    OpenAIRE

    Ansell, Stephen M.; Anne J Novak; Ziesmer, Steven; Price-Troska, Tammy; LaPlant, Betsy; Dillon, Stacey R.; Witzig, Thomas E.

    2009-01-01

    Serum B-lymphocyte stimulator (BLyS) levels are elevated in a subset of non-Hodgkin lymphoma (NHL) patients, particularly those with a family history of B-cell malignancies or a polymorphism in the BLyS gene. BLyS promotes growth of malignant B-cells and increased serum BLyS levels are associated with a poor clinical outcome. In this study, BLyS levels were measured before and after 4 weekly doses of rituximab in 30 patients with previously untreated follicular Grade 1 NHL. A significant incr...

  6. Rituximab enhances radiation-triggered apoptosis in non-Hodgkin's lymphoma cells via caspase-dependent and - independent mechanisms

    International Nuclear Information System (INIS)

    Rituximab (RTX), a chimeric human anti-CD20 monoclonal antibody, is currently employed in the treatment of malignant non-Hodgkin's lymphoma (NHL) either alone or in combination with other cytotoxic approaches. The present study examines the effects of ionizing radiation in combination with RTX on proliferation and apoptosis development in B-lymphoma RL and Raji cells. RTX was used at a concentration of 10 μg/mL 24 hours prior to irradiation at a single dose of 9 Gy. CD20 expression, cell viability, apoptosis, mitochondrial membrane potential and apoptosis-related proteins were evaluated in the treated B cells. The constitutive level of CD20 expression in RL and Raji lymphoma cells did not play an essential role in RTX-induced cell growth delay. Both lymphoma cells showed similar inhibition of cell proliferation without apoptosis development in response to RTX treatment. Exposure to ionizing radiation induced cell growth delay and apoptosis in RL cells, whereas Raji cells showed moderate radio-resistance and activation of cell growth at 24 hours after irradiation, which was accompanied by increased radiation-triggered CD20 expression. The simultaneous exposure of lymphoma cells to ionizing radiation and RTX abrogated radioresistance of Raji cells and significantly enhanced cell growth delay and apoptosis in RL cells. X-linked inhibitor of apoptosis protein (XIAP) and the inducible form of heat shock protein 70 (Hsp70) were positively modulated by RTX in combination with ionizing radiation in order to induce apoptosis. Furthermore, it was demonstrated that mitochondrial membrane potential dissipation is not an essential component to induce apoptosis-inducing factor (AIF) maturation and apoptosis. Our results show that RTX-triggered enhancement of radiation-induced apoptosis and cell growth delay is achieved by modulation of proteins involved in programmed cell death. (author)

  7. Thyroid Remnant Estimation by Diagnostic Dose I131 Scintigraphy or TcO4-99m Scintigraphy after Thyroidectomy: A Comparison with Therapeutic Dose I131 Imaging

    Directory of Open Access Journals (Sweden)

    Guanghui Liu

    2016-01-01

    Full Text Available In this clinical study, we have compared routine diagnostic dose 131I scan and TcO4-99m thyroid scintigraphy with therapeutic dose 131I imaging for accurate thyroid remnant estimation after total thyroidectomy. We conducted a retrospective review of the patients undergoing total thyroidectomy for differentiated thyroid carcinoma (DTC and subsequently receiving radioactive iodine (RAI treatment to ablate remnant thyroid tissue. All patients had therapeutic dose RAI whole body scan, which was compared with that of diagnostic dose RAI, TcO4-99m thyroid scan, and ultrasound examination. We concluded that therapeutic dose RAI scan reveals some extent thyroid remnant in all DTC patients following total thyroidectomy. Diagnostic RAI scan is much superior to ultrasound and TcO4-99m thyroid scan for the postoperative estimation of thyroid remnant. Ultrasound and TcO4-99m thyroid scan provide little information for thyroid remnant estimation and, therefore, would not replace diagnostic RAI scan.

  8. Thyroid dose of I-131 absorbed by the internal organs of a pregnant woman; Dosis tiroidea de I-131 absorbida por los organos internos de una embarazada

    Energy Technology Data Exchange (ETDEWEB)

    Arcos P, A.; Manzanares A, E.; Vega C, H.R.; Leon, C.L. de [Cuerpo Academico de Radiobiologia de la Universidad Autonoma de Zacatecas (Mexico)]. e-mail: emanz_44@yahoo.com

    2007-07-01

    The use of nuclear techniques, for diagnosis or treatment, generates stress in the patient and its relatives. During the pregnancy some sufferings related with the thyroid gland can be presented. If the patient is pregnant, OEP or NOEP, the stress comes from the fear to that the product can it turns affected. The dose is calculated that the Iodine 131, captured by the thyroid of a woman with three months of pregnancy, it deposits in the brain, stomach, heart, kidneys, liver, lungs, ovaries, pancreas, thymus, spleen and in the uterus. The thymus is the organ that receives the biggest dose. (Author)

  9. Rituximab plus Ifosfamide, Carboplatin and Etoposide for T-Cell/Histiocyte-Rich B-Cell Lymphoma Arising in Nodular Lymphocyte-Predominant Hodgkin’s Lymphoma

    Directory of Open Access Journals (Sweden)

    Hyung-Chul Park

    2012-08-01

    Full Text Available A small subset of patients with nodular lymphocyte-predominant Hodgkin’s lymphoma (NLPHLs develop a non-Hodgkin lymphoma either concurrently or subsequently, usuallyT-cell/histiocyte-rich B-cell lymphomas (T/HRBCL, which are subtypes of diffuse large B-cell lymphomas (DLBCL. The standard treatment of DLBCL patients is rituximab-based chemotherapy with cyclophosphamide, adriamycin, vincristine and prednisolone. However, the administration of this chemotherapy regimen to patients with DLBCL arising in NLPHL brings concern about the cardiac toxicity of anthracycline because the majority of these patients had already received anthracycline-based chemotherapy with doxorubicin, bleomycin, vinblastine and dacarbazine at the time of NLPHL. Herein, we report 2 patients with sequential transformation of NLPHL to T/HRBCL. They initially presented with limited-stage NLPHL and subsequently developed T/HRBCL after 16 and 8 months, respectively. At the time of T/HRBCL, they were treated with rituximab, ifosfamide, carboplatin and etoposide, and complete responses were obtained.

  10. A comparative study of preliminary dosimetry for human based on distribution data in rats with 111In, 90Y, 153Sm, and 177Lu labeled rituximab

    Directory of Open Access Journals (Sweden)

    Radfar Edalat

    2012-01-01

    Full Text Available Radio immunotherapy is one of the most important and effective therapies for B-cell non Hoddgkin’s lymphoma treatment. Today, anti CD-20 antibodies labeled with beta emitter radionuclides are used in radio immunotherapy. Various radionuclides for labeling anti CD-20 antibodies have been studied and developed for the treatment and diagnosis of malignancies. This paper describes the preparation, bio-distribution and absorbed dose rate of 111In, 90Y, 177Lu, and 153Sm labeled anti CD-20 antibodies (rituximab in human organs, after injection to rats. The macro cyclic bifunctional chelating agent, N-succinimidyl-1, 4, 7, 10-tetraazacyclododecane-1, 4, 7, 10-tetraacetic acid (DOTA-NHS for conjugation to antibody, was used to prepare DOTA-rituximab. The conjugates were purified by molecular filtration, the average number of DOTA conjugated per mAb was calculated and total concentration was determined by spectrophotometric method. Radio-labeling was performed at 40 °C for 24 hours. After the quality control studies, the final radioactive solution was injected intravenously into rats through their tail vein. The tissue uptakes of each injection were measured. Then we calculated S values for 177Lu and 153Sm by using specific absorbed fractions and data used in the manner of radio-labeled analysis and dosimetry for humans. The absorbed dose rate of each organ was calculated in the specific time by medical internal radiation dose method with linear approximation in the activity measurements.

  11. Central nervous system involvement in diffuse large B-cell lymphoma: an analysis of risks and prevention strategies in the post-rituximab era.

    Science.gov (United States)

    Fletcher, Christopher D; Kahl, Brad S

    2014-10-01

    Central nervous system (CNS) relapse in patients with diffuse large B-cell lymphoma (DLBCL) occurs infrequently (approximately 5%), but is almost universally fatal. Controversy exists regarding which factors most reliably identify high risk patients in the post-rituximab era. Clarification is also needed regarding the value of prophylaxis strategies when contemporary rituximab-based chemotherapy regimens (chemoimmunotherapy) are used. A systematic review with focus on the era of chemoimmunotherapy has been performed. Involvement of > 1 extranodal site plus an elevated lactate dehydrogenase level identifies individuals at highest risk (> 20%) for CNS recurrence who merit additional evaluation. Only certain solitary extranodal sites (testis, kidney and breast, but not bones, orbit or epidural space) appear to confer higher risk in patients receiving chemoimmunotherapy. Data from studies employing modern regimens suggest that intrathecal prophylaxis is ineffective even for high risk populations. Systemic prophylaxis (e.g. high dose methotrexate) may be useful, but does not have strong support in the literature. A significant portion of patients with high risk features (˜25%) may already have subclinical CNS disease, which requires alternative detection and treatment strategies. Flow cytometry is a promising approach with increased sensitivity. Widespread use of this approach could redefine what risk and prophylaxis mean. An algorithm for incorporating risk factors, evaluation and treatment is presented.

  12. Evaluation of the Rituximab Maintenance Improves Clinical Outcome of Relapsed/Resistant Follicular Non Hodgkin's Lymphoma, Both in Patients with and without Rituximab during Induction: Results of A Prospective Randomized Phase Ⅲ Intergroup Trial%无论诱导阶段是否曾使用过利妥昔单抗维持治疗均可改善复发/难治滤泡性淋巴瘤临床预后Ⅲ期随机对照研究的评价

    Institute of Scientific and Technical Information of China (English)

    夏忠军; 李文瑜

    2007-01-01

    @@ 1 文献类型 治疗. 2 证据水平 1b. 3 文献来源 Oers MHJ, Klasa R, Marcus RE, et al.Rituximab maintenance improves clinical outcome of relapsed/resistant follicular non-Hodgkin's lymphoma,both in patients with and without rituximab during induction: results of a prospective randomized phase Ⅲ intergroup trial [J]. Blood, 2006,108(10):3295-3301.

  13. Treatment with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone is beneficial but toxic in very elderly patients with diffuse large B-cell lymphoma : a population-based cohort study on treatment, toxicity and outcome

    NARCIS (Netherlands)

    Boslooper, Karin; Kibbelaar, Robby; Storm, Huib; Veeger, Nic J. G. M.; Hovenga, Sjoerd; Woolthuis, Gerhard; van Rees, Bas; de Graaf, Elly; van Roon, Eric; Kluin-Nelemans, Hanneke C.; Joosten, Peter; Hoogendoorn, Mels

    2014-01-01

    To assess treatment strategies, toxicity and outcome in very elderly patients (aged >= 75 years) diagnosed with diffuse large B-cell lymphoma (DLBCL) in the rituximab era, an observational population-based cohort study was performed. From 103 patients with a median age of 81 years, data of clinical

  14. High-Dose Therapy and Autologous Stem Cell Transplantation in First Relapse for Diffuse Large B Cell Lymphoma in the Rituximab Era : An Analysis Based on Data from the European Blood and Marrow Transplantation Registry

    NARCIS (Netherlands)

    Mounier, Nicolas; Canals, Carmen; Gisselbrecht, Christian; Cornelissen, Jan; Foa, Roberto; Conde, Eulogio; Maertens, John; Attal, Michel; Rambaldi, Alessandro; Crawley, Charles; Luan, Jian-Jian; Brune, Mats; Wittnebel, Sebastian; Cook, Gordon; van Imhoff, G. W.; Pfreundschuh, Michael; Sureda, Anna

    2012-01-01

    Autologous stem cell transplantation (ASCT) consolidation remains the treatment of choice for patients with relapsed diffuse large B cell lymphoma. The impact of rituximab combined with chemotherapy in either first- or second-line therapy on the ultimate results of ASCT remains to be determined, how

  15. Research advances of rituximab resistance in B-cell non-Hodgkin lymphoma%利妥昔单抗治疗B细胞非霍奇金淋巴瘤的耐药机制研究进展

    Institute of Scientific and Technical Information of China (English)

    吴剑秋

    2013-01-01

    Anti-CD20 monoclonal antibody rituximab has become an essential component of treatment regimens for B-cell non-Hodgkin lymphoma(NHL).It is routinely incorporated into all phases of conventional treatment of B-cell NHL,but the precise mechanisms of action of rituximab in human remain unknown.This article will clarify the mechanisms of action of rituximab,the incidence and potential mechanisms of resistance.Finally,the novel approaches to modulate the antibody,the tumor cell,and the host immunologic environment to overcome rituximab resistance are discussed.%抗CD20单克隆抗体利妥昔单抗已经成为治疗B细胞非霍奇金淋巴瘤(NHL)的重要组成部分.尽管临床应用广泛,但肿瘤细胞对利妥昔单抗的耐药机制尚不明确.文章阐述了利妥昔单抗的作用机制、耐药的发生以及潜在的耐药机制,并对调节抗体、肿瘤细胞和宿主的免疫状况等克服耐药的方法进行了探讨.

  16. Mutational profile and prognostic significance of TP53 in diffuse large B-cell lymphoma patients treated with R-CHOP: report from an International DLBCL Rituximab-CHOP Consortium Program Study

    NARCIS (Netherlands)

    Xu-Monette, Z.Y.; Wu, L.; Visco, C.; Tai, Y.C.; Tzankov, A.; Liu, W.M.; Montes-Moreno, S.; Dybkaer, K.; Chiu, A.; Orazi, A.; Zu, Y.; Bhagat, G.; Richards, K.L.; Hsi, E.D.; Zhao, X.F.; Choi, W.W.; Zhao, X.; Krieken, J.H. van; Huang, Q.; Huh, J.; Ai, W.; Ponzoni, M.; Ferreri, A.J.; Zhou, F.; Kahl, B.S.; Winter, J.N.; Xu, W.; Li, J.; Go, R.S.; Li, Y.; Piris, M.A.; Moller, M.B.; Miranda, R.N.; Abruzzo, L.V.; Medeiros, L.J.; Young, K.H.

    2012-01-01

    TP53 mutation is an independent marker of poor prognosis in patients with diffuse large B-cell lymphoma (DLBCL) treated with cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisone (CHOP) therapy. However, its prognostic value in the rituximab immunochemotherapy era remains undefined. In

  17. A clinical study on the therapeutic effect of rituximab in combination with autologous peripheral blood stem cell transplantation in treatment of CD20+ B cellulous non-Hodgkin lymphoma

    Directory of Open Access Journals (Sweden)

    Yong-sheng CHEN

    2013-07-01

    Full Text Available Objective To investigate the therapeutic effect of autologous peripheral blood stem cell transplantation (APBSCT in combination with rituximab in treatment of CD20+ B cellulous non-Hodgkin's lymphoma (B-NHL. Methods Sixty patients with CD20+ aggressive or refractory and recurrent B-NHL and treated with APBSCT in our department from Jan. 2005 to Jan. 2011 were admitted. All the subjects were divided into 2 groups according to their own choice: 25 patients received rituximab treatment (treatment group and 35 patients were treated without rituximab treatment (control group. All patients underwent chemotherapy and APBSCT. For patients in treatment group, rituximab was used with CHOP before collecting the stem cells and after the transplantation. After transplantation, rituximab and IL-2 were used in treatment group every 3-6 months as maintenance treatment. Results No side effect was observed during the use of rituximab either before or after transplantation. The mononuclear cell count in treatment and control group was (8.2±2.9×108/kg and (8.4±3.9×108/kg (P=0.822, respectively; CD34+cell count was (12.3±12.7×106/kg and (13.2±13.9×106/kg (P=0.799, respectively. Haemopoiesis reconstruction was successfully achieved in the patients of treatment group, while 3 patients in control group failed to have haemopoiesis reconstruction. No significant difference was found between two groups on the recovery time of neutrophilic granulocytes and platelets. All patients achieved complete remission. The average follow-up time was 22 months. The disease relapsed in two patients in treatment group and six in control group. The 3-year overall survival rate in treatment group (91.6% was a little higher than that in control group (69.5%, P=0.060. Conclusion To patients of CD20+ B lymphoma, the use of rituximab shows no side effect before or after collection of stem cell and hemopoiesis reconstruction, and the overall survival rate may be improved.

  18. Impact of rituximab on immunoglobulin concentrations and B cell numbers after cyclophosphamide treatment in patients with ANCA-associated vasculitides.

    Directory of Open Access Journals (Sweden)

    Nils Venhoff

    Full Text Available OBJECTIVE: To assess the impact of immunosuppressive therapy with cyclophosphamide (CYC and rituximab (RTX on serum immunoglobulin (Ig concentrations and B lymphocyte counts in patients with ANCA-associated vasculitides (AAVs. METHODS: Retrospective analysis of Ig concentrations and peripheral B cell counts in 55 AAV patients. RESULTS: CYC treatment resulted in a decrease in Ig levels (median; interquartile range IQR from IgG 12.8 g/L (8.15-15.45 to 9.17 g/L (8.04-9.90 (p = 0.002, IgM 1.05 g/L (0.70-1.41 to 0.83 g/L (0.60-1.17 (p = 0.046 and IgA 2.58 g/L (1.71-3.48 to 1.58 g/L (1-31-2.39 (p = 0.056 at a median follow-up time of 4 months. IgG remained significantly below the initial value at 14.5 months and 30 months analyses. Subsequent RTX treatment in patients that had previously received CYC resulted in a further decline in Ig levels from pre RTX IgG 9.84 g/L (8.71-11.60 to 7.11 g/L (5.75-8.77; p = 0.007, from pre RTX IgM 0.84 g/L (0.63-1.18 to 0.35 g/L (0.23-0.48; p<0.001 and from pre RTX IgA 2.03 g/L (1.37-2.50 to IgA 1.62 g/L (IQR 0.84-2.43; p = 0.365 14 months after RTX. Treatment with RTX induced a complete depletion of B cells in all patients. After a median observation time of 20 months median B lymphocyte counts remained severely suppressed (4 B-cells/µl, 1.25-9.5, p<0.001. Seven patients (21% that had been treated with CYC followed by RTX were started on Ig replacement because of severe bronchopulmonary infections and serum IgG concentrations below 5 g/L. CONCLUSIONS: In patients with AAVs, treatment with CYC leads to a decline in immunoglobulin concentrations. A subsequent RTX therapy aggravates the decline in serum immunoglobulin concentrations and results in a profoundly delayed B cell repopulation. Surveying patients with AAVs post CYC and RTX treatment for serum immunoglobulin concentrations and persisting hypogammaglobulinemia is warranted.

  19. Radiation Therapy in Primary Mediastinal B-Cell Lymphoma With Positron Emission Tomography Positivity After Rituximab Chemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Filippi, Andrea Riccardo, E-mail: andreariccardo.filippi@unito.it [Department of Oncology, University of Torino, Torino (Italy); Piva, Cristina [Department of Oncology, University of Torino, Torino (Italy); Giunta, Francesca; Bellò, Marilena [Nuclear Medicine, Città della Salute e della Scienza, Torino (Italy); Chiappella, Annalisa; Caracciolo, Daniele [Hematology, Città della Salute e della Scienza, Torino (Italy); Zotta, Michela [Department of Medical Sciences, University of Torino, Torino (Italy); Douroukas, Anastasios [Positron Emission Tomography Center IRMET, Torino (Italy); Ragona, Riccardo [Department of Oncology, University of Torino, Torino (Italy); Vitolo, Umberto [Hematology, Città della Salute e della Scienza, Torino (Italy); Bisi, Gianni [Department of Medical Sciences, University of Torino, Torino (Italy); Ricardi, Umberto [Department of Oncology, University of Torino, Torino (Italy)

    2013-10-01

    Purpose: To investigate the role of radiation therapy (RT) in patients affected with primary mediastinal B-cell lymphoma (PMBCL) with residual {sup 18}fluorodeoxyglucose positron emission tomography ({sup 18}FDG-PET)-positive disease after rituximab chemotherapy (R-CT). Methods and Materials: Thirty-seven patients treated with R-CT and RT, all with {sup 18}FDG-PET scan at diagnosis and before RT, were included. All {sup 18}FDG-PET scans were reviewed, and responses were classified according to the Deauville 5-point scoring system. Outcomes measures were overall survival (OS) and progression-free survival (PFS), estimated for the whole cohort and for subgroups according to {sup 18}FDG-PET score after R-CT. Results: The median follow-up time was 40.9 months. Three patients were assigned to Deauville score 1 (8.1%), 9 to score 2 (24.3%), 7 to score 3 (19%), 14 to score 4 (37.8%), and 4 to score 5 (10.8%). After RT, all patients with score 3-4 experienced a complete response (CR). Among patients with score 5, 1 was in CR (25%), 2 had persistent positivity (50%), and 1 showed progressive disease (25%). A total of 4 patients experienced progression or relapse: 1 of 33 (3%) with scores 1-4, and 3 of 4 (75%) with score 5. The 3-year OS and PFS of the whole cohort were 89.8% and 88.7%, respectively. OS was significantly different between scores 1-3 and scores 4-5 (100% vs 77% at 3 years, P<.05). Patients with a score of 5 had a significantly worse outcome than did all other patients (OS at 2 years, 33.3% vs 100%). Conclusions: Approximately 50% of PMBCL patients show residual disease at {sup 18}FDG-PET scan after R-CT. RT is able to convert to CR approximately 85% of these patients, but those with a Deauville score of 5 (10%) appear at high risk of progression and death, and they might be candidates for intensified programs.

  20. Evaluación económica de rituximab en combinación con fludarabina y ciclofosfamida en comparación con fludarabina y ciclofosfamida en el tratamiento de la leucemia linfática crónica Economic evaluation of rituximab added to fludarabine plus cyclophosphamide versus fludarabine plus cyclophosphamide for the treatment of chronic lymphocytic leukemia

    Directory of Open Access Journals (Sweden)

    Luis Felipe Casado

    2011-08-01

    Full Text Available Objetivos: Evaluar el coste-efectividad del esquema de rituximab, fludarabina y ciclofosfamida (R-FC en comparación con el de fludarabina y ciclofosfamida (FC en dos tipos de pacientes con leucemia linfática crónica (LLC: no tratados previamente o bien en recidiva/resistentes al tratamiento previo. Métodos: Dos modelos de Markov, utilizando los resultados publicados de superviviencia libre de progresión (SLP de pacientes con LLC tratados con R-FC o FC en primera o segunda línea, las tasas de progresión de la enfermedad y las tasas de mortalidad en España. A los estados de SLP y progresión se les asignaron utilidades obtenidas en un estudio sobre LLC. Los costes de los medicamentos y de los tratamientos de soporte, así como los años de vida ajustados por calidad (AVAC, se estimaron para un periodo de 10 años. Se efectuaron análisis de sensibilidad univariados y probabilísticos (Monte Carlo. Resultados: La adición de rituximab a la quimioterapia con FC aumentó los años de vida ganados (AVG y los AVAC tanto en primera como en segunda línea de tratamiento. La razón de coste-eficacia incremental fue de 20.703 € por AVG y de 19.343 € por AVAC con la primera línea de tratamiento, y de 23.183 € por AVG y 24.781 € por AVAC con la segunda línea de tratamiento. Conclusiones: En los pacientes con LLC no tratados previamente y en aquellos en recaída o resistentes al tratamiento previo, la adición de rituximab al esquema FC aumentó la esperanza de vida y los AVAC, y en ambos casos resultó ser un tratamiento coste-efectivo.Objectives: We evaluated the cost-effectiveness of rituximab added to the chemotherapy regimen of fludarabine plus cyclophosphamide (R-FC versus fludarabine plus cyclophosphamide (FC for the treatment of patients with previously untreated or relapsed/refractory chronic lymphocytic leukemia (CLL. Methods: Two Markov models were built, using published results on progression-free survival (PFS in patients

  1. Evaluación económica de rituximab en combinación con fludarabina y ciclofosfamida en comparación con fludarabina y ciclofosfamida en el tratamiento de la leucemia linfática crónica Economic evaluation of rituximab added to fludarabine plus cyclophosphamide versus fludarabine plus cyclophosphamide for the treatment of chronic lymphocytic leukemia

    OpenAIRE

    Luis Felipe Casado; José Antonio García Marco; Florinda Gilsanz; Marcos González; Eduardo Ríos; Javier de la Serna; Álvaro Urbano; Vicente Vicente; Carlos Rubio-Terrés; Castro, Antonio J.

    2011-01-01

    Objetivos: Evaluar el coste-efectividad del esquema de rituximab, fludarabina y ciclofosfamida (R-FC) en comparación con el de fludarabina y ciclofosfamida (FC) en dos tipos de pacientes con leucemia linfática crónica (LLC): no tratados previamente o bien en recidiva/resistentes al tratamiento previo. Métodos: Dos modelos de Markov, utilizando los resultados publicados de superviviencia libre de progresión (SLP) de pacientes con LLC tratados con R-FC o FC en primera o segunda línea, las tasas...

  2. Diffuse large B-cell lymphoma transformed from mucosa-associated lymphoid tissue lymphoma arising in a female urethra treated with rituximab for the first time.

    Science.gov (United States)

    Zahrani, A Al; Abdelsalam, M; Fiaar, A Al; Ibrahim, N; Al-Elawi, A; Muhammad, B

    2012-05-01

    A 30-year-old female patient presented to the gynecology clinic with a small (painless) swelling at the urethral orifice. She underwent surgical excision of the lesion. Pathological examination revealed non-Hodgkin's lymphoma of diffuse large B-cell type and mucosa-associated lymphoid tissue type, stage IE. The patient refused radiotherapy. Accordingly, we started CHOP-R chemotherapy. She received a total of 6 cycles of CHOP and 8 cycles of rituximab. Patient follow-up was done 3 months later through CT scan and cytoscopy confirming the complete remission. The patient has been disease-free for 4 years. We reviewed 26 cases of this rare entity reported previously. PMID:22679430

  3. Expression of CD40 is a positive prognostic factor of diffuse large B-cell lymphoma treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone

    Directory of Open Access Journals (Sweden)

    Song G

    2016-06-01

    Full Text Available Guoqi Song,1 Huiyun Ni,1 Linqing Zou,2 Shukui Wang,3 Fuliang Tian,4 Hong Liu,1 William C Cho5 1Department of Hematology, Affiliated Hospital of Nantong University, Nantong, 2Department of Human Anatomy, Nantong University, Nantong, 3Central Laboratory of Nanjing First Hospital, Nanjing Medical University, Nanjing, 4Maternal and Child Health Hospital of Lianyungang, Lianyungang, Jiangsu, People’s Republic of China; 5Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong Objectives: The objective of this study was to investigate the expression level of CD40 and its role in the prognosis of patients with diffuse large B-cell lymphoma (DLBCL who were treated with rituximab-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone.Design and methods: The immunohistochemical expressions of CD40 in 186 well-characterized DLBCL patients were evaluated by tissue microarrays, thereby revealing the relationship of the molecule CD40 with known tumor, patient-related variables, and survival rates.Results: The results showed that CD40 expressions were not statistically different between the germinal center B-cell-like (GCB type and the non-GCB type. We also analyzed the relationships of CD40 expression with overall survival (OS and progression-free survival (PFS in DLBCL patients who were uniformly treated with R-CHOP. A low expression of CD40 compared to high expression is related to poor OS and PFS. Conclusion: Our findings indicate that the CD40 level at onset acts as an independent prognostic predictor of DLBCL patients treated with R-CHOP. Keywords: CD40, diffuse large B-cell lymphoma, R-CHOP, prognostic factor

  4. Rituximab, bendamustine and lenalidomide in patients with aggressive B-cell lymphoma not eligible for anthracycline-based therapy or intensive salvage chemotherapy - SAKK 38/08.

    Science.gov (United States)

    Hitz, Felicitas; Zucca, Emanuele; Pabst, Thomas; Fischer, Natalie; Cairoli, Anne; Samaras, Panagiotis; Caspar, Clemens B; Mach, Nicolas; Krasniqi, Fatime; Schmidt, Adrian; Rothermundt, Christian; Enoiu, Milica; Eckhardt, Katrin; Berardi Vilei, Simona; Rondeau, Stephanie; Mey, Ulrich

    2016-07-01

    An increasing number of older patients are suffering from aggressive lymphoma. Effective and more tolerable treatment regimens are urgently needed for this growing patient population. Patients with aggressive lymphoma not eligible for anthracycline-based first-line therapy or intensive salvage regimens were treated with the rituximab-bendamustine-lenalidomide (R-BL) regimen (rituximab 375 mg/m(2)  day 1, bendamustine 70 mg/m(2)  d 1, 2, lenalidomide 10 mg d 1-21) for six cycles every 4 weeks. Forty-one patients with a median age of 75 (range 40-94) years were enrolled: 33 patients had substantial co-morbidities. 13 patients were not eligible for anthracycline-based first-line chemotherapy, 28 patients had relapsed/refractory disease. The primary endpoint, overall response, was achieved by 25 (61%) patients (95% confidence interval 45-76%). Grade ≥ 3 toxicity comprised haematological (59%), skin (15%), constitutional (15%) and neurological (12%) events. 9 patients died during trial treatment: 5 from lymphoma progression, 2 from toxicity, 2 with sudden death. After a median follow-up of 25·9 (interquartile range 20·4-31·6) months, 13 patients were still alive. Median overall survival was 14·5 months. In conclusion, R-BL can be considered a treatment option for elderly patients with treatment naïve or relapsed/refractory aggressive lymphoma not eligible for standard aggressive regimens. PMID:27018242

  5. Excellent outcomes and lack of prognostic impact of cell of origin for localized diffuse large B-cell lymphoma in the rituximab era.

    Science.gov (United States)

    Kumar, Anita; Lunning, Matthew A; Zhang, Zhigang; Migliacci, Jocelyn C; Moskowitz, Craig H; Zelenetz, Andrew D

    2015-12-01

    Therapeutic options for limited-stage diffuse large B cell lymphoma (DLBCL) include short- or full-course R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone) ± radiotherapy. The optimal treatment remains unclear. The prognostic value of cell-of-origin (COO) in early stage DLBCL is unknown. Patients with limited-stage DLBCL (stage I or stage II, non-bulky) treated with R-CHOP ± involved field radiotherapy (IFRT) from 1999 to 2012 were included. COO by the Hans algorithm was analysed in a subset of patients. Of 261 patients, 30% were stage I (N = 82), 37% stage IE (N = 96), IIE (N = 37). The stage-modified International Prognostic Index stratified patients into prognostically relevant groups. There was no significant difference in progression-free survival (PFS) or overall survival (OS) for patients in the germinal centre B-cell-like (GCB; n = 65) and non-GCB cohorts (n = 22). Seventeen patients received R-CHOP × 3-4 cycles (Arm A), 147 received R-CHOP × 3-4 cycles + IFRT (Arm B), 48 received R-CHOP × 6 cycles (Arm C), and 50 received R-CHOP × 6 cycles + IFRT (Arm D). The outcomes were excellent, with 5-year PFS of 82% and 5-year OS of 93%, and were similar across the 4 treatment groups. In the rituximab era, outcomes for limited-stage DLBCL, regardless of treatment approach, were excellent. Baseline COO was not a significant prognostic factor in patients treated with short-course R-CHOP + IFRT. PMID:26456939

  6. 131Ⅰ-rituximab therapy of B cell non-Hodgkin lymphoma%131Ⅰ-rituximab治疗B细胞非霍奇金淋巴瘤

    Institute of Scientific and Technical Information of China (English)

    蔡秋琼; 杜明华

    2008-01-01

    放射免疫治疗是将单克隆抗体(单抗)耦联放射性核素,在肿瘤局部产生足够的电离辐射生物学效应,达到高效、低毒的治疗效果.非霍奇金淋巴瘤(NHL)是最常见的淋巴系统恶性肿瘤之一,其绝大多数是B细胞来源,细胞分化抗原CD20是放射免疫治疗B细胞NHL的最佳靶点,用131Ⅰ标记rituximab(一种抗CD20单抗)在治疗B细胞NHL的临床研究中显示出良好的效果,但仍存在许多问题,人们正在进一步研究解决此类问题,以取得更好的治疗效果.%Radioimmunotherapy,a kind of internal radiation therapy,can achieve high performance and low toxicity by fewer monoclonal antibodies couple radioactive nuclides,created sufficient ionization biologic effect on tumor.Non-Hodgkin lymphoma(NHL) is the most common hematological malignancy.Most of them are B cell lymphomas.CD20 is the best target of radioimmunotherapy on B cell-NHL.Clinical trials indicate 131Ⅰ-rituximab is effective on B cell-NHL,while many problems are existed.Approaches are under investigation to improve outcomes in patients with B cell-NHL.

  7. Chemoimmunotherapy for relapsed/refractory and progressive 17p13-deleted chronic lymphocytic leukemia (CLL) combining pentostatin, alemtuzumab, and low-dose rituximab is effective and tolerable and limits loss of CD20 expression by circulating CLL cells.

    Science.gov (United States)

    Zent, Clive S; Taylor, Ronald P; Lindorfer, Margaret A; Beum, Paul V; LaPlant, Betsy; Wu, Wenting; Call, Timothy G; Bowen, Deborah A; Conte, Michael J; Frederick, Lori A; Link, Brian K; Blackwell, Sue E; Veeramani, Suresh; Baig, Nisar A; Viswanatha, David S; Weiner, George J; Witzig, Thomas E

    2014-07-01

    Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL) patients with purine analog refractory disease or TP53 dysfunction still have limited treatment options and poor survival. Alemtuzumab-containing chemoimmunotherapy regimens can be effective but frequently cause serious infections. We report a Phase II trial testing the efficacy and tolerability of a short-duration regimen combining pentostatin, alemtuzumab, and low-dose high-frequency rituximab designed to decrease the risk of treatment-associated infections and to limit the loss of CD20 expression by CLL cells. The study enrolled 39 patients with progressive CLL that was either relapsed/refractory (n = 36) or previously untreated with 17p13 deletion (17p13-) (n = 3). Thirteen (33%) patients had both 17p13- and TP53 mutations predicted to be dysfunctional, and eight patients had purine analog refractory CLL without TP53 dysfunction. Twenty-six (67%) patients completed therapy, with only five (13%) patients having treatment-limiting toxicity and no treatment-related deaths. Twenty-two (56%) patients responded to treatment, with 11 (28%) complete responses (four with incomplete bone marrow recovery). Median progression-free survival was 7.2 months, time to next treatment was 9.1 months, and overall survival was 34.1 months. The majority of deaths (82%) were caused by progressive disease, including transformed diffuse large B-cell lymphoma (n = 6). Correlative studies showed that low-dose rituximab activates complement and natural killer cells without a profound and sustained decrease in expression of CD20 by circulating CLL cells. We conclude that pentostatin, alemtuzumab, and low-dose high-frequency rituximab is a tolerable and effective therapy for CLL and that low-dose rituximab therapy can activate innate immune cytotoxic mechanisms without substantially decreasing CD20 expression. PMID:24723493

  8. An experiment to use medical I-131 as tracer in a city sewer system

    Energy Technology Data Exchange (ETDEWEB)

    Ulbrich, Susanne; Fischer, Helmut W. [University of Bremen, Institute of Environmental Physics, Otto-Hahn-Allee 1, D-28359 Bremen (Germany)

    2014-07-01

    City sewer systems have to reliably carry residential and industrial wastewater to treatment plants, often mixed with rainwater. Transport in the sewer system is regularly modelled in order to predict sewerage levels, transport velocities and volume discharges. Radioisotopes would be interesting tracers, as they can be detected quickly and without the need of applying wet chemistry. Medical isotopes are released in large quantities (many MBq) by excretion from patients either at the location of administration or from elsewhere, most probably the patient's home. Depending on diagnostic or treatment modality, isotopes of different physical characteristics are used, often bound to compounds of specific metabolic behaviour. Routine environmental surveillance regularly detects the most common diagnostic ({sup 99m}Tc) and therapeutic ({sup 131}I) isotopes in city wastewater samples. Except for {sup 131}I in the case of a nuclear emergency, no contributions from sources other than medical are expected. Medical isotopes therefore might be used for tracing purposes, provided individual inputs can be identified and separated. A field experiment has been designed involving {sup 131}I releases from a single patient who had undergone radioiodine thyroid ablation therapy. This modality is applied after thyroid cancer surgery in order to destroy residual thyroid tissue. Activities up to 5 GBq of {sup 131}I are used which are excreted within few days, as no iodine-retaining thyroid tissue remains. In Germany, about 20,000 of these treatments are performed yearly. For a sewer system of 500,000 inhabitants, about 150 cases would be expected per year, making it quite improbable to have interference between individual patient releases in the same region of the city sewer system. Practically, the radiometric laboratory was informed of the expected release of an (anonymous) patient from the collaborating radiotherapy unit several days in advance, plus the approximate location of the patient's home. Together with the sewage system authority, automated sampling (mostly in 6 h intervals) over one week at four locations between the patient's home quarter and the sewage plant inlet was planned and successfully conducted, delivering a total of 84 samples. Sampling started before the assumed arrival of the patient at his home, to account for 'background' signal due to releases from other patients. The samples were investigated for {sup 131}I by high resolution gamma spectroscopy, with a detection threshold of down to ca. 0.1 Bq/l, depending on the allocated measurement time. Data time series plots show clearly distinguishable peaks in {sup 131}I activity, with peak amplitude decreasing from over 1 kBq/l to below 1 Bq/l with distance from the patient's home quarter (due to dilution) and peak time being retarded (due to transport time). At the two most distant sampling points, the peak appears on a variable background, attributed to {sup 131}I releases of other patients. Modelling with specific sewer system software is still under way, but the data already show that under suitable conditions medical isotopes can successfully be used as sewage tracers. (authors)

  9. Exposure rate measurements and radiation control in post therapy with I131

    International Nuclear Information System (INIS)

    During hyperthyroidism treatment, 131I activities from 111 MBq up to 296 MBq are used. In the aim to determine if the 131I uptake by the patient is a radiological risk to family members and public around the patient exposure rate measurements were carried out, using a limit 1.8 m R/h. Measurements were carried out in the Nuclear Medicine department of Almenara hospital in Lima, Peru. The exposure rate was measured to 0.3, 0.6, and 1.0 m from the patient from 0 to 11 days after post-administrated dose (Pda). In this study measurements were carried out in 21 hyperthyroid patients. Measurements to 1 meter, along 2-4 (16/16), 5-7 (15/15), and 8-11 (14/14) days after Pda, indicate the dose rate around 100% of patients is ≤ 1.8 m R /h. Measurements to 0.6 meters along 2-4 (16/16), 5 -7 (15/15), and 8-11 (14/14) days after Pda, indicate that the dose rate around 44% (7/16), 93% (14/15), and 100% (14/14) of patients is ≤ 1.8 m R h. On the other hand, dose rate measurements to 0.3 meters, along 2-4 (16/16), 5-7 (15/15), and 8 -11 (14/14) days after Pda, indicate that de dose rate is 13% (2/16), 6% (1/15), and 43% (6/14) of patients is ≤ 1.8 m R/h. Measured exposure rates are alike to values reported in the literature, and were used to define radiation control recommendations. (Author)

  10. [Blocking of the thyroid against I-131 following a nuclear disaster].

    Science.gov (United States)

    Kroizman-Sheiner, Einat; Brickner, Dov; Canfi, Ayala; Schwarzfuchs, Dan

    2005-07-01

    The Chernobyl accident, the recent terrorists' attacks and constant threats, have all once again evoked the fear of a nuclear disaster, in Israel and worldwide. Iodine-131 is a major fission product of nuclear reactors and is highly likely to be released into the atmosphere in severe nuclear disasters. The radioiodine is released as a gas, easily spreads over large areas and is easily absorbed via the respiratory system. Iodine-131 emits gamma and beta radiation in high energies, and is readily absorbed by the thyroid which is a target organ for iodine. The resulting exposure to the thyroid might be very high. A sharp increase in thyroid cancer incidence in children was observed following the Chernobyl accident. This article reviews the medical knowledge about strategies and medications aimed at minimizing the absorption of radioiodine into the thyroid. In addition to regular safety means such as sheltering, restriction of locally produced food products and relocation of the population, the best prophylaxis against thyroid exposure is overloading the gland with stable iodine (as potassium iodide), as soon as possible. Recently, the Israeli government decided to distribute Potassium Iodide tablets to the population in the vicinity of the two nuclear research centers in the country. When this treatment is contraindicated, iodine free thionamides or potassium perchlorate are suggested.

  11. Technical solution for radioactive waste management resulting from the I-131 therapy

    International Nuclear Information System (INIS)

    The paper discusses a system designed for the collection and storage of biological wastes arising from the therapy with l-131. This system is based on the use of either retention or septic tanks, in which the waste is stored or delayed until the activity decays to acceptable levels, in order to comply with authorized limits established by the Regulatory Authority for discharge to environment. A method for estimating waste activity concentration as a function of the number of patients, the activity delivered to each one of them, as well as other parameter related to the system design are discussed. The general requirements to be met by the system are also included. (authors). 4 refs., 4 figs

  12. Estimation of effective dose at thyroid cancer patients treated with I131

    International Nuclear Information System (INIS)

    Full text of publication follows. Radioiodine therapy for thyroid cancer patients and hyperthyroid patients at the Institute of Pathophysiology and nuclear medicine is performed in a form of capsules. During the oral application it is reasonable to presume that 15 minutes in stomach is long enough to make additional exposure to stomach as well to other organs nearby. It is almost impossible to perform direct measurements to estimate internal doses of organs, so it is rather recommended to estimate the dose by calculation. Absorbed energy per unit transformation in stomach and surrounding organs has been calculated. The dose equivalents in several internal organs have been calculated in aim to determine the effective doses using appropriate tissue weighting factor values. The MCNP-4b model was used for this calculation. The phantom model was created using three major sections: - an elliptical cylinder representing the trunk and arms - two truncated circular cones representing the legs and feet - a circular cylinder on which sits an elliptical cylinder capped by half an ellipsoid representing the neck and head. The stomach wall is represented by the volume between two concentric ellipsoids and the contents by the volume within the inner ellipsoid. Also TLD measurements were performed over gastric region for limited time of 15 minutes. Estimated effective dose was highest in stomach 7,43*10-02 Sv. The estimated values for other organs like colon, liver, lungs, ovary and bone surface was less than the estimated effective dose of stomach. (authors)

  13. Iodine I-131 With or Without Selumetinib in Treating Patients With Recurrent or Metastatic Thyroid Cancer

    Science.gov (United States)

    2016-10-13

    Poorly Differentiated Thyroid Gland Carcinoma; Recurrent Thyroid Gland Carcinoma; Stage IVA Thyroid Gland Follicular Carcinoma; Stage IVA Thyroid Gland Papillary Carcinoma; Stage IVB Thyroid Gland Follicular Carcinoma; Stage IVB Thyroid Gland Papillary Carcinoma; Stage IVC Thyroid Gland Follicular Carcinoma; Stage IVC Thyroid Gland Papillary Carcinoma

  14. Thyroid dose of I-131 absorbed by the internal organs of a pregnant woman

    International Nuclear Information System (INIS)

    The use of nuclear techniques, for diagnosis or treatment, generates stress in the patient and its relatives. During the pregnancy some sufferings related with the thyroid gland can be presented. If the patient is pregnant, OEP or NOEP, the stress comes from the fear to that the product can it turns affected. The dose is calculated that the Iodine 131, captured by the thyroid of a woman with three months of pregnancy, it deposits in the brain, stomach, heart, kidneys, liver, lungs, ovaries, pancreas, thymus, spleen and in the uterus. The thymus is the organ that receives the biggest dose. (Author)

  15. Correlation of Thyroid Hormone Levels with Radioactive Iodine (I131 Thyroid Utakes

    Directory of Open Access Journals (Sweden)

    Shoukat H Khan,Syed M.Ahmad, N.A.Khan, Frooq A.Bhat,T.J.Quershi,Tariq Wani

    2001-07-01

    Full Text Available Radioactive iodine uptakes (RAIU by thyroid gland is often performed to evaluate its functionalstatus. How accurately it correlates with the Tri-iodothyronine(T,, Tetra-iodothyronine(T4 andthyroid stimulating hormone(TSH radioimmunoassay (RIA levels was studied in a total of 134patients. It was observed that there was a significant positive correlation between 2 and 24 hoursthyroid RAIU values with T3 & T, RIA values.

  16. Medical evaluations of ionizing radiation effects during I131 therapy in patients after thyroid carcinoma surgery

    International Nuclear Information System (INIS)

    This study shows the para-clinical studies on a 39 years old patient who was operated on of a thyroid carcinoma and who, under the beirwaltes medical record (in use in our country), received in the post surgical stage, a Iodine-131 dose of about 2960 MBq (80 mCi) for ablation, having been noted subsequently her pregnancy condition. (author). 6 refs

  17. Internal dosimetry for the radiological protection of the patient in the therapy with I-131

    International Nuclear Information System (INIS)

    In the patients with differentiated thyroid cancer (CADIT) subjected to therapy with radiopharmaceuticals should be considered the possible risk of sharp depression of the bone marrow like consequence of the intolerance to the quantity of administered activity. The manifestation of the myelotoxicity can limit in a substantial way the future treatments and to deteriorate the predict of resolution of the illness. In this work it shows the physical-mathematical mark of a methodology for the estimated absorbed dose in bone marrow based in the MIRD scheme whose objective is to protect the one patient of the noxious and undesirable effects of the internal radiotherapy in organs that are not target of the same one. The formalism incorporates specific information of the patient and also peculiar characteristics of the internal therapy in patient with CADIT. The considerations are the following ones: (1) the main organ to protect is the bone marrow: (2) the accumulated activity, in bone marrow, it is obtained starting from measurements in blood: (3) the used isotope almost exclusively in this type of therapies is the 131I; (4) it is used as radiopharmaceutical at the 131INa that it is characterized to be a simple, inorganic and small molecule: (5) the statistical incidence of the CADIT is bigger in women than in men. It is explained for that it was selected the formalism that is presented, the principles on which it is sustained which are their reaches and their limitations. They are also presented future innovations that can be implemented to effects of improving the estimates. The work is framed inside the thematic of the medical applications of open radioactive sources and it constitutes a contribution to the invigoration of the internal therapy with radiopharmaceuticals. This is due to that the methodology of dose estimation presented supplements with a theoretical biophysics base the protocols of empiric prescription broadly used in this practice. For these reasons, the dosimetric information obtained, adjusted to each concrete case, it contributes to improve the radiological protection of the patient. (Author)

  18. Ascorbic acid stabilization of Re-188- and I-131-radiolabeled peptides for radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Guhlke, S.; Sartor, J.; Bender, H.; Biersack, H.J. [Bonn Univ. (Germany). Dept. of Nuclear Medicine; Zamora, P.O. [Bonn Univ. (Germany). Dept. of Nuclear Medicine]|[RhoMed Inc., Albuquerque, NM (United States); Knapp, F.F. Jr. [Oak Ridge National Lab. (ORNL), TN (United States). Nuclear Medicine Group; Rhodes, B.A. [RhoMed Inc., Albuquerque, NM (United States)

    1997-12-31

    Re-188 labeled RC-160 [ cyclic NH{sub 2}-(D)-Phe-Cys-Tyr-(D)-Trp-Lys-Val-Cys-Trp-NH{sub 2} ] cyclic NH is a radiolabeled somatostatin analog which is being explored for its potential as a local/regionally administered radiotherapeutic agent targeting somatostatin-receptor-positive tumors. The stability of {sup 188}Re-RC-160 towards radiolytic effects is a prerequisite for the success of such an approach. High radiation flux was found to result in radiolysis of the peptide, but addition of ascorbic acid to preparations of RC-160 and also somatostatin-14 was found to stabilize these peptides minimizing these radiolytic effects. Subsequent to ascorbic acid stabilization, {sup 188}Re-RC-160 was determined in vitro and in vivo to bind to somatostatin-receptor-positive cells (NCI-H69 human small cell lung carcinoma) but not to receptor-negative cells (Raji, Burkitt`s lymphoma). The comparative binding of Re-188 labeled RC-160 or CTOP [ cyclic NH{sub 2}-(D)-Phe-CysTyr-(D)-Trp-Orn-Thr-Pen-Thr-ol], a {mu}-opiod-receptor antagonist used as a negative control compound, was also determined in vitro and in vivo using NCI-H69 cells as targets. {sup 188}Re-RC-160 demonstrated a higher amount of net binding in vitro and in vivo compared to {sup 188}ReCTOP. (orig.)

  19. THE MANAGEMENT OF THYROID CARCINOMA--THE ROLE OF RADIO-IODINE (I-131)

    Energy Technology Data Exchange (ETDEWEB)

    Workman, James B.

    1963-06-15

    Experience from the management of 156 patients with proven thyroid cancer, followed from 1 to 11 years, is reported. Although no sweeping conclusions can be drawn, it appears that radioiodine continues to have a place in the overall management of most cases of this malignant disease. (auth)

  20. Demonstration by radionuclide imaging of possible vascular steal from a renal transplant. [I-131, Tc-99

    Energy Technology Data Exchange (ETDEWEB)

    Bloss, R.S.; McConnell, R.W.; McConnell, B.G.; Floyd, M.; Conner, W.T.; Henry, R.G.; Kahan, B.D.

    1979-10-01

    Radionuclide studies in a renal-transplant patient with congestive heart failure suggested vascular steal from the renal allograft by a contralateral femoral arteriovenous fistula. These reliable, noninvasive diagnostic procedures have potential use in similar settings to evaluate allograft perfusion and function. Correction by removal of the fistula was demonstrated.

  1. An experiment to use medical I-131 as tracer in a city sewer system

    International Nuclear Information System (INIS)

    City sewer systems have to reliably carry residential and industrial wastewater to treatment plants, often mixed with rainwater. Transport in the sewer system is regularly modelled in order to predict sewerage levels, transport velocities and volume discharges. Radioisotopes would be interesting tracers, as they can be detected quickly and without the need of applying wet chemistry. Medical isotopes are released in large quantities (many MBq) by excretion from patients either at the location of administration or from elsewhere, most probably the patient's home. Depending on diagnostic or treatment modality, isotopes of different physical characteristics are used, often bound to compounds of specific metabolic behaviour. Routine environmental surveillance regularly detects the most common diagnostic (99mTc) and therapeutic (131I) isotopes in city wastewater samples. Except for 131I in the case of a nuclear emergency, no contributions from sources other than medical are expected. Medical isotopes therefore might be used for tracing purposes, provided individual inputs can be identified and separated. A field experiment has been designed involving 131I releases from a single patient who had undergone radioiodine thyroid ablation therapy. This modality is applied after thyroid cancer surgery in order to destroy residual thyroid tissue. Activities up to 5 GBq of 131I are used which are excreted within few days, as no iodine-retaining thyroid tissue remains. In Germany, about 20,000 of these treatments are performed yearly. For a sewer system of 500,000 inhabitants, about 150 cases would be expected per year, making it quite improbable to have interference between individual patient releases in the same region of the city sewer system. Practically, the radiometric laboratory was informed of the expected release of an (anonymous) patient from the collaborating radiotherapy unit several days in advance, plus the approximate location of the patient's home. Together with the sewage system authority, automated sampling (mostly in 6 h intervals) over one week at four locations between the patient's home quarter and the sewage plant inlet was planned and successfully conducted, delivering a total of 84 samples. Sampling started before the assumed arrival of the patient at his home, to account for 'background' signal due to releases from other patients. The samples were investigated for 131I by high resolution gamma spectroscopy, with a detection threshold of down to ca. 0.1 Bq/l, depending on the allocated measurement time. Data time series plots show clearly distinguishable peaks in 131I activity, with peak amplitude decreasing from over 1 kBq/l to below 1 Bq/l with distance from the patient's home quarter (due to dilution) and peak time being retarded (due to transport time). At the two most distant sampling points, the peak appears on a variable background, attributed to 131I releases of other patients. Modelling with specific sewer system software is still under way, but the data already show that under suitable conditions medical isotopes can successfully be used as sewage tracers. (authors)

  2. Rapid-progressive decrease of cognitive and physical functions due to rituximab%利妥昔单抗致认知和躯体功能障碍

    Institute of Scientific and Technical Information of China (English)

    李进峰; 闫秀娟; 张金彪; 张媛

    2015-01-01

    A 63-year-old female with non-Hodgkin′s lymphoma was treated with a chemotherapeutic regimen composed of rituximab,cyclophosphamide,doxorubicin,vincristine,prednisolone( R-CHOP). She was given rituximab 600 mg plus 750 ml of 0. 9% sodium chloride injection intravenous drip on the first day, at the same time treatments for hydration,alkalization,protecting visceral function,prevention of adverse reactions were given. On day 2,the patient developed an involuntary shaking limbs,a lower limbs weakness,a slightly slow reaction and an unsteady gait. MRI of the brain did not show any significant finding. On day 3,she had a fever,cognitive impairment and confusion. On day 4,the patient could not have independent feeding and defecation. Methyl prednisolone,drugs for improving microcirculation and rehydration therapy were applied. Two days later, the patient′s consciousness restored. He can eat independently,defecate by himself,and his limbs and neuropsychological symptoms were relieved. Five days later,the symptoms were apparently improved.%1例63岁女性患者因非霍奇金淋巴瘤拟行R-CHOP(利妥昔单抗、环磷酰胺、阿霉素、长春新碱、泼尼松龙)方案治疗。首日给予利妥昔单抗600 mg加入0.9%氯化钠注射液750 ml静脉滴注,同时给予水化、碱化、保护脏器功能、预防不良反应等治疗。第2天患者出现四肢不自主抖动、双下肢乏力、反应略迟钝和行走不稳,头颅磁共振成像检查未见异常;第3天出现发热、认知障碍;第4天不能自主进食及自主排便。给予甲泼尼龙琥珀酸钠、改善微循环、补液等支持治疗,2d后患者意识转清,可自主进食、排便,四肢和神经精神症状缓解,5d后症状明显减轻。

  3. Hepatitis B virus reactivation and hepatitis in diffuse large B-cell lymphoma patients with resolved hepatitis B receiving rituximab-containing chemotherapy:risk factors and survival

    Institute of Scientific and Technical Information of China (English)

    Kai-Lin Chen; De-Hui Zou; Li-Yang Hu; Michael Lucas Wirian; Qing-Qing Cai; Jie Chen; Hui-Lan Rao; Ying Guo; Hui-Qiang Huang; Liang Zhang; Jian-Yong Shao; Tong-Yu Lin; Wen-Qi Jiang

    2015-01-01

    Introduction:Hepatitis B virus (HBV) reactivation has been reported in B-cel lymphoma patients with resolved hepatitis B (hepatitis B surface antigen [HBsAg]-negative and hepatitis B core antibody [HBcAb]-positive). This study aimed to assess HBV reactivation and hepatitis occurrence in diffuse large B-cel lymphoma (DLBCL) patients with resolved hepatitis B receiving rituximab-containing chemotherapy compared with HBsAg-negative/HBcAb-negative patients to identify risk factors for HBV reactivation and hepatitis occurrence and to analyze whether HBV reactivation and hepatitis affect the survival of DLBCL patients with resolved hepatitis B. Methods:We reviewed the clinical data of 278 patients with DLBCL treated with rituximab-containing therapy between January 2004 and May 2008 at Sun Yat-sen University Cancer Center, China. Predictive factors for HBV reactivation, hepatitis development, and survival were examined by univariate analysis using the chi-square or Fisher’s exact test and by multivariate analysis using the Cox regression model. Results:Among the 278 patients, 165 were HBsAg-negative. Among these 165 patients, 6 (10.9%) of 55 HBcAb-positive (resolved HBV infection) patients experienced HBV reactivation compared with none (0%) of 110 HBcAb-negative patients (P=0.001). Patients with resolved hepatitis B had a higher hepatitis occurrence rate than HBsAg-negative/HBcAb-negative patients (21.8%vs. 8.2%, P=0.013). HBcAb positivity and elevated baseline alanine aminotransferase (ALT) levels were independent risk factors for hepatitis. Among the 55 patients with resolved hepatitis B, patients with elevated baseline serum ALT or aspartate aminotransferase (AST) levels were more likely to develop hepatitis than those with normal serum ALT or AST levels (P=0.037, P=0.005, respectively). An elevated baseline AST level was an independent risk factor for hepatitis in these patients. Six patients with HBV reactivation recovered after immediate antiviral therapy, and

  4. Value of Surveillance Studies for Patients With Stage I to II Diffuse Large B-Cell Lymphoma in the Rituximab Era

    Energy Technology Data Exchange (ETDEWEB)

    Hiniker, Susan M.; Pollom, Erqi L. [Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California (United States); Khodadoust, Michael S. [Division of Oncology, Department of Medicine, Stanford Cancer Institute, Stanford, California (United States); Kozak, Margaret M. [Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California (United States); Xu, Guofan; Quon, Andrew [Division of Nuclear Medicine, Department of Radiology, Stanford Cancer Institute, Stanford, California (United States); Advani, Ranjana H. [Division of Oncology, Department of Medicine, Stanford Cancer Institute, Stanford, California (United States); Hoppe, Richard T., E-mail: rhoppe@stanford.edu [Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California (United States)

    2015-05-01

    Background: The role of surveillance studies in limited-stage diffuse large B-cell lymphoma (DLBCL) in the rituximab era has not been well defined. We sought to evaluate the use of imaging (computed tomography [CT] and positron emission tomography [PET]-CT) scans and lactate dehydrogenase (LDH) in surveillance of patients with stage I to II DLBCL. Methods: A retrospective analysis was performed of patients who received definitive treatment between 2000 and 2013. Results: One hundred sixty-two consecutive patients with stage I to II DLBCL were treated with chemotherapy +/− rituximab, radiation, or combined modality therapy. The 5-year rates of overall survival (OS) and freedom from progression (FFP) were 81.2% and 80.8%, respectively. Of the 162 patients, 124 (77%) were followed up with at least 1 surveillance PET scan beyond end-of-treatment scans; of those, 94 of 124 (76%) achieved a complete metabolic response on PET scan after completion of chemotherapy, and this was associated with superior FFP (P=.01, HR=0.3) and OS (P=.01, HR 0.3). Eighteen patients experienced relapse after initial response to therapy. Nine relapses were initially suspected by surveillance imaging studies (8 PET, 1 CT), and 9 were suspected clinically (5 by patient-reported symptoms and 4 by symptoms and physical examination). No relapses were detected by surveillance LDH. The median duration from initiation of treatment to relapse was 14.3 months among patients with relapses suspected by imaging, and 59.8 months among patients with relapses suspected clinically (P=.077). There was no significant difference in OS from date of first therapy or OS after relapse between patients whose relapse was suspected by imaging versus clinically. Thirteen of 18 patients underwent successful salvage therapy after relapse. Conclusions: A complete response on PET scan immediately after initial chemotherapy is associated with superior FFP and OS in stage I to II DLBCL. The use of PET scans as

  5. Prolonged extracorporeal membrane oxygenation therapy for severe acute respiratory distress syndrome in a child affected by rituximab-resistant autoimmune hemolytic anemia: a case report

    Directory of Open Access Journals (Sweden)

    Beretta Chiara

    2009-04-01

    Full Text Available Abstract Introduction Autoimmune hemolytic anemia in children younger than 2 years of age is usually characterized by a severe course, with a mortality rate of approximately 10%. The prolonged immunosuppression following specific treatment may be associated with a high risk of developing severe infections. Recently, the use of monoclonal antibodies (rituximab has allowed sustained remissions to be obtained in the majority of pediatric patients with refractory autoimmune hemolytic anemia. Case presentation We describe the case of an 8-month-old Caucasian girl affected by a severe form of autoimmune hemolytic anemia, which required continuous steroid treatment for 16 months. Thereafter, she received 4 weekly doses of rituximab (375 mg/m2/dose associated with steroid therapy, which was then tapered over the subsequent 2 weeks. One month after the last dose of rrituximab, she presented with recurrence of severe hemolysis and received two more doses of rrituximab. The patient remained in clinical remission for 7 months, before presenting with a further relapse. An alternative heavy immunosuppressive therapy was administered combining cyclophosphamide 10 mg/kg/day for 10 days with methylprednisolone 40 mg/kg/day for 5 days, which was then tapered down over 3 weeks. While still on steroid therapy, the patient developed an interstitial pneumonia with Acute Respiratory Distress Syndrome, which required immediate admission to the intensive care unit where extracorporeal membrane oxygenation therapy was administered continuously for 37 days. At 16-month follow-up, the patient is alive and in good clinical condition, with no organ dysfunction, free from any immunosuppressive treatment and with a normal Hb level. Conclusions This case shows that aggressive combined immunosuppressive therapy may lead to a sustained complete remission in children with refractory autoimmune hemolytic anemia. However, the severe life-threatening complication presented by our

  6. The HELIOS trial protocol: a phase III study of ibrutinib in combination with bendamustine and rituximab in relapsed/refractory chronic lymphocytic leukemia.

    Science.gov (United States)

    Hallek, Michael; Kay, Neil E; Osterborg, Anders; Chanan-Khan, Asher A; Mahler, Michelle; Salman, Mariya; Wan, Ying; Sun, Steven; Zhuang, Sen Hong; Howes, Angela

    2015-01-01

    Ibrutinib is an orally administered, covalent inhibitor of Bruton's tyrosine kinase with activity in B-cell malignancies based on Phase I/II studies. We describe the design and rationale for the Phase III HELIOS trial (trial registration: EudraCT No. 2012-000600-15; UTN No. U1111-1135-3745) investigating whether ibrutinib added to bendamustine and rituximab (BR) provides benefits over BR alone in patients with relapsed/refractory chronic lymphocytic leukemia/small lymphocytic lymphoma. Eligible patients must have relapsed/refractory disease measurable on CT scan and meet ≥ 1 International Workshop on Chronic Lymphocytic Leukemia criterion for requiring treatment; patients with del(17p) are excluded. All patients receive BR (maximum six cycles) as background therapy and are randomized 1:1 to placebo or ibrutinib 420 mg/day. Treatment with ibrutinib or placebo will start concomitantly with BR and continue until disease progression or unacceptable toxicity. The primary end point is progression-free survival. Secondary end points include safety, objective response rate, overall survival, rate of minimal residual disease-negative remissions, and patient-reported outcomes. Tumor response will be assessed using the International Workshop on Chronic Lymphocytic Leukemia guidelines. PMID:24901734

  7. 177Lu标记单克隆抗体Rituximab及其初步生物学评价%Preparation and Preliminary Biological Evaluation of 177Lu Labelled Rituximab

    Institute of Scientific and Technical Information of China (English)

    马秀凤; 张君丽; 李洪玉; 梁积新; 杨云; 杨春慧; 杜进

    2014-01-01

    以CHX-A'-DTPA和p-SCN-Bz-DTPA为双功能螯合剂,分别对Rituximab进行偶联,用177Lu进行标记,制备177 Lu-Rituximab.在优化条件下,177 Lu对单抗偶联物CHX-A"-DTPA-Rit uximab和p-SCN-Bz-DT-PA-Rituximab的标记率和放化纯度均大于99%.室温及37℃条件下,177Lu-Rituximab在各种测试体系中均显示良好的体外稳定性.在正常小鼠体内的生物分布结果显示,177Lu-Rituximab发生了分解,游离的177Lu在骨中形成较高浓集.177Lu-p-SCN-Bz-DTPA-Rituximab比177Lu-CHX-A"-DTPA-Rituximab的体内清除快,而且游离177 Lu的骨摄取低,结果表明,p-SCN-Bz-DTPA更适于作为双功能螯合剂用于单抗的177Lu标记.

  8. Prognostic factors in primary diffuse large B-cell lymphoma of adrenal gland treated with rituximab-CHOP chemotherapy from the Consortium for Improving Survival of Lymphoma (CISL

    Directory of Open Access Journals (Sweden)

    Kim Yu

    2012-08-01

    Full Text Available Abstract Background The objective of this study was to identify prognostic factors for survival in patients with primary diffuse large B-cell lymphoma (DLBCL of the adrenal gland. Methods Thirty one patients diagnosed with primary adrenal DLBCL from 14 Korean institutions and treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone were analyzed. Results Complete remission (CR and overall response rate after R-CHOP chemotherapy were 54.8% and 87.0%. The 2-year estimates of overall survival (OS and progression-free survival (PFS were 68.3% and 51.1%. In patients achieving CR, significant prolongations of OS (P = 0.029 and PFS (P = 0.005 were observed. Ann Arbor stage had no influence on OS. There was no significant difference in OS between patients with unilateral involvement of adrenal gland and those with bilateral involvement. When staging was modified to include bilateral adrenal involvement as one extranodal site, early stage (I or II significantly correlated with longer OS (P = 0.021 and PFS (P 0.001. Conclusions Contrary to prior reports, our data suggests that outcomes of primary adrenal DLBCL are encouraging using a regimen of R-CHOP, and that achieving CR after R-CHOP is predictive of survival. Likewise, our modified staging system may have prognostic value.

  9. Reduced-dose ICE chemotherapy ± rituximab is a safe and effective salvage therapy for fit elderly patients with diffuse large B-cell lymphoma.

    Science.gov (United States)

    Sarid, Nadav; Joffe, Erel; Gibstein, Lili; Avivi, Irit; Polliack, Aaron; Perry, Chava; Herishanu, Yair

    2016-07-01

    The risk of developing non-Hodgkin lymphoma increases with age, yet elderly patients are under-represented in clinical trials. Here, we evaluate a combination regimen including ifosfamide, carboplatin and etoposide with or without rituximab (ICE ± R) in 32 fit elderly patients (median age 75.6 years) with relapsed or refractory diffuse large B-cell lymphoma. ICE ± R was generally administered in reduced doses and was well tolerated. The overall response rate (ORR) was 53.1% with a complete response (CR) rate of 40.6%. The median progression free survival (PFS) and overall survival (OS) were 3.9 and 17.0 months, respectively. Patients who responded to ICE ± R achieved median PFS of 47.2 months and OS of 78.9 months. Patients ineligible for autologous transplantation who responded to ICE ± R were treated with additional cycles, and achieved a median PFS of 18.9 months and OS of 21.7 months. Previous response to first-line therapy was the strongest predictor of response, PFS and OS to second-line treatment. PMID:26643787

  10. Patterns of neutropenia and risk factors for febrile neutropenia of diffuse large B-cell lymphoma patients treated with rituximab-CHOP.

    Science.gov (United States)

    Choi, Yong Won; Jeong, Seong Hyun; Ahn, Mi Sun; Lee, Hyun Woo; Kang, Seok Yun; Choi, Jin-Hyuk; Jin, U Ram; Park, Joon Seong

    2014-11-01

    Febrile neutropenia (FN) is the major toxicity of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) regimen in the treatment of diffuse large B-cell lymphoma (DLBCL). The prediction of neutropenia and FN is mandatory to continue the planned R-CHOP therapy resulting in successful anti-cancer treatment. The clinical features and patterns of neutropenia and FN from 181 DLBCL patients treated with R-CHOP were analyzed retrospectively. Sixty percent (60.2%) of patients experienced at least one episode of grade 4 neutropenia. Among them, 42.2% of episodes progressed to FN. Forty-eight percent (48.8%) of patients with FN was experienced their first FN during the first cycle of R-CHOP. All those patients never experienced FN again during the rest cycles of R-CHOP. Female, higher stage, international prognostic index (IPI), age ≥65 yr, comorbidities, bone marrow involvement, and baseline serum albumin ≤3.5 mg/dL were significant risk factors for FN by univariate analysis. Among these variables, comorbidities (P=0.009), bone marrow involvement (P=0.006), and female gender (P=0.024) were independent risk factors for FN based on multivariate analysis. On observing the patterns of neutropenia and FN, primary prophylaxis of granulocyte colony-stimulating factor (G-CSF) and antibiotics should be considered particularly in female patients, patients with comorbidities, or when there is bone marrow involvement of disease.

  11. A Case of Subacute Cutaneous Lupus Erythematosus in a Patient with Mixed Connective Tissue Disease: Successful Treatment with Plasmapheresis and Rituximab

    Directory of Open Access Journals (Sweden)

    M. Fantò

    2013-01-01

    Full Text Available A 30-year-old woman affected by Mixed Connective Tissue Disease with scleroderma spectrum developed a facial eruption, a clinical and histological characteristic of subacute cutaneous lupus erythematosus (SCLE. Speckled anti-nuclear antibodies, high-titer anti-ribonucleoprotein1, anti-Sm, anti-Cardiolipin (aCL IgG/IgM, and anti-Ro/SSA antibodies were positive. SCLE was resistant to Azathioprine, Hydroxychloroquine, and Methotrexate while Mycophenolate Mofetil was suspended due to side effects. Subsequently, the patient was treated with three cycles of therapeutic plasma exchange (TPE followed, one month after the last TPE, by the anti-CD20 antibody Rituximab (RTX (375 mg/m2 weekly for 4 weeks. Eight and 16 months later the patient received other two TPE and RTX cycles, respectively. This therapeutic approach has allowed to obtain a complete skin healing persistent even after 8-month follow-up. Moreover, mitigation of Raynaud's phenomenon, resolution of alopecia, and a decline of aCL IgG/IgM and anti-Ro/SSA antibodies were observed.

  12. A phase II randomized trial comparing standard and low dose rituximab combined with alemtuzumab as initial treatment of progressive chronic lymphocytic leukemia in older patients: a trial of the ECOG-ACRIN cancer research group (E1908).

    Science.gov (United States)

    Zent, Clive S; Victoria Wang, Xin; Ketterling, Rhett P; Hanson, Curtis A; Libby, Edward N; Barrientos, Jacqueline C; Call, Timothy G; Chang, Julie E; Liu, Jane J; Calvo, Alejandro R; Lazarus, Hillard M; Rowe, Jacob M; Luger, Selina M; Litzow, Mark R; Tallman, Martin S

    2016-03-01

    Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL) patients requiring initial therapy are often older and frailer and unsuitable candidates for standard chemoimmunotherapy regimens. Shorter duration combination monoclonal antibody (mAb) therapy using alemtuzumab and rituximab has been shown to be effective and tolerable treatment for CLL. Standard dose anti-CD20 mAb therapy causes loss of CD20 expression by surviving CLL cells, which can be minimized by decreasing the mAb dose. We report a randomized phase II clinical trial enrolling older (≥ 65 years) patients (median age 76 years, n = 31) with treatment naïve progressive CLL. Patients received 8-12 weeks of standard subcutaneous alemtuzumab with either intravenous standard (375 mg/m(2) weekly)(n = 16) or low dose (20 mg/m(2) 3x week)(n = 15) rituximab. This study was closed before full accrual because the manufacturer withdrew alemtuzumab for treatment of CLL. The overall response rate was 90% with an 45% complete response rate, median progression-free survival of 17.9 months and no significant differences in outcome between the low and standard dose rituximab arms. The major toxicities were cytopenia and infection with one treatment fatality caused by progressive multifocal leukoencephalopathy but no other opportunistic infections. Combination mAb therapy was effective and tolerable treatment for older and frailer patients with progressive CLL, achieving a high rate of complete remissions. These data support the role of mAb in therapy for less fit CLL patients and the further study of low dose higher frequency anti-CD20 mAb therapy as a potentially more effective use of anti-CD20 mAb in the treatment of CLL.

  13. O rituximabe como uma opção para pacientes com vasculite sistêmica grave refratária à terapia convencional: relato de sete casos e revisão de literatura

    OpenAIRE

    Leonardo Sales da Silva; Karla Valéria Miranda de Campos; Ana Karla Guedes de Melo; Danielle Christinne Soares Egypto de Brito; Alessandra Sousa Braz; Eutilia Andrade Medeiros Freire

    2015-01-01

    Resumo O maior entendimento das bases fisiopatológicas e do comportamento das vasculites sistêmicas, aliado ao desenvolvimento de regimes terapêuticos com perfil de segurança e eficácia cada vezes melhores, modificou drasticamente o prognóstico dos pacientes diagnosticados com essas entidades clínicas. Recentemente, o emprego do rituximabe no tratamento de pacientes com vasculites ANCA associadas em ensaios clínicos randomizados se mostrou uma opção importante em casos selecionados, especialm...

  14. Screen of CD20 mimotope using monoclonal antibody Rituximab%CD20抗原模拟表位的筛选

    Institute of Scientific and Technical Information of China (English)

    吴守振; 张阔; 李萌; 贺丽清; 秦鑫; 张英起

    2009-01-01

    目的:筛选CD20分子的模拟表位肽,构建针对CD20分子的治疗性疫苗,以期为淋巴瘤以及其它B细胞相关性疾病的治疗提供新的方向.方法:利用噬菌体随机呈现肽库筛选技术,以人淋巴细胞分化抗原CD20 mAb Rituximab为靶点,筛选CD20分子的模拟表位肽.通过ELISA方法检测筛选出的阳性噬菌体与Rituximab的特异性结合,并以竞争性结合实验检测筛选出的阳性噬菌体与Raji细胞表面的CD20分子竞争结合Rituximab的能力.最后以Sanger双脱氧链终止法测定DNA序列,推断其氨基酸序列.结果:成功筛选出针对CD20 mAb Rituximab的阳性噬菌体,获得了CD20分子的模拟表位肽QDKLTQWPKWLE.获得的阳性噬菌体能够与Rituximab特异性结合,并且表达该表位的噬菌体可以竞争性抑制Rituximab与天然CD20分子的结合.结论:CD20分子的抗原表位肽QDKLTQWPKWLE能够与mAb Rituximab特异性结合,与天然CD20分子竞争性结合mAb Rituximab,并具有潜在的应用价值.

  15. RITUXIMAB TREATMENT EFFICACY IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS REFRACTORY TO STANDARD THERAPY IN THE LONG-TERM FOLLOW-UP

    Directory of Open Access Journals (Sweden)

    M. E. Tsanyan

    2014-01-01

    Full Text Available Objective. To evaluate the efficacy and safety of rituximab (RTM treatment in the long-term follow-up of patients with systemic lupus erythematosus (SLE refractory to standard therapy. Material and methods. RTM therapy was prescribed to 97 SLE patients with high disease activity and insufficient effica- cy of using high doses of glucocorticoids (GC and cytostatics. The median follow-up time (25th; 75th percentiles was 18 [12; 36] months. The most common clinical manifestations of SLE included nephritis (62%, skin lesion (33%, and lesion of the nervous system (22.7%. The clinical assessment of the SLE activity was carried out using the SLEDAI-2K activity index. In assessing the therapy efficacy, the following concepts were used: the partial response (PR, complete response (CR, and flare. Flare was classified as moderate (MF and severe (SF using the SLE flare index (SFI. Results. Immediately after RTM therapy, depletion of B-cells was determined in 78% of the patients with SLE. During the 6-year follow-up, the effect of RTM therapy was achieved in 84% of the patients after repeated courses of RTM (CR – 56%, PR – 28%. In total, flares were observed in 24 (24.7% patients; the median interval from RTM administration to flare was 12 [12; 24] months. In the long-term follow-up, the decline in the SLEDAI-2K index, normalization of laboratory test values, and the decrease in the daily GC dose were noted. Most patients tolerated well both the first and repeated courses of RTM therapy. Conclusion. According to the results of the long-term follow-up, RTM therapy is a highly effective method to treat SLE patients with the ineffectiveness of previously conducted standard therapy with GC and cytostatics. Good tolerance of RTM treatment has been noted; no increase in risk of infectious complications or adverse reactions has been found. 

  16. Treatment of a case of pemphigus vulgaris with combined rituximab%联合rituximab治疗一例寻常型天疱疮的疗效观察

    Institute of Scientific and Technical Information of China (English)

    朱海琴; 潘萌; 李金枝; 周芸; 夏群力; 王颖; 郑捷

    2009-01-01

    Objective To study the efficacy of rituximab in the treatment of pemphigus vulgaris (PV) and its underlying mechanism. Methods A 38-year-old female with PV presented with refractory, painful oral ulcers and erosions. Since she was poorly responsive to prednisone 80 mg daily, intravenous ritu-ximab of 500 mg once a week was given for successive 3 weeks followed by 5 successive days of intra-venous gamma globulin at a dose of 400 mg/kg per day, and a total of two treatment sessions were conducted. ELISA was used to detect the serum titer of anti-Dsg3 antibodies and their IgG subtypes (IgG1 and IgG4) as well as serum level of interferon-gamma (IFN-gamma), interleukin-4 (IL-4), interleukin-10 (IL-10). Results Three months after the end of two treatment sessions, the symptom was obviously improved, and lesions subsided; alter another 1 month, clinical symptom fully disappeared. During the 1-year follow-up, no lesions recurred. The anti-Dsg3 antibody titer was 253.33 U/mL before treatment, plateaued at 250 U/mL within 4 weeks after the initial infusion, decreased till 3 months after the withdrawal, and reached 26.06 U/mL 7 months after the withdrawal, and remained within normal range till the time of this writing. The serum titer of IgGl subclass of anti-Dsg3 antibodies dropped dramatically fight after the first infusion, but that of IgG4 subclass remained at a high level at early stage of medication, began to decline until 3 months after the with-drawal, and finally reached the normal range following clinical remission. Also, serum level of IFN-garnma and IL-10 correlated with the severity of PV. Conclusions Combined rituximab is effective for the control of PV, likely by eliminating Dsg3-specific antibodies, especially IgG4 subclass of them.%目的 观察联合抗CD20单克隆抗体rituximab治疗寻常型天疱疮的临床疗效,探讨其作用机制.方法 寻常型天疱疮患者1例,口腔黏膜顽固性痛性糜烂和溃疡,甲泼尼龙80 mg/d,

  17. A European multicentre and open-label controlled randomized trial to evaluate the efficacy of Sequential treatment with TAcrolimus–Rituximab versus steroids plus cyclophosphamide in patients with primary MEmbranous Nephropathy: the STARMEN study

    Science.gov (United States)

    Rojas-Rivera, Jorge; Fernández-Juárez, Gema; Ortiz, Alberto; Hofstra, Julia; Gesualdo, Loreto; Tesar, Vladimir; Wetzels, Jack; Segarra, Alfons; Egido, Jesus; Praga, Manuel

    2015-01-01

    Background Patients with primary membranous nephropathy (MN) and persistent nephrotic syndrome have a high risk of progression to end-stage renal disease. The Ponticelli protocol (steroids with alkylating agents) is the most effective immunosuppressive therapy for this condition, but it has severe adverse effects. Tacrolimus and rituximab have demonstrated efficacy for remission of nephrotic syndrome in MN with a safer profile. However, the published evidence is largely based on small or short-term observational studies, historical cohorts, comparisons with conservative therapy or clinical trials without appropriate control groups, and there is no head-to-head comparison with the Ponticelli protocol. Methods The STARMEN randomized clinical trial will compare the efficacy of sequential tacrolimus–rituximab therapy with a modified Ponticelli protocol (steroids plus cyclophosphamide). The trial will also evaluate the role of antibodies against the M-type phospholipase A2 receptor (anti-PLA2R) and other antibodies as markers of response to treatment and long-term prognosis. Results The trial has already started with 23 patients having been enrolled as of 1 April 2015, an estimated 21.7% of the estimated sample. PMID:26413273

  18. 应用基因表达谱芯片技术研究Rituximab的耐药机制%Preliminary cDNA microarray studies of Rituximab resistance mechanisms

    Institute of Scientific and Technical Information of China (English)

    潘梅芳; 岑洪; 谭晓虹; 王明月

    2015-01-01

    Objective In this study,we aimed to use cDNA microarrays to identify differentially expressed genes and activation or inhibition of signaling pathways that may account for the phenotype of rituximab-resistant cell lines. Methods Rituximab-resistant B-cell non-Hodgkin’s lymphoma cell lines were established,and cDNA microarray analysis was performed on the resistant and parental cell lines. Bioinformatics analysis was carried out using the KEGG database and DAVID software. Results We identified 70 genes that were up-regulated and 42 that were down-regulated in both Jeko-1/R and Raji/R resistant cell lines compared to parental lines. KEGG pathway analysis suggested that the MAPK signaling pathway is significantly more active in Jeko-1/R and Raji/R cells. GO term analysis of differentially expressed genes suggested that rituximab-resistant cells show the characteristics of“anti-apoptosis”,“promoting proliferation”and“blood vessel development”. Conclusion Our results suggest that rituximab resistance is most closely associated with the MAPK signaling pathway,which may act to inhibit apoptosis and promote proliferation and vascular development. These findings provide a theoretical basis for predicting and overcoming rituximab resistance in the clinical setting.%目的:应用基因表达谱芯片技术检测Rituximab耐药细胞株差异表达基因、富集信号通路及相关生物学行为,初步探讨Rituximab的耐药机制。方法成功构建Rituximab耐药B细胞性非霍奇金淋巴瘤细胞株Jeko-1/R和Raji/R,应用基因表达谱芯片技术检测耐药细胞株与亲本细胞株的差异表达基因,用KEGG数据库及DAVID软件进行生物信息学分析。结果在两株Rituximab耐药细胞株中,同为上调和同为下调表达的差异基因分别有70个和42个;KEGG通路分析提示Rituximab耐药细胞与亲本细胞相比,MAPK信号通路呈富集;基因本体论(gene ontology,GO)分析提示耐药细胞生物

  19. Potential resource and cost saving analysis of subcutaneous versus intravenous administration for rituximab in non-Hodgkin's lymphoma and for trastuzumab in breast cancer in 17 Italian hospitals based on a systematic survey

    Directory of Open Access Journals (Sweden)

    Ponzetti C

    2016-05-01

    Full Text Available Clemente Ponzetti,1 Monica Canciani,2 Massimo Farina,2 Sara Era,3 Stefan Walzer4,5 1Group Policlinic Monza, Alessandria, National Scientific Associazione Nazionale dei Medici delle Direzioni Ospedaliere (National Association of Hospital Physicians, Bologna, 2Studio EmmEffe S.r.l, Milan, 3Roche S.p.a., Monza, Italy; 4MArS Market Access and Pricing Strategy GmbH, Weil am Rhein, 5Health Care Management, State University Baden-Wuerttemberg, Loerrach, Germany Introduction: Subcutaneous versions of different oncology therapies have been available for patients for a few years, yet patient-relevant and hospital benefits have not been assessed in real life. Methods: In order to analyze the impact of subcutaneous administrations for rituximab or trastuzumab in comparison to the respective intravenous mode a primary research in Italy was executed. The study’s primary objectives were to analyze the resource and cost implications from different perspectives (patient, medical staff in the real world. The route of administration was discussed and aligned with the participating centers in order to capture all relevant therapy parts. After the successful execution of a pilot study 19 centers in six regions in Italy were recruited to participate. Results: Significant time savings might be achieved with the subcutaneous mode through significantly lower patient preparation time including less time preparing the actual dosing for each individual patient. The total time difference is 3.3 hours with rituximab in hematology (non-Hodgkin’s lymphoma, which adds up to 23.55 hours for a full course of treatment per patient (overall preparation time: 40.1 hours intravenous [95% confidence interval (CI: ±0.47] vs 16.6 hours subcutaneous [95% CI: ±0.2]. In early breast cancer (trastuzumab, the time saving might be 3.3 hours for the first cycle and the total time saving for patient preparation might be 17.2 hours (overall preparation time: 38.8 hours intravenous [95% CI

  20. Temozolomide plus rituximab for elderly with relapsed primary central nervous system lymphoma%替莫唑胺联合利妥昔单抗对复发的老年原发中枢神经淋巴瘤的应用

    Institute of Scientific and Technical Information of China (English)

    Qingfeng Li; Gang Wu; Zhihua Sun; Jinghua Ren

    2011-01-01

    Objective: The aim of our study was to analyze the long-term results of rituximab combined with temozolomide in treatment of elderly patients (> 60 years) with relapsed primary central nervous system lymphoma (PCNSL). Methods: Twelve postoperative elderly patients (> 60 years) were treated between August 2004 and October 2009. Temozolomide 100 mg/m2to 200 mg/m2 days 1 to 7 and 15 to 21 and rituximab 375 mg/m2 days 1,5, 8, 22. The maximum number of rituximab cycles was two. After one or two cycles of this combination, patients with an objective response and an acceptable level of toxicity continued treatment with single agent temozolomide (days 1 to 5, every 28 days). The overall survival was analyzed by using Kaplan-Meier. Results: The overall survival was 9 months. Toxicity was very mild with no grade 3-4 neurotoxicity toxic events. Conclusion: Rituximab combined with temozolomide seems to yields substantial long-term survival with moderate toxicity for the treatment of elderly relapsed PCNSL.

  1. CHOP-like chemotherapy with or without rituximab in young patients with good-prognosis diffuse large-B-cell lymphoma: 6-year results of an open-label randomised study of the MabThera International Trial (MInT) Group

    DEFF Research Database (Denmark)

    Pfreundschuh, Michael; Kuhnt, Evelyn; Trümper, Lorenz;

    2011-01-01

    The MInT study was the first to show improved 3-year outcomes with the addition of rituximab to a CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone)-like regimen in young patients with good-prognosis diffuse large-B-cell lymphoma. Extended follow-up was needed to establish long...

  2. 利妥昔单抗耐药淋巴瘤细胞株构建及其表型分析%Development and characterization of a Rituximab-resistant lymphoma cell line

    Institute of Scientific and Technical Information of China (English)

    王文廉; 万里新; 屈中玉

    2015-01-01

    OBJECTIVE To recapitulate various aspects of acquired resistance by developing and characterizing a Rituximab-resistant lymphoma cell line (Daudi-R),and to provide new ideas in combating Rituximab resistance.METHODS For the generation of Daudi-R clones,wide type cells were grown with step-wise increasing concentrations of Rituximab (0.125-128 μtg/mL) in the presence of 10% fresh human serum.The CDC,ADCC and apoptosis inducing abilities of Rituximab were analyzed in both the wide type and resistant lymphoma clones.The expression of CD20 and two membrane-bound complement regulatory proteins (CD55 and CD59) on surface of wild type and resistant lymphoma cells were compared by Flow Cytometry.The amount of intracellular apoptotic regulatory proteins (Bcl-2,Bcl-xl,Bax and Bak) were detected by western blotting analysis.RESULTS Rituximab induced CDC in Daudi-WT cells were respectively (86.4± 4.08) %,(78.79 ± 6.91) % and (62.87 ± 4.12) % at the concentration of 10,2 and 0.4 μg/mL,comparing with (26.23±42.53)%(t=25.08,P<0.001),(24.67±1.49)% (t=15.43,P<0.001)and (17.99±2.33)% (t=18.98,P<0.001) in Daudi-R cells.Cross-linked Rituximab moderately killed resistant clones (16.11 ± 3.50) %,compared with wild type clones (26.11± 2.78)%,t =3.877,P =0.018.The surface CD20 in resistant clones experienced a transient down-regulation in the first 3 days [(0.73±0.07) fold,Dunnett t test I-J=-0.29,SE=0.091,P=0.035] and a recovery until 10 days [(1.18±0.15) fold,Dunnett t test I-J=-0.18,SE=0.091,P=0.169] after the last treatment of Rituximab.The CD55 and CD59 positive subsets in resistant clones were significantly up-regulated from (1.59 ± 0.62)% and (1.39±0.59)% to (90.1±3.74)%(t=-40.49,P<0.001) and (90.33±2.69)% (t=-54.4,P<0.001),respectively.Western blotting results revealed that the expression of two apoptosis inhibitors (Bcl-2 and Bcl-xl) and promoters (Bax and Bak) respectively experienced an obvious up-and down-regulation in Daudi

  3. Fludarabine-based versus CHOP-like regimens with or without rituximab in patients with previously untreated indolent lymphoma: a retrospective analysis of safety and efficacy

    Directory of Open Access Journals (Sweden)

    Xu XX

    2013-10-01

    Full Text Available Xiao-xiao Xu,1 Bei Yan,2 Zhen-xing Wang,3 Yong Yu,1 Xiao-xiong Wu,2 Yi-zhuo Zhang11Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, 2Department of Hematology, First Affiliated Hospital of Chinese People's Liberation Army General Hospital, Beijing, 3Department of Stomach Oncology, TianJin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, Tianjin, People's Republic of ChinaAbstract: Fludarabine-based regimens and CHOP (doxorubicin, cyclophosphamide, vincristine, prednisone-like regimens with or without rituximab are the most common treatment modalities for indolent lymphoma. However, there is no clear evidence to date about which chemotherapy regimen should be the proper initial treatment of indolent lymphoma. More recently, the use of fludarabine has raised concerns due to its high number of toxicities, especially hematological toxicity and infectious complications. The present study aimed to retrospectively evaluate both the efficacy and the potential toxicities of the two main regimens (fludarabine-based and CHOP-like regimens in patients with previously untreated indolent lymphoma. Among a total of 107 patients assessed, 54 patients received fludarabine-based regimens (FLU arm and 53 received CHOP or CHOPE (doxorubicin, cyclophosphamide, vincristine, prednisone, or plus etoposide regimens (CHOP arm. The results demonstrated that fludarabine-based regimens could induce significantly improved progression-free survival (PFS compared with CHOP-like regimens. However, the FLU arm showed overall survival, complete response, and overall response rates similar to those of the CHOP arm. Grade 3–4 neutropenia occurred in 42.6% of the FLU arm and 7.5% of the CHOP arm (P 60 years and presentation of grade 3–4 myelosuppression were the independent factors to infection, and the FLU arm had significantly

  4. 活体成像分析异硫氰酸荧光素标记Rituximab在荷淋巴瘤裸鼠体内的生物分布%In vivo imaging analysis of biodistribution of FITC-labeled Rituximab in lymphoma-bearing nude mice

    Institute of Scientific and Technical Information of China (English)

    张胜华; 程昕; 钟根深; 熊冬生; 邵荣光

    2010-01-01

    目的 应用活体动物体内光学成像系统观察抗体药物Rituximab在荷淋巴瘤裸鼠体内的生物分布.方法 制备FITC标记的Rituximab(FITC-Rituximab),用激光扫描共聚焦显微镜和流式细胞仪体外分析FITC-Rituximab与人淋巴瘤Raji细胞的亲和力;建立裸鼠淋巴瘤皮下移植瘤模型,应用活体动物体内光学成像系统观察FITC-Rituximab在荷瘤小鼠体内的分布.结果 流式细胞仪和激光扫描共聚焦显微镜检测证明FITC-Rituximab与淋巴瘤Raji细胞有较好的亲合活性,主要结合在细胞膜表面.体内活体动物光学成像分析表明,FITC-Rituximab在1 h内即可特异性地在肿瘤部位富集,3~4 h即可进入肿瘤组织内部并达到最大浓度富集,8~10 h后在肿瘤组织仍可观察到FITCRituximab的特异性的富集,而在其他组织器官没有可见的荧光存在;双侧皮下移植瘤模型再次证明FITC-Rituximab具有对CD20抗原过表达的淋巴瘤特异性结合能力.结论 动物活体成像系统能够准确地监测FITC标记Rituximab在荷瘤裸鼠体内的动态分布情况,该技术对实时分析抗体药物在荷瘤小鼠体内的靶向效果具有参考价值和指导意义.%Objective To conduct an in vivo optical imaging analysis of the biodistribution of antibody Rituximab in lymphoma tumor-bearing nude mice. Methods Laser scanning confocal microscope and flow cytometry were employed to determine the affinity of FITC-labeled Rituximab (FITC-Rituximab)with human lymphoma Raji cells. And the in vivo optical imaging system was used to analyze the biodistribution of FITC-Rituximab in lymphoma-transplanted xenograft nude mice. Results The results of flow cytometry and laser scanning confocal microscope demonstrated that FITC-Rituximab had remarkable affinity with lymphoma Raji cells and was mainly bound at cell membrane. The results of in vivo imaging analysis suggested that FITC-Rituximab could specifically accumulated at peritumor tissue less

  5. 特异性前哨淋巴结显像剂99Tcm-rituximab药盒的制备及生物评价%Preparation and Evaluation of a Freeze-dried Kit of 99Tcm-rituximab for Sentinel Lymph Node Imaging

    Institute of Scientific and Technical Information of China (English)

    李艳; 李囡; 翟士桢; 王雪鹃; 杨志

    2011-01-01

    采用2-巯基乙醇修饰Rituximab(利妥昔单克隆抗体),制得其冻干药盒.所制得的冻干药盒性质稳定,可在-20℃冷冻保存3个月以上.利用99Tcm-葡庚糖酸钠(GH)交换法,标记冻干药盒得到99Tcm-rituximab,标记率和放化纯度均大于90%.生物分布结果显示:SD大鼠经前脚掌皮下注射99Tcm-rituximab后,前哨淋巴结的摄取值在1~4 h内逐渐增加,在4h时达到(2.14±0.46)%ID,前哨淋巴结与注射点的放射性摄取比在4h时达到最大(14.80%±2.11%),且在18h时,这一比值基本保持不变.SPECT显像结果表明,在30 min~18 h内,大鼠的前哨淋巴结清晰可见,无次级淋巴结显影.本研究提供了一种特异性前哨淋巴结显像剂的药盒化制备方法,该方法操作简便,性能稳定,便于在临床推广应用.%99Tcm-rituximab has been demonstrated to be having favourable properties for sentinel lymph node imaging. The aim of this research was to develop the formulation of the 99Tcm-rituximab freeze-dried kit. Firstly the rituximab was modified by 2-Mercapitoethanol, with the glucose as the excipient, and 1 mL phosphate buffers to compose the kit, which was dispensed into nitrogen-filled vials and aliquots frozen at - 20 ℃. 99Tcm-Rituximab was prepared from the 99Tcm-glucose via ligand exchange method. Both of the labeling yield and the radiochemical purity were more than 90%. The results of biodisdistribution of 99Tcm-rituximab in normal rat with front pad injection showed that the accumulation of the sentinel lymph node increased from 1 h (0. 93±0. 39%ID) to 4 h (2.14±0. 46%ID). The ratio of the uptake of sentinel lymph node to that of the injection site was 14. 80 + 2. 11% at 4 h, with no significant change at 18 h (13. 03% ±3. 98%). The SPECT imaging in rat showed that the sentinel lymph node can be seen clearly without the secondary lymph node imaging 30 min~18 h p. I.. In general, the frozen kit of rituximab was feasible to prepare the sentinel imaging

  6. 性别影响利妥昔单抗治疗弥漫大B细胞淋巴瘤%Gender affects the curative effect of rituximab for treatment of diffuse large B cell lymphoma

    Institute of Scientific and Technical Information of China (English)

    刘洋; 刘景华; 刘彦琴; 王吉刚; 白颖; 周凡

    2014-01-01

    目的:探讨性别对利妥昔单抗治疗弥漫大B细胞淋巴瘤5年无进展生存的影响。方法:回顾分析我院2003年1月至2011年1月收治的155例弥漫大B细胞淋巴瘤患者的临床及实验室资料。按照使用利妥昔单抗与否分为R-CHOP组和CHOP组;R-CHOP组按照性别分为R-CHOP-M组和R-CHOP-F组;CHOP组按照性别分为CHOP-M组和CHOP-F组;无进展生存采用Kaplan-Meier方法并描绘生存曲线。结果:5年无进展生存率,R-CHOP组比CHOP组高,R-CHOP-F组比R-CHOP-M组高;CHOP-M组和CHOP-F组无明显差异;R-CHOP-M组比CHOP-M稍高,但差异无统计学意义;R-CHOP-F组比CHOP-F高。结论:使用利妥昔单抗的女性患者获益要比男性患者大,这对使用利妥昔单抗治疗男性弥漫大B细胞淋巴瘤时,药物剂量的调整有重要的指导意义。%Objective To study the effect of gender on the curative effect of rituximab for the treatment of diffuse large B cell lymphoma with five-year progression-free survival. Methods The clinical and laboratorial data of 155 diffuse large B cell lymphoma patients from January 2003 to January 2011 were retrospectively analyzed. The patients were divided it into R-CHOP group and CHOP group according to if rituximab was used, and then subdivided based on their gender into R-CHOP-M, R-CHOP-F groups and CHOP-M, CHOP-F groups, respectively. Kaplan-Meier survival curve was plotted for the progression-free survival. Results The five-year progression-free survival rate in the R-CHOP group was higher than the CHOP group, and the rate of R-CHOP-F group was higher than R-CHOP-M group, but there were no significant differences between the CHOP-M group and the CHOP-F group. The rate of the R-CHOP-M group was a little bit higher than the CHOP-M group with no statistical significance. The rate of the R-CHOP-F group was higher than CHOP-F group. Conclusion Rituximab is beneficial for female than for male, which may contribute to the

  7. Synergistic and persistent effect of T-cell immunotherapy with anti-CD19 or anti-CD38 chimeric receptor in conjunction with rituximab on B-cell non-Hodgkin lymphoma.

    Science.gov (United States)

    Mihara, Keichiro; Yanagihara, Kazuyoshi; Takigahira, Misato; Kitanaka, Akira; Imai, Chihaya; Bhattacharyya, Joyeeta; Kubo, Takanori; Takei, Yoshifumi; Yasunaga, Shin'ichiro; Takihara, Yoshihiro; Kimura, Akiro

    2010-10-01

    Using artificial receptors, it is possible to redirect the specificity of immune cells to tumour-associated antigens, which is expected to provide a useful strategy for cancer immunotherapy. Given that B-cell non-Hodgkin lymphoma (B-NHL) cells invariably express CD19 and CD38, these antigens may be suitable molecular candidates for such immunotherapy. We transduced human peripheral T cells or a T-cell line with either anti-CD19-chimeric receptor (CAR) or anti-CD38-CAR, which contained an anti-CD19 or anti-CD38 antibody-derived single-chain variable domain respectively. Retroviral transduction led to anti-CD19-CAR or anti-CD38-CAR expression in T cells with high efficiency (>60%). The T cell line, Hut78, when transduced with anti-CD19-CAR or anti-CD38-CAR, exerted strong cytotoxicity against the B-NHL cell lines, HT and RL, and lymphoma cells isolated from patients. Interestingly, use of both CARs had an additive cytotoxic effect on HT cells in vitro. In conjunction with rituximab, human peripheral T cells expressing either anti-CD19-CAR or anti-CD38-CAR enhanced cytotoxicity against HT-luciferase cells in xenografted mice. Moreover, the synergistic tumour-suppressing activity was persistent in vivo for over 2 months. These results provide a powerful rationale for clinical testing of the combination of rituximab with autologous T cells carrying either CAR on aggressive or relapsed B-NHLs. PMID:20678160

  8. Image-Based Assessment and Clinical Significance of Absorbed Radiation Dose to Tumor in Repeated High-Dose {sup 131}I Anti-CD20 Monoclonal Antibody (Rituximab) Radioimmunotherapy for Non-Hodgkin's Lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Byun, Byung Hyun; Kim, Kyeong Min; Woo, Sang Keun; Choi, Tae Hyun; Kang, Hye Jin; Oh, Dong Hyun; Kim, Byeong Il; Choen, Gi Jeong; Choi, Chang Woon; Lim, Sang Moo [Korea Institute of Radiological and Medical Sciences, Seoul (Korea, Republic of)

    2009-02-15

    We assessed the absorbed dose to the tumor (Dose tumor) by using pretreatment FDG-PET and whole-body (WB) planar images in repeated radioimmunotherapy (RIT) with {sup 131}I rituximab for NHL. Patients with NHL (n=4) were administered a therapeutic dose of {sup 131}I rituximab. Serial WB planar images after RIT were acquired and overlaid to the coronal maximum intensity projection (MIP) PET image before RIT. On registered MIP PET and WB planar images, 2D-ROIs were drawn on the region of tumor (n=7) and left medial thigh as background, and Dosetumor was calculated. The correlation between Dosetumor and the CT-based tumor volume change after RIT was analyzed. The differences of Dosetumor and the tumor volume change according to the number of RIT were also assessed. The values of absorbed dose were 397.7{+-}646.2cGy (53.0{approx}2853.0cGy). The values of CT-based tumor volume were 11.3{+-}9.1 cc (2.9{approx}34.2cc), and the % changes of tumor volume before and after RIT were -29.8{+-}44.3% (-100.0%{approx}+42.5%), respectively. Dosetumor and the tumor volume change did not show the linear relationship (p>0.05). Dosetumor and the tumor volume change did not correlate with the number of repeated administration (p>0.05). We could determine the position and contour of viable tumor by MIP PET image. And, registration of PET and gamma camera images was possible to estimate the quantitative values of absorbed dose to tumor.

  9. Dosimetric calculation of I-131 activity for the treatment to patients having differentiated thyroid cancer. Benefits and limitations; Calculo dosimetrico de la actividad de I-131 para tratamiento de pacientes con cancer diferenciado de tiroides (CADT). Beneficios y limitaciones

    Energy Technology Data Exchange (ETDEWEB)

    Cabrejas, R. C.; Chebel, G. M.; Fadel, A. M.; Rojo, A. M.; Deluca, G.; Degross, O. J.; Valdivieso, C. M.; Carbejas, M. L.

    2006-07-01

    Maximum safe activity calculation, that has to be administered for treatment to patients having Differentiated Thyroid Cancer (CADT). No important side effects should be produced. Post treatment evolution was analysed. 23 Dosimetric studies were performed determining blood and whole body uptake curves (CE)during 5 days. Using the MIRDOSE software, the maximum safe activity in the whole body (CE)was calculated. The retained activity in the body (AR), 48 hs. post tracer dose. Should have been less than 2.96 GBq so as to avoid lung fibrosis. 17 patients that received activities<11.1 GBq, had no side effects. Three patients presents special situations: high AR, users in the mouth, and plaque to and leucopenia. This methodology has benefits because AT can be estimated. This was possible for 85% of the patients. When AR was high at 48 hr, AT was diminished to avoid pulmonary lesions. Tumor absorbed dose estimation, will allow the administration of AT>11.1 GBq in the future. (Author)

  10. Treatment of solitary, autonomously-functioning, non-toxic thyroid nodules with I131 Adenema tiroideo autónomo no tóxico tratamiento con I131

    Directory of Open Access Journals (Sweden)

    Federico Uribe Londoño

    1991-03-01

    Full Text Available

    Fifteen euthyroid patients (14 women and 1man with solitary autonomously functioning non-toxic thyroid nodules (AFTN were treated with high doses of I131 (mean 19.2 mCi. Diagnosis was made by I131 thyroid scan and triiodothyronine suppression test. The size of the nodule was determined by thyroid ecography both before and after treatment. Evaluation of thyroid function was performed clinically and by T3 T4 and TSH determinations before therapy and during follow.up. AII patients had complete suppression of the surrounding thyroid parenchyma. Two cases of hypothyroidism were found in the first two years of follow-up. We have no explanation for this fact since extranodular thyroid tissue was suppressed and the patients were receiving oral triiodothyronine during radioidine treatment. The nodules decreasedin size In 9 of 13 patients followed (average decrease 45% and disappeared in other 2. our findings suggest that solitary non-toxic AFTN should be treated with I131 particularly if complete suppression of the surrounding thyroid tissue is found. If complete disappearance of the nodule is considered desirable surgical removal must be performed.

    Se trataron 14 mujeres y un hombre, con adenomas tiroideos solitarios funcionalmente autónomos, no tóxicos, con I131 a una dosis promedio de 19.2 mCi. La gamagrafía tiroidea demostró hipercaptación del nódulo con supresión total del resto de la glándula. El tamaño del nódulo se determinó por medio de ecografía tiroidea antes y después del tratamiento, y su autonomía por la prueba de supresión con triyodotironina. El estado tiroideo se puso de presente clínicamente y por la medición de T3, T 4 y TSH en el plasma, antes de la terapia con el radiofármaco y durante la evolución postratamiento. En dos pacientes se presentó hipotiroidismo desde los dos primeros años del período de seguimiento, a pesar de que el tejido tiroideo circundante estaba suprimido y de la administración oral de triyodotironina simultáneamente con el yodo radioactivo. En 13 pacientes se logró hacer seguimiento; en 9 de ellos (69.2% hubo disminución del tamaño del nódulo (promedio de 45%; en dos desapareció y en otros dos no se modificó la lesión. Se sugiere que el tratamiento de los adenomas tiroideos autónomos no tóxicos con I131 es el más apropiado, especialmente si el tejido extranodular está suprimido; ello en vista de la Infrecuencia del hipotiroldismo postratamiento y de la inocultad y facilidad de su administración. Sin embargo, cuando se desea la desaparición total del adenoma y no existen contraindicaciones, debe recurrirse a la cirugía

  11. Dosimetric comparison fixed-individualized activity in the treatment of serious disease with I -131; Comparacion dosimetrica actividad fija-actividad individualizada en el tratamiento de la enfermedad de graves con I-131

    Energy Technology Data Exchange (ETDEWEB)

    Melgar Perez, J.; Orellana Salas, A.; Santaella, Y.; Arrocha Acevedo, J. F.

    2013-07-01

    The iodine-131 therapy has become the treatment with radiopharmaceuticals more frequent in our country, as well as the largest source of exposure to ionizing radiation for members who surround the patient. The aim of this article is to analyse the recommendations of radiological protection which are delivered to the patient receiving radiation discharge, in terms of the duration of the same time, taking into account the radiopharmaceutical dose, the time of entry, the dose rate measured at one meter and the family environment among others. (Author)

  12. Internal dosimetry for the radiological protection of the patient in the therapy with I-131; Dosimetria interna para la proteccion radiologica del paciente en la terapia con I-131

    Energy Technology Data Exchange (ETDEWEB)

    Deluca, G.M.; Rojo, A.M. [Autoridad Regulatoria Nuclear, Av. Del Libertador 8250 (C1429BNP), Buenos Aires (Argentina)]. e-mail: gdeluca@cae.arn.gov.ar

    2006-07-01

    In the patients with differentiated thyroid cancer (CADIT) subjected to therapy with radiopharmaceuticals should be considered the possible risk of sharp depression of the bone marrow like consequence of the intolerance to the quantity of administered activity. The manifestation of the myelotoxicity can limit in a substantial way the future treatments and to deteriorate the predict of resolution of the illness. In this work it shows the physical-mathematical mark of a methodology for the estimated absorbed dose in bone marrow based in the MIRD scheme whose objective is to protect the one patient of the noxious and undesirable effects of the internal radiotherapy in organs that are not target of the same one. The formalism incorporates specific information of the patient and also peculiar characteristics of the internal therapy in patient with CADIT. The considerations are the following ones: (1) the main organ to protect is the bone marrow: (2) the accumulated activity, in bone marrow, it is obtained starting from measurements in blood: (3) the used isotope almost exclusively in this type of therapies is the {sup 131}I; (4) it is used as radiopharmaceutical at the {sup 131}INa that it is characterized to be a simple, inorganic and small molecule: (5) the statistical incidence of the CADIT is bigger in women than in men. It is explained for that it was selected the formalism that is presented, the principles on which it is sustained which are their reaches and their limitations. They are also presented future innovations that can be implemented to effects of improving the estimates. The work is framed inside the thematic of the medical applications of open radioactive sources and it constitutes a contribution to the invigoration of the internal therapy with radiopharmaceuticals. This is due to that the methodology of dose estimation presented supplements with a theoretical biophysics base the protocols of empiric prescription broadly used in this practice. For these reasons, the dosimetric information obtained, adjusted to each concrete case, it contributes to improve the radiological protection of the patient. (Author)

  13. Radiation exposure from liquid discharges from I-131 therapy rooms into a piping system in the building

    International Nuclear Information System (INIS)

    Full text: Over 80% of the activity from patients undergoing radioiodine therapy for thyroid cancer is eliminated during the first three days. In our iodine therapy unit, numbers of hospitalized patients have increased from less than 200 in 2004 to more than 300 patients in 2006. The total amount of activity used is about 1,900 MBq, and the estimated amount excreted would then be about 1,800 MBq. This results in significant volume of liquid discharges into the piping system. In this study, we monitored external dose rates in non-radiation areas adjacent to pipeline connections in the building to ensure that the dose to any individual in these areas does not exceed 1 mSv per year. Materials and Methods: Exposure rates in areas adjacent to the pipeline junction connections were measured periodically from April 2006 to February 2007, five floors below the therapy unit. The measurements were made inside the wall in contact with the junction, behind the wall and in hallways 1 meter from the wall, using a GM detector or an ionization chamber. The results were recorded in μSv/h and the dose received was estimated for members of the public. Results: Significant increases in dose rates were detected in three floors below the unit. They were 2030, 1025 and 515 Sv/h at contact with the pipeline connections, 915, 1015 and 35 μSv/h behind the wall, and 36, 56 and 25 μSv/h in hallways on floors 1, 2 and 3 respectively. After appropriate wall shielding had been provided, dose rate behind the wall reduced to 23 μSv/h, and to 0.52 μSv/h in hallways. By using an occupancy factor 1/4 for hallways, the calculated dose meets the public dose limits of 1 mSv per year. Conclusions: Therapeutic application of 131I for the treatment of thyroid cancer generates a significant amount of liquid waste into the sewers. These low activity wastes originate mainly from toilets, showers, wash basins and floor drains. Although waste discharges can be handled without exceeding the permissible limits, there is possible exposure to the sewer workers if repairs become necessary. Appropriate precautions should be taken and radiation levels should be measured as the drain or sewer pipeline is opened up. (author)

  14. Analysis of influence of dosimetric factors on the outcome of I-131 therapy in patients with hyperthyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Knapska-Kucharska, M.; Oszukowska, L.; Makarewicz, J. [Department of Nuclear Medecine and Oncological Endocrinology, Province Hospital, Zgierz (Poland); Lewinski, A. [Chair and Department of Endocrinology and Metabolic Diseases, Medical University, Lodz (Poland)

    2012-07-01

    The influence of dosimetric factors on the outcome of {sup 131}I therapy has been examined in hyperthyroid patients submitted to {sup 131}I treatment. The following factors - which could have influence on the effects of therapy with radioiodine - were analysed: the goitre volume, the thyroid radioiodine uptake after 24 h, and the effective half-life time of {sup 131}I (EHL). Five hundred (500) randomly selected patients with hyperthyroidism, treated with {sup 131}I, were studied. They were divided into three groups (based on clinical examination, hormonal and immunological tests, thyroid scintigraphy and ultrasound imaging). The study shows that the effectiveness of {sup 131}I therapy depends on the thyroid volume and absorbed dose in all the groups of patients and on the thyroid radioiodine uptake and EHL in patients with a single autonomously functioning thyroid nodule. We have failed to determine the borderline D, distinguishing between effective and ineffective therapy. The treatment outcome can be predicted with approximately 70% accuracy, based on minimal absorbed dose

  15. Decitabine in Treating Patients With Metastatic Papillary Thyroid Cancer or Follicular Thyroid Cancer Unresponsive to Iodine I 131

    Science.gov (United States)

    2014-08-20

    Recurrent Thyroid Cancer; Stage IVA Follicular Thyroid Cancer; Stage IVA Papillary Thyroid Cancer; Stage IVB Follicular Thyroid Cancer; Stage IVB Papillary Thyroid Cancer; Stage IVC Follicular Thyroid Cancer; Stage IVC Papillary Thyroid Cancer

  16. 前哨淋巴结显像剂99Tcm-IT-Rituximab的制备及其定位性能%The preparation and localization study of a novel sentinel lymphoscintigraphy agent 99Tcm-IT-Rituximab

    Institute of Scientific and Technical Information of China (English)

    王雪鹃; 杨志; 林保和; 徐冰; 张岩; 张梅颖

    2006-01-01

    目的 研究前哨淋巴结(SLN)显像剂99Tcm-亚氨基噻吩(IT)-美罗华(Rituximab)的标记方法及其定位效应.方法 采用2-IT作为双功能连接剂,制备99TcmIT-Rituximab,确定最佳反应条件,评价标记抗体分子完整性及生物活性.观察比较99Tcm-IT-Rituximab及99Tcm-硫胶体(SC)2种示踪剂在小鼠淋巴结中的定位性能.将99Tcm-IT-Rituximab作为显像剂,对10例乳腺癌患者行乳腺癌SLN动态显像.结果 2-IT与Rituximab连接的最佳物质的量比为10∶1,4℃反应45 min后,每分子抗体螯合上的游离巯基数平均为2.1个.IT-Rituximab分子保持完整、免疫活性保留完全.99Tcm-IT-Rituximab的标记率>90%,其与B淋巴瘤细胞株Raji细胞的结合率为69.4%.动物显像结果显示99Tcm-IT-Rituximab可清晰定位小鼠SLN,注射后30 min~24 h SLN均可显影,2 h后SLN显影清晰,至24 h未见次级淋巴结显影.动物体内分布数据显示99Tcm-IT-Rituximab定位性能明显优于99Tcm-SC,24 h时SLN百分注射剂量率(%ID)为4.49%,次级及第3级淋巴结基本无摄取,24 h注射点滞留率为22.14%.结论 该标记方法简单,标记率高;99Tcm-IT-Rituximab在SLN中定位性能良好,是一种潜在的新型SLN显像剂.

  17. Rituximab对紫杉醇诱导人B淋巴瘤细胞株凋亡的增敏作用%Rituximab-mediated Sensitiziation of B-NHL Cell Lines to Apoptosis Induced by Paclitaxel

    Institute of Scientific and Technical Information of China (English)

    张红雨; 管忠震; 黄岩; 张星; 林桐榆

    2008-01-01

    目的 基于对CHOP(gg磷酰胺、阿霉素、长春新碱和强的松)联合化疗方案治疗侵袭性淋巴瘤疗效的不尽人意,本文研究利妥昔单抗(Rituximab)对新一代化疗药物Paclitaxel的化疗增敏作用,并探讨其可能的作用机制.方法 (1)体外培养Caudi、Ramos、Namalwa和Raji细胞,采用XTT法测定细胞增殖抑制率:以药物浓度为横坐标.抑制率为纵坐标绘出细胞增殖抑制曲线,比较单药和两药协同作用曲线,若联合作用曲线左移表示有协同作用,右移表示有拮抗作用.(2)Western blot测定:Daudi、Ramos、Raji和Na-malwa细胞经Rituximab 20μg/ml作用24小时后检测抗凋亡蛋白Bcl.2的表达情况.结果 (1)XrT法测定Paclitaxel单药及与Rituximab联合作用对各细胞株增殖抑制率:对Daudi、Namalwa、Ramos和Raji细胞株,Rituximab对Paclitaxel的细胞毒作用有明显的增敏作用;(2)Western blot测定:在Namalwa和Raji细胞株中,经Rituzdmab作用24小时后,可见Bcl.2蛋白表达下调.结论 (1)单药Rituximab对Paclitaxel有明显的化疗增敏作用.(2)在Namalwa和Rail细胞株,经Rituximab作用24小时后可见Bcl-2表达下调,可能是Rituximab增敏的机制之一.

  18. Study on CHOP combined Rituximab in treatment of B - cell non - Hodgkin' s lymphoma%美罗华联合CHOP治疗B细胞性非霍奇金淋巴瘤

    Institute of Scientific and Technical Information of China (English)

    闫轶鹏; 王婉玲; 黄琰; 杨满; 王冉; 贺立山

    2011-01-01

    目的 评价美罗华( Rituximah)联合CHOP(R- CHOP)方案治疗CD20阳性B细胞性非霍奇金淋巴瘤(NHL)的临床疗效及不良反应.方法 将60例初治B细胞淋巴瘤患者分为R-CHOP组和CHOP组各30例.R - CHOP组采用R-CHOP方案化疗;CHOP组采用CHOP方案化疗.6个疗程后比较两组的临床疗效及不良反应.结果 R -CHOP组完全缓解率达80%,总有效率90%;CHOP组完全缓解率为60%,总有效率为73.3%,两组疗效差异有统计学意义(P<0.01).两组不良反应差异无统计学意义(P>0.05).结论 美罗华联合CHOP方案治疗CD20阳性B细胞性非霍奇金淋巴瘤疗效显著,不良反应与单纯化疗相似,可作为该病目前的首选方案.%Objective To evaluate the clinical efficacy and adverse reactions of rituximab (Ritux-imah) combined CHOP (R - CHOP) treatment of CD20 - positive B - cell non - Hodgkin's lymphoma ( NHL). Methods Totally 60 patients with previously untreated B - cell lymphoma patients were divided into R - CHOP and CHOP groups each 30 cases. R - CHOP group with R - CHOP chemotherapy; CHOP group with CHOP chemotherapy, after 6 treatment course compared the clinical efficacy and adverse reactions. Results R - CHOP group complete remission rate of 80% total efficiency 90% ; CHOP complete remission rate was 60% , total effective rate was 73. 3% , two groups had statistically significant difference ( P 0.05). Conclusions Rituximab Combined CHOP in the treatment of CD20 - positive B - cell non - Hodgkin' s lymphoma effect is significant, adverse reactions with similar chemotherapy alone, as the disease is currently the preferred solution.

  19. 前哨淋巴结显像剂99Tcm-rituximab体外特性和安全限度的实验研究%Experimental Study of Biological Property and Safety Limitation of Sentinel Lymph Node Imaging Agent 99Tcm-rituximab

    Institute of Scientific and Technical Information of China (English)

    王雪鹃; 张岩; 李艳; 翟士桢; 林保和; 杨志

    2011-01-01

    用99Tcm标记rituximab(美罗华)评价特异性前哨淋巴结(SLN)示踪剂99Tcm-rituximab体外特性及其体内应用的安全性.采用聚丙烯酰胺凝胶电泳(SDS-PAGE)检测了99Tcm-Rituximab的分子完整性;采用间接酶联免疫荧光分析(ELISA)及流式细胞术检测了99Tcm-rituximab的免疫活性;最后依据中华药典的要求行99Tcm-Rituximab安全限度及在正常小鼠体内分布实验.结果显示:99Tcm- rituximab标记率为90%~95%;标记化合物分子完整,免疫活性保留完全,标记化合物无菌无热源.受试小鼠以60 mg/kg剂量注射99 Tcm-rituximab(相当于人体用量的500倍),1周内未见小鼠死亡.小鼠体内分布结果显示:99Tcm-rituximab入血后主要通过肾脏排泄,放射性摄取值由1h的(14.01±0.61)%ID/g减少为24 h的(3.51±0.48)% ID/g;肝脏亦可见摄取.各器官未见有明显的放射性滞留.因此,99Tcm-rituximab结构及性能稳定,无急性毒性,使用安全,可应用于临床.%To evaluate the biological property and safety limitation of a specific sentinel lym-phoscintigraphy imaging agent, 99Tcm-rituximab, 99Tcm-rituximab were analyzed for chemical and radiochemical purity, via SDS-PAGE and ITLC-SG. The immunoreactivity were detected via ELISA and flow cytometry. The safety limitation and biodistribution were tested according to the Chinese Pharmacopeia. The results showed that 99Tcm-rituximab, with a labeling yield of 90%~95%, was intact, and processed similar immunoreactivity of ritux-imab. The final product was bacteria and pyogen free, and was safe to the body. According to the data of biodistribution, most of agent was excreted by the kiney, and the radio uptake decreased from (14. 01±0. 61)%ID/g at 1 h to (3. 51+0. 48) %ID/g at 24 h. The liver also uptook the agent. No accumulation was found in the normal tissue. 99Tcm-rituximab is stable and contains a good immunoreacivity and can be effectively used for clinical study.

  20. Validation of prospective whole-body bone marrow dosimetry by SPECT/CT multimodality imaging in {sup 131}I-anti-CD20 rituximab radioimmunotherapy of non-Hodgkin's lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Boucek, Jan A. [Fremantle Hospital, Department of Nuclear Medicine, Fremantle (Australia); Turner, J. Harvey [Fremantle Hospital, Department of Nuclear Medicine, Fremantle (Australia); University of Western Australia, School of Medicine and Pharmacology (Australia)

    2005-04-01

    Radioimmunotherapy (RIT) for relapsed non-Hodgkin's lymphoma is emerging as a promising treatment strategy. Myelosuppression is the dose-limiting toxicity and may be particularly problematic in patients heavily pretreated with chemotherapy. Reliable dosimetry is likely to minimise toxicity and improve treatment efficacy, and the aim of this study was to elucidate the complex problems of dosimetry of RIT by using an integrated SPECT/CT system. As a part of a clinical trial of {sup 131}I-anti-CD20 rituximab RIT of non-Hodgkin's lymphoma, we employed a patient-specific prospective dosimetry method utilising the whole-body effective half-life of antibody and the patient's ideal weight to calculate the administered activity for RIT corresponding to a prescribed radiation absorbed dose of 0.75 Gy to the whole body. A novel technique of quantitation of bone marrow uptake with hybrid SPECT/CT imaging was developed to validate this methodology by using post-RIT extended imaging and data collection. A strong, statistically significant correlation (p=0.001) between whole-body effective half-life of antibody and effective marrow half-life was demonstrated. Furthermore, it was found that bone marrow activity concentration was proportional to administered activity per unit weight, height or body surface area (p<0.001). The results of this study show the proposed whole-body dosimetry method to be valid and clinically applicable for safe, effective RIT. (orig.)