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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

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    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

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    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. I-131 rituximab (chimeric anti Cd 20 mab) radioimmunotherapy of non-Hodgkins lymphoma

    International Nuclear Information System (INIS)

    Full text: Commercially available anti-CD 20 monoclonal antibody, rituximab (MabThera) may be efficiently radioiodinated with 131I using standard Chloramine-T methodology in a hospital radiopharmacy, under appropriate regulatory authority approvals. Multicentre clinical trials of 131I-rituximab radioimmunotherapy have been performed in patients with relapsed or refractory low grade non-Hodgkins lymphoma with therapeutically effective administered activities being determined on the basis of individualised prospective patient dosimetry. A non-myeloablative regimen of 131I-radioimmunotherapy predicated upon a maximum prescribed dose of 0.75 Gy to whole body has been used to minimise myelotoxicity in patients undergoing radioimmunotherapy, even when they have been heavily pre-treated with chemotherapy and/or there is tumour infiltration of bone marrow greater than 25%. Provided that baseline leucocytes exceeded an absolute neutrophil count of 1.5 x 109/L and platelets > 100 x 109 /L, the incidence of grade IV haematological toxicity was 16% for neutrophils and 4 % for platelets which was self-limited. The red marrow radiation absorbed dose in selected patients receiving 131I activities estimated to deliver 0.75 Gy to whole body was calculated to be less than 2 Gy using Monte Carlo methodology on post therapy CT/SPECT imaging. Predictive dosimetry was performed by serial whole body imaging following IV administration of a standard 200 MBq 131I-rituximab tracer and determination of individual pharmacokinetics of the radiolabelled antibody in each patient. A standard dose of 375 mg/m2 unlabelled rituximab (MabThera) was administered IV immediately prior to the tracer and therapy doses of 131I-rituximab to minimise nonspecific uptake of the radiolabelled antibody and to optimise the tumour to background activity. The administration of a standard course of 4 cycles of cold rituximab (MabThera) in association with the prescribed maximum activity of 131I-rituximab constitutes

  4. 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

  5. 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 ...

  6. APMP comparison of activity measurements of I-131 (APMP.RI(II)-K2.I-131)

    International Nuclear Information System (INIS)

    The international comparison of activity measurements of 131I (APMP.RI(II)-K2.I-131) was carried out within the framework of the Asia-Pacific Metrology Programme (APMP). Seven laboratories took part in the comparison, and five of them undertook absolute measurements. One ampoule containing the same radioactive solution as that used in the APMP comparison was sent to the International Reference System (SIR) for activity comparison at the Bureau International des Poids et Mesures (BIPM) in order to link the APMP comparison to the BIPM.RI(II)-K1.I-131 comparison and to evaluate degrees of equivalence with the key comparison reference value (KCRV). (authors)

  7. Radiation exposure in I-131 iodine therapy

    International Nuclear Information System (INIS)

    In the past five years, the applied I-131 radioactivity quantity has doubled with a constant number of beds. In 1984, it was 925 GBq (25 Ci). Despite this development, no changes in the professional radiation exposure were made out. The evaluation shows a dose smaller than 0.04 man Sv/TBq (0.16 man rem/Ci) of I-131 applied. This value is below the traceability limit of the film badges. The incorporation load of the personnel (27 members) was determined by monthly body counter measurements. Only in one measurement thyroid gland activity of 5 kBq (140 nCi) was detected. Most measurements did not show any incorporation; and the few positive results were below 0.74 kBq (20 nCi). The environmental load due to unfiltered release from patients' rooms was determined at the fence of the nuclear research plant. The maximum was 0.24 mSv/a thyroid gland dose of a small child in 1982 taking into account the measured 90% partion of organic compound iodine. The waste water is decayed following chemical treatment in storage tanks. (orig./HP)

  8. Rituximab Injection

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    ... a certain type of medication called a tumor necrosis factor (TNF) inhibitor. Rituximab is also used with ... redness, tenderness, swelling or warmth of area of skin chest tightness Rituximab may cause other side effects. ...

  9. 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)

  10. I-131 metaiodobenzylguanidine imaging after bone marrow transplantation for neuroblastoma

    International Nuclear Information System (INIS)

    This paper evaluates I-131 metaiodobenzylguanidine (MIBG) imaging after bone marrow transplantation (BMT) for advanced neuroblastoma (NBL). The authors reviewed 26 pre-BMT and 91 post-BMT I-131 MIBG studies in 31 children with NBL. Tc-99m methylene diphosphonate (MDP) bone scans and CT scans were obtained at the same time. In 10 of 16 living, disease-free patients, all pre- and post-BMT I-131 MIBG studies were negative; six had initially positive I-131 MIBG studies that became negative after BMT. I-131 MIBG studies normalized more rapidly than did bone scans. Two children with normal I-131 MIBF results developed new bone scan findings typical of trauma

  11. 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

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

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    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.

  13. 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

  14. False-positive I-131 uptake in meningioma

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    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.

  15. 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

  16. Experimental and clinical studies on the intrahepatic I-131-Lipiodol

    International Nuclear Information System (INIS)

    I-131-Lipiodol, a new therapeutic agent, has been used in the treatment of hepatocellular carcinoma (HCC) since Lipiodol retains within the vascular HCC following intrahepatic arterial injection. Radioiodination of Lipiodol was achieved by using a simple exchange method and the agent was used for the treatment of HCC following the biodistribution studies in dogs and human subjects. Desired radiation doses and easily be delivered up to 12,000 rad while keeping the radiation doses to normal liver, lung and whole body safe and tolerable. Clinical studies in 50 patients with hepatoma were performed by this method in order to estimate the therapeutic effect, safety, indication and limitations. The results as follows: 1. Biodistribution studies The effective half life of I-131-Lipiodol in the tumor was 6 days and retained in the tumor as long as 3 months. About 10% of radioactivity was demonstrated in the lungs with effective half life decay. The I-131-Lipiodol in the normal liver tissue seems to be metabolized in the hepatocytes and excreted into the bile and urine. No demonstrable radioactivity was noted in the thyroid, bowels, spleen and bone marrow. 2. Histologic studies Histologic studies following the untrahepatic I-131-Lipiodol of the canine liver revealed the Lipiodol particles in the bile duct cells and cytoplasm of hepatocytes. In human resected hepatomas after I-131-Lipiodol infusion, Lipiodol droplets were demonstrated in the tumor vessels, sinusoids as well as in the tumor cell cytoplasm. Extensive hemorrhagic necrosis of tumor was demonstrated after treatment with I-131-Lipiodol. 3. Clinical studies Response rate was most prominent in those cases of single massive types which measures less than 5cm in diameter. Multinodular type was also responsive rather than single massive type, however, infiltrative type of tumor or the tumors measuring more than 8cm was less effective on this therapy. 4. Adverse reactions Adverse reactions from the procedure include

  17. I-131 Extraction from Fresh water and Sewage plant effluent

    International Nuclear Information System (INIS)

    The amount of maximum I-131 body activity of a patient released from a hospital in Germany (250 MBq) is comparable to the yearly reported total release of I-131 from all commercial nuclear power plants to ambient air and water. A large fraction of the body activity will be excreted and find its way to surface waters, through the sewage system. Thus medical iodine is the major contributor to the environmental I-131 in surface waters. Due to the path it follows (patient-sewage-sewage plant-fresh water) it can form organic complexes and as a result its concentration of organic iodine is relatively high. Existing methods, focusing on the removal of mainly iodide (I-) and iodate (IO3-), were found to be insufficient to successfully extract the iodine from environmental samples, leading to highly variable results depending on the contribution of organic iodine. The reported work is based on testing and modifying existing methods. In order to accomplish the highest iodine yield, the inorganic iodine extraction is followed by a supplementary procedure for additionally separating the iodine bound to dissolved organic matter. The results show only slight variations of the I-131 extraction yield which is close to 90%, constituting this method as appropriate for successfully extracting I-131 from environmental samples (WWTP effluent, river water, lake water). Another advantage of our method is its applicability to high volume samples (20 L, 50 L), making it possible for a gamma spectrometer to detect activities as low as 0.5 mBq/l. (authors)

  18. 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...

  19. Risk of thyroid cancer due to I-131

    International Nuclear Information System (INIS)

    The process of increasing thyroid cancer in children after Chernobyl accident is explained. The current situation of thyroid exposure and ultrasonography of thyroid after Fukushima nuclear accident are compared with the experiment of Chernobyl. It is consisted of 1) thyroid and iodine, medical treatment for radioactive iodine, 2) adult thyroid cancer due to Chernobyl nuclear accident, 3) increase of adult thyroid cancer after Chernobyl nuclear accident, 4) Fukushima nuclear accident and thyroid cancer and 5) principle of future research of thyroid. Nuclear tests in the world and change of I-131 in thyroid of sheep in Tokyo (1955 to 1987), ultrasonography of thyroid for atomic bomb survivor, some examples of many adult patients of thyroid cancer at EU mission, annual incidence of adult thyroid cancer after Chernobyl accident (1986 to 1995), distribution of thyroid I-131 from March 26 to 30, 2011, and results of thyroid test in Fukushima prefecture are illustrated. (S.Y.)

  20. I-131 therapy for graves' disease in children and adolescents

    International Nuclear Information System (INIS)

    Graves' disease is the most common thyroid disease in Vietnam. For children and adolescents the therapy with anti-thyroid drugs is often inefficacious or relapsed in a short time after therapy. Therefore the treatment with I-131 is the first choice when the anti-thyroid therapy is failed. 45 patients with the median age 15 (range 8-16), including 9 males and 36 females , were hospitalized and treated with 1-131.28/45 (62%) patients are not cured with antithyroid drug (ATD), 17/45 (38%) were the first use of I-131. Examen findings show: an elevated concentration of serum free thyroxin (fT4) = 92 pmol/L ±62, a decrease of TSH=0.04 UI/L±0.02, the 2h uptake=51%±22%, the 24h uptake=71%± 28%. We have divided the patients in three group of severity, based on pulse rates (PR): 5 patients in mild group (PR 100 <121), 9 patients in severe group (PR 121-140). The hematological and biochemical findings were in normal range. All patients were treated with capsules of I-131, oral administration. The mean dose was: 7±1.2 mCi. The mean dose per gram of thyroid tissue was 274.5±97 mCi. The therapy efficacy was very high: 41/45 (91%) return to euthyroid status with only a single dose, 4/45 (9%) needed a second dose of I-131 after 3 months with several moderate clinical symptoms. Conclusions: The radioiodine therapy for Graves' disease is a method of choice for all juvenile patients non responding to ATD treatment. The mean dose of 7 mCi is sufficient, safe and efficacious. The recurrence rate is relative low, about 9-10%. (authors)

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

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    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.

  2. 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)

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

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    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.

  4. 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

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    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

  5. 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

  6. Algorithms for recruiting patients for I-131 MIBG therapy

    International Nuclear Information System (INIS)

    Aim: Aim of this study was to evaluate the use of I-123 MIBG in diagnostic algorithms for neuroendocrine tumours and check for the consequences in terms of recruiting patients for I-131 MIBG therapy. Methods: During the years 1996 to 2001, overall 166 scintigraphic studies with I-123 MIBG were performed in 132 patients (58 men, 74 women; mean age, 53 years). In all patients, 4 and 24 hr whole-body scintigraphy was performed after i.v. injection of 5 mCi (185 MBq) I-123 MIBG and at 24 hrs an additional SPECT of the region suspicious of bearing tumour(s). 68 of the 166 studies were performed focusing on tracer accumulation especially in the adrenal region and 98 in search of a (metastatic) neuroendocrine tumour of the abdomen/chest. Patients with adequate, potentially therapeutic, accumulation were referred to the nuclear medicine ward (in accordance with the treating physicians (e.g., endocrinologist)). These patients received 100 mCi (3.7 GBq) I-131 MIBG including whole body scintigraphy at appropriate time depending on accumulation and half-life. Results: Overall, in 166 studies 39 single foci of MIBG were localized (22 in the adrenal region). Multiple foci were found in 28 studies (carcinoid, medullary thyroid carcinoma, malignant pheochromocytoma). In all of these 28 cases, the diagnosis of malignancy was verified by histology in at least one focus. From this group of patients finally 10 entered the I-131 MIBG therapy with a mean of 2.4 doses (time interval, 4 months). At present (mean follow-up time, 18 months), 7 patients are alive (4 stable diseases, 3 with biochemically and morphologically partial response). An additional medication of interferone and/or sandostatine received 5 (of the living) patients. 7 patients reported subjective improvement (missing flush, normal blood pressure). Conclusion: At present, at our institution MIBG scintigraphy focuses less on patients with pheochromocytoma but rather on those with other neuroendocrine tumorous. The

  7. 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...

  8. 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.

  9. Calibration of filters for detection of airborne I-131 in the environment of nuclear power plant

    International Nuclear Information System (INIS)

    A simple and clean method for efficiency calibration of filters for collection of airborne I and corresponding Ge(Li) spectrometer is described. As the calibrated source of gaseous I-131 the radiopharmaceutical water solution of NaI is used. As calibration example the absolute activity distribution of I-131 measured in a charcoal filter is shown. (author)

  10. I-131 originating from nuclear medicine in German rivers; Nuklearmedizinisches {sup 131}I in deutschen Fluessen

    Energy Technology Data Exchange (ETDEWEB)

    Fischer, Helmut W. [Bremen Univ. (Germany). Fachbereich 1 - Physik; Strobl, Christopher [Bundesamt fuer Strahlenschutz, Oberschleissheim (Germany). Dienststelle Muenchen; Gellermann, Rainer

    2014-04-01

    The OSPAR agreement obligates the German government to determine and report the annual I-131 insertion from German rivers into the Northern Atlantic Ocean. In the frame of a research program the I-131 concentrations were determined in the rivers Elbe, Weser, Ems and Rhein that allowed the evaluation of the contamination load into the Northern Sea using a balance model.

  11. 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  <1%,‑26% and 33%, respectively. The adverse effects of partial volume were significantly smaller with the Monte Carlo simulated CDR correction compared with geometric Gaussian or no CDR modelling. Scatter correction showed a small effect on quantification of small volumes. When using a weighting factor, TEW correction was comparable to Monte Carlo reconstruction in all measured parameters, although this approach is clinically impractical since this factor may be patient dependent. Monte Carlo based scatter correction including accurately simulated

  12. Long-term follow-up study of I-131 therapy for Graves' disease

    International Nuclear Information System (INIS)

    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 T3 uptake level and T4 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 T3 were recovered to higher than normal range at 6 months in euthyroid group, while the levels of T3 were kept within the normal range in the seventy percent of hypothyroid group. Patients who were still lower in the level of T3 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)

  13. 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.

  14. 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.

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

    International Nuclear Information System (INIS)

    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

  16. I131-MIBG in early diagnose of neuroblastoma in symptomatic children

    International Nuclear Information System (INIS)

    Aim: Neuroblastoma is the second most common solid tumors in childhood which derivates from neural crest. It is very malignant and almost always patient comes with metastasis. However there are some diagnostic tools to detection of lesion in the early stage of tumor. We decided to have a review with using I-131 MIBG in patients suspected and/or proved to have neuroblastoma. Material and Methods: 300-500 μci I 131 MIBG was injected intravenously in patients (5 patients with age range 4 years old) referred for their bone pain and pelvic mass(detected with anatomical tools). Images were obtained 24 to 72 hours throughout the body with ADAC gamma camera and SPECT was performed in each local abnormal uptake. Each patient has already had a WBBS with TcMDP. Results: All abnormal tracer uptakes were seen in bone scan were revealed clearly in I131 MIBG. However, three to five other abnormal tracer activities were only seen in MIBG scan. The main tumoral lesions were showed perfectly in pelvic,that was not seen in WBBS. With a statistical analysis, I131 MIBG has 94% sensitivity 85-100% specificity, compare to Tc99m-MDP that was 78% and 51% respectively. Conclusions: We found that I131 MIBG is the most useful method to diagnose of patients with neuroblastoma and reproved that it has a competitive role in management, follow-up of these tumors especially in detection of metastasis

  17. Influence of rainfall upon the I-131 concentration in the wheat top and soil contaminated from the Chernobyl accident

    International Nuclear Information System (INIS)

    1) Increase of I-131 concentration in wheat top was caused by the direct dry deposition of the I-131 in the air, not by the direct wet deposition of the I-131 in the rainfall. I-131 concentration in wheat top was decreased by the rainfall, especially above 10 mm/day, by 7-35 % compared with the preceding day. 2) In contrast to the wheat top, the increase of I-131 concentration in surface soil (0-0.5 cm) was caused by the direct wet deposition of I-131 in the rainfall, not by direct dry deposition of I-131 in the air. The increase rate of I-131 caused by rainfall was 9-90 % compared with the preceding day. 3) It was estimated that the decrease of approximately 50 % during the period from 9:00 on May 8 through 9:00 on May 10 was caused by the volatilization of I-131 from the surface soil under the clear weather and the high air temperature. 4) Fifty-seven % of I-131 deposited on the soil has been retained in 0-1.0 cm horizon; the remainder distributed in 1.0-7.5 cm horizon at June 20. On the other hand, about 100 % of Cs-137 and Cs-134 has been retained in 0-1.0 cm horizon at June 20. 5) About 10 % of I-131 was removed from wheat top by gentle washing with water. It was estimated that the same level percent of I-131 would be removed from wheat top by the rainfall. 6) It was confirmed chemically that 94.1 % of I-131 in the rain water was in the form of iodate, 4.4 % was iodide. This ratio was almost the same as the stable iodine in the rain water. (author)

  18. 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

  19. Ovarian teratoma mimicking metastasis on I-131 scan : a case report.

    Science.gov (United States)

    Yoon, Sohee; Soo Hong, In

    2013-03-01

    The whole body I-131 scan is routinely performed in the postoperative treatment of patients with well-differentiated thyroid cancer. Accurate interpretation of whole body I-131 scan after thyroidectomy is critical to appropriate management of patients with thyroid cancer, to prevent unnecessary surgical removal or exposure to radioiodine. Unfortunately, false-positive uptakes in several other organs and their associated disease processes have been reported. We report a case of false-positive iodine uptake in the pelvic region with incidentally diagnosed mature cystic teratoma. PMID:24895508

  20. Ovarian teratoma mimicking metastasis on I 131 Scan: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Sohee; Hong, Insoo [Yonsei Univ. Wonju College of Medicine, Wonju (Korea, Republic of)

    2012-03-15

    The whole body I 131 scan is routinely performed in the postoperative treatment of patients with well differentiated thyroid cancer. Accurate interpretation of whole body I 131 scan after thyroidectomy is critical to appropriate management of patients with thyroid cancer, to prevent unnecessary surgical removal or exposure to radioiodine. Unfortunately, false positive uptakes in several other organs and their associated disease processes have been reported. We report a case of false positive iodine uptake in the pelvic region with incidentally diagnosed mature cystic teratoma.

  1. Significance of I-131 norcholesterol scintigraphy for diagnosis of adrenal dysfunction

    International Nuclear Information System (INIS)

    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.)

  2. Construction and assembling of a cell to produce I-131 in the radioisotopes production plant

    International Nuclear Information System (INIS)

    It has been constructed, improved and installed a cell with iron structures, Pb shielding, with an acrylic tight precinct, an air inlet and extraction system, services of water, light, active and conventional drainage, compressed air, vacuum and installation of other facilities suitable for the I-131 radioisotope production in the Radioisotopes Production Plant (PPR)

  3. 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

  4. Metastasis survey with a high dose of I-131 May Stun the thyroid

    International Nuclear Information System (INIS)

    This paper reports that up to 10 mCi of I-131 has been advocated as a scanning dose to help select patients for I-131 thyroablation after total thyroidectomy for differentiated thyroid cancers. A study was conducted to determine if such doses could stun the thyroid cells and if the same phenomenon occurred with I-123. The diagnostic scans and their corresponding therapy scans were visually compared in 33 patients. If the thyroid activity in the therapy scan (after 100-200 mCi) was less than in the diagnostic scan, the thyroid was considered stunned. Twenty-six patients received I-131 (3-10 mCi) and seven received I-123 (300 μCi). Stunning occurred in two of the five patients given 3 mCi, two of the three given 5 mCi, and 16 of the 18 given 10 mCi of I-131, and in one of the seven patients given I-123 (P = .0007). Fifteen of the 24 remnants compared with one of 11 distant metastases were stunned (P = .004). Seven of the 13 patients with stunned thyroid function showed unsuccessful ablation

  5. Evaluation of results of more than 20 years treating hyperthyroidism by I-131

    International Nuclear Information System (INIS)

    The authors have summarized their works of more than 20 years using I-131 for treatment and close observation of 723 patients with hyperthyroidism in 1000 ones in the Nuclear Medicine Department, Bach Mai University Hospital in Hanoi to collect data and draw experience for the report. Patient selection for the treatment is based on clinical features and laboratory tests results by the Nuclear Medicine Department such as thyroid uptake, scintigraphy and RIA determinations of thyroid hormones. I-131 dose is determined in compliance with a prevailing formula. The average dose is 6.2 ± 1.1 mCi (that is 233.1 ± 40.7 MBq). The average number of times is 1.3 time for one patient. The results are as follows: Euthyroid status after 4- year following- up from date of I-131 dose administration: 72.3%; Persistent or recurrent hyperthyroidism: 20.0%; Hypothyroid complications: appear 4 to 12 months after date of I-131 administration: 3.0%; appear 4 years after date of I-131 administration: 7.7%; appear 6 years after date of I-131 administration. 14.0%; so the cumulative hypothyroid rate is 2.3% per year. No occurrence of other serious complications by all the observed patients. This is therefore a safe, efficient treatment method to be applied on a large scale including adolescents and children. However, much more study has still to be made on the dose due to high rate of recurrence of the therapeutic method although the hypothyroid complications cases are not serious. Hyperthyroidism is a common health problem in Viet Nam. Previously, only anti-thyroid drugs and surgery were used. Use of I-131 was firstly introduced to Viet Nam in the Nuclear Medicine Department in Bach Mai in 1974 and afterwards applied larger nationwide. Initial therapeutic results have been published in national medical magazines. This is a general study aiming at analyzing the way to carry out the work and get experience and recommendation from gained results for further work in the future. (author)

  6. 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)

  7. 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)

  8. Radioiodine (I-131) treatment for uncomplicated hyperthyroidism: An assessment of optimal dose and cost-effectiveness

    International Nuclear Information System (INIS)

    Aim: Radioiodine (I-131) is increasingly being considered for the treatment of hyperthyroidism but there is no general agreement for the initial dose. To determine the cost-effectiveness and optimal dose of I-131 to cure disease, we prospectively studied the outcome of radioiodine therapy of 423 patients. Material and Methods: Any of the fixed doses of 6, 8, 10, 12 or 15 mCi of I-131 was administered to the patients relating to thyroid gland size. The individual was excluded from this study who had multinodular goitre and autonomous toxic nodule. Patients were classified as cured if the clinical and biochemical status was either euthyroid or hypothyroid at one year without further treatment by antithyroid drugs or radioiodine. The costs were assessed by analyzing the total cost of care including office visit, laboratory testing, radioiodine treatment, average conveyance and income loss of patient and attendant and thyroxine replacement for a period of 2 years from the day of I-131 administration. Results: The results showed a progressive increase of cure rate from the doses of 6, 8 and 10 mCi by 67%, 76.5% and 85.7% respectively but the cure rate for the doses of 12 and 15 mCi was 87.9% and 88.8% respectively. Cure was directly related to the dose between 6 and 10 mCi but at higher doses the cure rate was increased marginally at the expense of increased total body radiation. There was little variation in total costs, but was higher for low dose-therapy and the cost proportion between the 6 mCi regimen and 10 mCi regimen was 1.04:1. Conclusion: We could conclude that an initial 10 mCi of I-131 may be the optimal dose for curing hyperthyroidism and will also limit the total costs

  9. 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)

  10. Preparation of a radioactive boron compound (B-I-131-lipiodol) for neutron capture therapy of hepatoma

    International Nuclear Information System (INIS)

    In our research, a radioactive boron compound, B-I-131-lipiodol, that can be selectively retained in hepatoma cells was prepared. Combining the effect of α particles produced by boron neutron capture reaction with the β particles released by radionuclides in the radioactive boron compounds will produce a synergistic killing effect on cancer cells. Human hepatoma HepG2 cell cultures were used to examine the stability and the intracellular distribution of the radioactive boron drug. Microscopes were used to examine the interaction and retention of B-I-131-lipiodol globules in the individual hepatoma cell. Moreover, ICP-AES and NaI scintillation counter were performed to determine boron concentrations and I-131 radioactivity, respectively. Results showed that B-I-131-lipiodol with a boron concentration and a specific radioactivity ranged from 500-2000 ppm and 0.05-10 mCi/mL respectively was stably retained in serum. The radiochemical purity of B-I-131-lipiodol was 98%. After supplement with a medium containing B-I-131-lipiodol, the HepG2 cells had intracellular B-I-131-lipiodol globules in the cytoplasm as seen by inverted light microscope, the I-131 and boron can be stably retained in HepG2 cells. (author)

  11. 10 CFR 35.392 - Training for the oral administration of sodium iodide I-131 requiring a written directive in...

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Training for the oral administration of sodium iodide I... sodium iodide I-131 requiring a written directive in quantities less than or equal to 1.22 gigabecquerels... oral administration of sodium iodide I-131 requiring a written directive in quantities less than...

  12. Indication of doxorubicin cardiotoxicity by impairment of pIPPA I 131 utilization

    International Nuclear Information System (INIS)

    The present study was designed to evaluate if doxorubicin (D) can impair myocardial fatty acid utilization. To this end we studied the myocardial utilization of pIPPA I 131 in untreated (Co, n=6) and D (20 mg/kg intraperitoneal) treated rats. D was given 24 h (24 D, n=6) and 48 hours (48 D, n=6) before tracer administration. One min after i.v. pIPPA I 131 (50 μCi) injection, the hearts were rapidly removed, frozen in liquid nitrogen, weighed, and counted. Following lipid extraction of homogenized heart extracts 131 I radioactivity distribution was analyzed by thin-layer chromatographity (TLC). In additional rat experiments, high energy phosphates (12 rats/group) and carnitine (20 rats/group) were determined enzymatically in heart extracts. The mean pIPPA uptake in rat heart (%dose/g) was 2.49 in Co, 1.74 in 24 D, and 2.36 in 48 D rats. Usually five peaks were separated by TLC, that with a mean Rf value of 0.92 corresponding to pIPPA I 131, the remaining four representing catabolites of pIPPA metabolism. The mean relative amount of unmetabolized pIPPA I 131 as compared to the sum of pIPPA I 131 catabolites was less in Co than in 24 D or 48 D rats (P<0.05) (anti x: 46.5% vs 72.4% vs 59.4%, respectively). The mean carnitine content of H extracts was higher in Co (0.55 μM/g) than in D treated rats (24 D, 0.42 μM/g; 48 D, 0.46 μM/g) (P<0.05). The total amount of higher energy phosphates was not different between the groups. However the mean ATP/AMP ratio was higher in Co (35.9) than in 24 D (22.3) or 48 D (27.1) rats (P<0.05). We conclude that D therapy is accompanied by a partial reversible impairment in myocardial pIPPA utilization, possibly mediated by carnitine deficiency. Thus, pIPPA I 131 might be useful in patients on D therapy to evaluate eventual D-induced effects on myocardial fatty acid utilization. (orig.)

  13. Initial radioiodine remnant ablation success rates compared by diagnostic scan methods: I123 versus I131

    International Nuclear Information System (INIS)

    Full text of publication follows. Objective: to see if diagnostic whole body scan (DxWBS) performed with I-131 prior diminishes the success rate of initial radioiodine remnant ablation (RRA) compared to I-123 DxWBS in differentiated thyroid cancer patients. Material and methods: consecutive thyroid cancer patients who received total thyroidectomy for differentiated thyroid cancer and then high dose RRA (either 100 mCi or 150 mCi) within 6 months were included. DxWBSs were performed with I-123 or with I-131. Prior to the DxWBSs, all patients followed strict low iodine diet for 2 weeks and withdrew hormone to stimulate TSH above 30 mIU/l. Patients with extra-thyroidal extension of tumor, lymph node metastasis, or distant metastasis were excluded. The initial RRA was defined as successful if the next DxWBS done 6 months to 1 year later was negative and stimulated thyroglobulin level was below 2 ng/ml. Results: of 71 patients who had I-123 DxWBSs, 31 patients went on to receive RRA with 100 mCi and 40 patients received 150 mCi. Of 73 patients who had I-131 DxWBSs, 66 received 100 mCi and 7 patients received 150 mCi. The overall success rate was 79% for patients who had I-123 DxWBS prior to RRA (68% for 100 mCi and 86% for 150 mCi), and 68% for patient who had I-131 DxWBSs (68% for 100 mCi and 71% for 150 mCi). Conclusion: for patients who received 100 mCi, the RRA success rate was the same for I-123 DxWBS and I-131 DxWBS. For patients treated with 150 mCi, the success rate may be lower in patients who receive RRA following DxWBS with I-131 compared to DxWBS with I-123. (authors)

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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)

  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. 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)

  1. The influence of I-131 therapy on FDG uptake in differentiated thyroid cancer

    International Nuclear Information System (INIS)

    18F-fluorodeoxyglucose positron emission tomography (FDG-PET) [or PET/computed tomography (CT)] is more likely to show false-negative results when it is performed shortly after chemotherapy and/or radiotherapy because of ''metabolic stunning''. The present study aimed to evaluate the influence of I-131 therapy on FDG uptake and the detection of recurrence or metastasis of differentiated thyroid cancer (DTC). We retrospectively enrolled 16 consecutive FDG-PET/CT studies which had been performed in patients with DTC with elevated thyroglobulin (TG) but negative I-131 whole-body scan. All studies were performed under L-thyroxine suppression. The patients were divided into groups A and B for PET/CT performed within 4 months of I-131 therapy or no such therapy, respectively. Each lesion identified on PET/CT was characterized using a 5-point scale by visual analysis: 0=definitely benign, 1=probably benign, 2=equivocal, 3=probably malignant, and 4=definitely malignant. The maximum standardized uptake value (SUVmax) in each lesion was also measured for semiquantitative analysis. We compared the visual grading and SUVmax of the lesion of highest FDG uptake between groups A and B. For visual analysis, group B had significantly more patients with an uptake score of 3 or 4 than group A (80% vs. 17%, P=0.01). In addition, there were significantly more equivocal results from group A than from group B (67% vs. 10%, P=0.02). If the patients with the highest uptake scores of 2, 3, and 4 were considered to be positive for local recurrence or metastasis, there would be no significant difference between the positive rates of groups A and B (83% vs. 90%, P=0.7). However, the mean SUVmax of positive results was significantly lower for group A than for group B (3.1±0.9 and 6.6±3.5 respectively, P=0.02). The preliminary results suggested that FDG uptake in DTC may be negatively influenced by I-131 therapy within 4 months, resulting in lower FDG uptake and more equivocal results. Further

  2. Thyroid uptake of I-131 during anti-thyroid drug treatment

    International Nuclear Information System (INIS)

    Hyperthyroidism is a global ailment and its treatment is very promising either by ant-thyroid drug or by radioiodine. Iodine-131 uptake test is very important for evaluation of hyperthyroid in respect to its therapy and to exclude thyroiditis. This study was performed to observe the thyroid uptake pattern during intake of anti-thyroid medicine and workout the possibility to start I-131 therapy just after withdraw of antithyroid drug without waiting few days. In this study total 252 patient's I-131 uptake test is performed. Among the patient 135 (53.57%) were female, 117 (64.43%) were male. All this patients were hyperthyroid both clinically and biochemically. Thyroid uptake was taken to all patients at 24 hours after oral administration of 5 to 10 micro-curie of I -131. Uptake was taken by an uptake system and recorded as percentage uptake. These patients are grouped into three categories. Group-A-newly diagnosed cases, who have not taken antithyroid drug or I-131 therapy, there were 82 patients in this group, and their mean uptake was 37.12 ±18.5%. Group B - this group of patients were studied during intake of antithyroid medicine, there were 130 patients in this group and their mean uptake was 34.34±16.0%. Group-B patients were further divided in two sub-groups, patients having antithyroid drug for 1 to 3 weeks (group-B 1), group B1 have mean uptake 37±21% and those were taking antithyroid for 3 weeks to 2 years (group-B2), group B2 have uptake 34.34±20%. Group C- these patients are taken from those patients who had withdrawn antithyroid drug for 3 days to 3 months, there were 40 such patients. Group C further divided into two sub-group, group-C1 (stopped for 3-10 days) and group C2 (stopped for 11 days to 3 months). Group C1 had mean uptake 38±16% and group C2 had mean uptake 35±19%. From this study it is observed that Iodine-131 uptake percentage of untreated hyperthyroid; during antithyroid drug treatment and after withdraw of antithyroid drug almost

  3. 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

  4. 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

  5. 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...

  6. 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

  7. 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)

  8. Targeted therapy of neuroblastoma with I-131 MIBG: Experience in 15 cases

    International Nuclear Information System (INIS)

    Full text: I-131 MIBG has been proven to be an effective therapeutic option in neuroblastoma targeted both at the primary tumor and its distant metastasis. We describe our initial experience in the targeted treatment of 15 patients with neuroblastoma. The patients were grouped and treated according to three protocols. Group 1: patients were in the advanced stage of the disease with either metastatic or unresectable disease; Group II: patients were treated immediately after diagnosis before surgery or any other management. Group III patients were treated with combined I-131 MIBG and high dose chemotherapy. The method of administration was by slow infusion (120min). Dose varied from 4 to 12 GBq in a single dose. All patients were followed up with periodic blood counts, liver and kidney function tests, thyroid and adrenal function tests. The response rate in group-I was 38%, group-II patients showed 52% and in group-III the overall response rate was 72.6%. Responses depended on high tumoral I-131 MIBG uptake and limited spread of the neoplasm. As regards toxicity, the major side effect observed was myelosuppression and this was found to be more severe in patients with bone marrow involvement and after chemotherapy. Toxicity was relatively mild in the neuroblastoma patients who were treated at diagnosis. There was no incidence of serious infections or significant bleeding in any of our patients. Extramedullary toxicity of hypothyroidism was observed in 1 patient. On the basis of the results, we can conclude that MIBG is an excellent pharmaceutical for the delivery of therapeutic doses of radioiodine for neuroblastoma. When combined with chemotherapy it is effective in obtaining a rapid response in heavily pre-treated patients who are resistant to other therapies. (author)

  9. 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)

  10. Determination of I-131 content in children's and cow's thyroid in Kozloduj NPP region

    International Nuclear Information System (INIS)

    Within the scope of general programme for the radiation safety investigations the I-131 content in thyroid has been measured. For this purpose a group of 20 children within the age of 8-12 supplied with milk from private cows was selected as well as a group of dairy cows of local breed during milking period. Both groups were selected in a village located at 4km from the NPP in the direction of the dominating winds. According to the measuring results both the separate and average count rates for the two groups did not differ from the background ones

  11. Myocardial distribution of I131-labeled hexadecenoic acid in relation to the dog local coronary flow

    International Nuclear Information System (INIS)

    20 anesthetized and thoracotomized dogs are studied. The local myocardial blood flow is measured with sup(99m)Tc human albumin microspheres. The intramyocardial distribution of the 16-I(131)-9-hexadecenoic acid in relation to local blood flow is studied in basal conditions (7 dogs), after experimental infarction (6 dogs) and postischemic reactive hyperhemia (7 dogs). We conclude that during basal condition, after infarction but not during reactive hyperhemia, the distribution of the labeled fatty acid reflect the local variations of blood flow

  12. 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

  13. Effects of changed working methods on personnel doses at a I-131 and afterloading therapy ward

    International Nuclear Information System (INIS)

    The external load of the personnel from I-131 therapy can be kept small (almost 'neglectable') by appropriate behaviour without keeping patients 'under-lock and key'. The marked decrease in personnel doses is due to improved radiation protection for afterloading therapy (gynecological Ra-therapy, Cs-137-therapy) by technical equipment. This therapy is now possible but with the door of the application room closed; when the door is opened, the instruments automatically go back to their original position. From 1975 through 1982, there were remote control errors forcing the personnel to withdraw the instruments to the safe manually. Despite working regulations the personnel was able to go into the room without prior instrument withdrawal. The personnel doses so received were within the tolerance limits, however markedly above the inevitable values. Because of regular thyroid gland examination of the personnel there is proof for the fact that the radiation load of this organ from I-131 is probably smaller than 2% (6 mSv/a=600 mrem/a) of the annual limit value of 0.3 Sv (30 rem) which corresponds to 6 times the value of normal load. (orig./HP)

  14. 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

  15. Methodology for Gamma cameras calibration for I-131 uptake quantification in Hyperthyroidism diseases

    International Nuclear Information System (INIS)

    Optimization and verification of Patient-Specific Treatment Planning with unsealed I-131 sources is a desirable goal from medical and radiation protection point of view. To obtain a practical protocol to combine the estimation of the related parameters with patient's specific treatment dose in hyperthyroidism disease, 3 equipment were studied (Iodine Probe, a Philips Forte Camera with pin-hole collimators and a Mediso Nucline with HEGP for planar and SPECT techniques) and crossed calibrated. The linear behaviour on diagnostic and therapeutic activity range was verified, showing a linear correlation fitting factor R2 > 0.99. The differences between thyroid uptake determinations in all equipment were less than 6% for therapeutic activities and less than 1.1% in the diagnostic range. The combined protocol to calculate, with only one administration of I131, all the necessary parameters to the treatment dose estimation in 2D or 3D, avoiding wasting time with gamma cameras, was established and verified. Following this protocol the difference between apparent and calculated activities were less than 3%. (Author)

  16. Calibration of the Accuscan II In Vivo System for I-131 Thyroid Counting

    Energy Technology Data Exchange (ETDEWEB)

    Orval R. Perry; David L. Georgeson

    2011-07-01

    This report describes the March 2011 calibration of the Accuscan II HpGe In Vivo system for I-131 thyroid counting. The source used for the calibration was an Analytics mixed gamma source 82834-121 distributed in an epoxy matrix in a Wheaton Liquid Scintillation Vial with energies from 88.0 keV to 1836.1 keV. The center of the detectors was position 64-feet from the vault floor. This position places the approximate center line of the detectors at the center line of the source in the thyroid tube. The calibration was performed using an RMC II phantom (Appendix J). Validation testing was performed using a Ba-133 source and an ANSI N44.3 Phantom (Appendix I). This report includes an overview introduction and records for the energy/FWHM and efficiency calibrations including verification counting. The Accuscan II system was successfully calibrated for counting the thyroid for I-131 and verified in accordance with ANSI/HPS N13.30-1996 criteria.

  17. Evaluation for Preparation of I-131-MIBG for Diagnosis and Therapy Neuroblastoma

    International Nuclear Information System (INIS)

    Evaluation for preparation of 131I-MIBG have been carried out. Production/preparation of 131I-MIBG was carried out by labeling MIBG with I-131, the radiochemical purity of 131I-MIBG was analysed using TLC/paper chromatography. The stability in the human body by using fresh human plasma, at room temperature and at 8°C was carried out. The chemical purity of synthesized MIBG was found to be > 95%, the labeled MIBG with I-131 was analysed using TLC/paper chromatography. The radiochemical purity of 131I-MIBG was obtained at higher than 95 %. The stability of labeled MIBG in fresh human plasma and at 8°C was stable up to 141 hours, while at room temperature was stable up to 120 hours. The results of labeling of 131I-MIBG from 2010-2012 showed that these products were colorless clear solution with pH between 5.5.0-7.0, sterile and pyrogen-free, radiochemical purity > 95%. The quality control results were found to be met with the requirements of 131I-MIBG injection solution used for diagnosis and therapy of neuroblastoma in Hospital. (author)

  18. 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

  19. 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)

  20. 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)

  1. 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

  2. Rituximab-Induced Hypersensitivity Pneumonitis

    OpenAIRE

    Tonelli, Adriano R.; Lottenberg, Richard; Robert W Allan; Sriram, P.S

    2008-01-01

    Rituximab is a chimeric anti-CD20 monoclonal antibody used to treat CD20+ non-Hodgkin's lymphoma. Although pulmonary adverse reactions such as cough, rhinitis, bronchospasm, dyspnea and sinusitis are relatively common, other respiratory conditions like cryptogenic organizing pneumonia, interstitial pneumonitis and diffuse alveolar hemorrhage have rarely been reported. Only 2 possible cases of rituximab-associated hypersensitivity pneumonitis have been described to date. We present a case of h...

  3. Usefulness of partial volume effect-corrected F-18 FDG PET/CT for predicting I-131 accumulation in the metastatic lymph nodes of patients with thyroid carcinoma

    International Nuclear Information System (INIS)

    The purpose of this study was to evaluate the clinical usefulness of partial volume effect (PVE)-corrected F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT for predicting I-131 accumulation in metastatic lymph nodes (mLNs) during I-131 therapy for papillary thyroid carcinoma (PTC). Sixty-five mLNs in 31 PTC patients who underwent F-18 FDG PET/CT in an initial radioiodine therapy (RIT) were retrospectively evaluated. Of these, 25 mLNs were I-131-positive and 40 were I-131-negative. standardized uptake value (SUV)max and SUVmax with PVE correction (cSUVmax) were measured for each mLN, where PVE correction was performed utilizing a simple table lookup correction method. Then, SUVmax/cSUVmax was compared between I-131-positive and I-131-negative mLNs, including the analyses for the mLNs with small-sized (<1 cm) and weak FDG accumulation (SUVmax<3.5). The predictability for I-131 accumulation with SUVmax/cSUVmax was also compared. For all 65 mLNs, SUVmax/cSUVmax was significantly higher in I-131-negative than I-131-positive mLNs (p<0.0001). Only in cSUVmax, I-131-negative mLNs were significantly higher than I-131-positive, in terms of the 30 small-sized mLNs (p=0.0001) and 14 mLNs with weak FDG uptake (p=0.007). The highest accuracy in predictability for I-131 accumulation was significantly better with cSUVmax (92%) than SUVmax (62%) (p<0.0001). PVE-corrected F-18 FDG PET/CT is a valuable predictor of I-131 accumulation in mLNs during RIT. (author)

  4. Influence of rainfall upon the I-131 concentration in the wheat [Triticum aestivum] top and soil contaminated from the Chernobyl accident

    International Nuclear Information System (INIS)

    1) Increase of I-131 concentration in wheat top was caused by the direct dry deposition of the I-131 in the air, not by the direct wet deposition of the I-131 in the rainfall. I-131 concentration in wheat top was decreased by the rainfall, especially above 10 mm/day, by 7-35 % compared with the preceding day. 2) In contrast to the wheat top, the increase of I-131 concentration in surface soil (0-0.5 cm) was caused by the direct wet deposition of I-131 in the rainfall, not by direct dry deposition of I-131 in the air. The increase rate of I-131 caused by rainfall was 9-90 % compared with the preceding day. 3) It was estimated that the decrease of approximately 50 % during the period from 9:00 on May 8 through 9:00 on May 10 was caused by the volatilization of I-131 from the surface soil under the clear weather and the high air temperature. 4) Fifty-seven % of I-131 deposited on the soil has been retained in 0-1.0 cm horizon; the remainder distributed in 1.0-7.5 cm horizon at June 20. On the other hand, about 100 % of Cs-137 and Cs-134 has been retained in 0-1.0 cm horizon at June 20. 5) About 10 % of I-131 was removed from wheat top by gentle washing with water. It was estimated that the same level percent of I-131 would be removed from wheat top by the rainfall. 6) It was confirmed chemically that 94.1 % of I-131 in the rain water was in the form of iodate, 4.4 % was iodide. This ratio was almost the same as the stable iodine in the rain water. (author)

  5. The anti-thyroid antibody and I-131 uptake in thyroid disorder patient

    International Nuclear Information System (INIS)

    The problem of thyroid disorder is extensive in Bangladesh, even more than that of other developing countries. The high incidence rate of goiter is reduced after universal iodine supplement. This study has been undertaken to study the an-thyroid anti-body level among the thyroid disorder population (anti-TPO and anti-thyrogobulin antibody) and TSAb among Graves' disease and sub-acute thyroiditis. This study was performed over 300 persons of them 150 have some type of thyroid (patient) disorder and 150 have got no clinical thyroid disorder (volunteer). We also studied TSH receptor anti-body (TSAb) in 112 Graves' disease patients and 86 patients with sub-acute thyroiditis. All the patient had I-131 Uptake in 24 hours. Among the patient 42(28%) had elevated anti-TPO, 12(8%) had borderline and 96(64%) had normal anti-TPO. It was found the uptake percentage of this group of patient hade slight lower than average uptake of our population. 13±5% It was found that 28(18.6%) had elevated anti thyrogobulin anti-body, 9 (6.2%) had borderline and 113(75.3%) had normal level anti thyrogobulin anti-body. It was also that found the uptake percentage of this group of patient had slight lower than average uptake of our population. We also found that 21% patient had elevated both the antibodies. Among the normal volunteer 24(16%) had elevated anti-TPO, 8 (5.3%) had borderline and 118(78.7%) had normal level of anti-TPO. Thyroid 1-131 uptake was 15±4%. It was found that 14(9.3%) had elevated anti thyrogobulin anti-body, 6(4.1%) had borderline and 130 (76.6%) had normal level of anti thyrogobulin anti-body. Among the normal volunteer 6% had elevated both the antibodies. It was found 91% patient Graves' disease had positive TSAb and 92% of' sub-acute thyroiditis has negative TSAb, I-131 uptake was 31±8% among this group of patient.. Thyroid stimulating antibody is found in 91% of Graves' disease and very few patient with sub-acute thyroiditis. The uptake of I-131 in sub

  6. Improved detection of lung or bone metastases with an I-131 whole body scan on the 7th day after high-dose I-131 therapy in patients with thyroid cancer

    Energy Technology Data Exchange (ETDEWEB)

    Chong, Ar I; Song, Ho Chun; Min, Jung Joon; Kim, Ja Hae; Yoo, Su Ung; Oh, Jong Ryool; Bom, Hee Seung [Chonnam National University Medical School, Gwangju (Korea, Republic of); Jeong, Shin Young [Kyungpook National University Hospital, Daegu (Korea, Republic of); Ha, Jung Min [Chosun University Hospital, Gwangju (Korea, Republic of)

    2010-12-15

    The purpose of this study is to compare post-therapy third day and seventh day I-131 whole body scans (3DWBS and 7DWBS) in detecting lung or bone metastasis from well-differentiated thyroid cancer. We enrolled 52 patients with lung or bone metastasis out of 1,152 patients who were treated with high-dose I-131 therapy from January 2008 to June 2009. All patients underwent 3DWBS and 7DWBS. I-131 avidity was classified into three grades: no uptake, suspicious for uptake, and definite uptake. We compared the presence and grades of metastatic lesions on each scan. We categorized all cases into three groups based on I-131 uptake on each scan and compared several clinical parameters including FDG uptake and thyroglobulin (Tg) level among the groups. Sixty metastatic cases from 52 patients (45 lung and 15 bone metastases) were included. In 35 cases, I-131-avid metastatic lesions were detected by both 3DWBS and 7DWBS (group A). In 15 cases, metastatic lesions were missed on 3DWBS but detected on 7DWBS (group B). In 10 cases, I-131 uptake was not detected on either 3DWBS or 7DWBS (group C). The of 45 cases (22.2%) of lung metastasis that were negative on 3DWBS were detected on 7DWBS (p=0.002). Five of 15 cases (33.3%) of bone metastasis that were negative on 3DWBS were detected on 7DWBS (p=0.0625). The serum Tg level (TSH stimulated) was significantly different among groups A, B, and C (p=0.0030). However, after exclusion of cases without a history of I-131 therapy, there was no significant difference in serum Tg level among the groups (p=0.2330). The number of cases with a prior history of metastasis was higher in group A than in group B (p=0.0069). However, there was no significant difference in prior history of metastasis between groups A and C (p=0.8107). 7DWBS showed more lung or bone metastatic lesions than 3DWBS. After high-dose I-131 therapy, 7DWBS should be considered regardless of the results of the 3DWBS for the diagnosis of lung or bone metastasis from well

  7. 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

  8. 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

  9. The measurements of gastro-intestinal protein loss by means of I131-labelled polyvinylpyrrolidone

    International Nuclear Information System (INIS)

    A method for studying gastrointestinal protein loss is outlined. This method uses I131-labelled po1yvinylpyrrolidone (PVP). Po1yvinylpyrrolidone is a highly polymerized, chemically stable substance which following intravenous injection, penetrates, even under physiological conditions from lymph and blood vessels into the lumen of the gastrointestinal tract. This transfer of PVP is increased in certain pathological conditions, notably in diseases which cause hypo-proteinaemia. Thus, Labelled PVP can be used as a tracer for proteins, in that the rate of permeation of PVP through the intestinal wall provides an index of the rate of permeation of plasma proteins. An increased permeation of PVP is indicative of a disturbance in the permeability of the intestinal wall. The great advantage of PVP is that it is not split up enzymatically and that it cannot be re-absorbed. 1 tab

  10. 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.

  11. Simulation for separation of radioisotopes I-123 from tellurium target using tracer I-131

    International Nuclear Information System (INIS)

    Radioisotope Iodine-123 (123 I) can be used as material for the preparation of radiopharmaceutical imaging with SPECT tool. This is caused to 123I emits gamma rays with energies 159 keV and a half-life 13.2 h. 123I radioisotope was made from the target material in the form of a thin layer of solid tellurium targets with the reaction 123Te (p, n) 123I in energy protons 8-15 MeV or 124Te (p, 2n) 123I in the 20-26 MeV proton energy using the cyclotron. The use of I-131 tracer to simulate the separation of I-123 radioisotope from the tellurium target because BATAN Cyclotron CS-30 have not produce current yet so it can not generate a radioisotope I-123. Simulation of I-123 radioisotope separation from the tellurium target using tracer I-131 can be performed by irradiating solid tellurium targets in the reactor. Separation is conducted by dissolving Te targets in the target puck into the dissolution vessel with CrO3 and H2SO4 then insert to the distillation flask. Furthermore, tellurium irradiated in the reactor as a tracer was added to the distillation flask to be dissolved along with tellurium the results of electroplating. Before distilled done first iodate is reduced with oxalic acid to produce iodine. Iodine was formed, then carried distillation and distillate containing I accommodated with an alkaline solution containing sulfite Based on the results of separation experiments three times the yield were obtained with respectively 12.85%, 13.9% and 5.2% with 1-131 radio nuclide purity of 100%. (author)

  12. Thyroid Dose Estimation Using WBC and I-131 Concentration in Working Area of Radioisotope Production at Normal Operation

    International Nuclear Information System (INIS)

    Thyroid dose estimation at Radioisotope Production Centre workers using WBC and calculation based on I-131 concentration in working area has been done. The aim of this research is to get the relation between WBC result and calculation using I-131 concentration in working area. The result indicates differences in a range of 3,2% to 53,2%. These differences caused of parameters which influence the calculation are not accurate. These results also indicate that dose estimation using WBC is relatively batter and more accurate but need to have certain information about time of intake

  13. 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

    2015-01-01

    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. PMID:26198990

  14. 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.

  15. 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

  16. 10 CFR 35.394 - Training for the oral administration of sodium iodide I-131 requiring a written directive in...

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Training for the oral administration of sodium iodide I... Byproduct Material-Written Directive Required § 35.394 Training for the oral administration of sodium iodide... of sodium iodide I-131 requiring a written directive in quantities greater than 1.22...

  17. 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

  18. The therapeutic effects and absorbed dose of I-131 MIBG in patients with malignant pheochromocytoma

    International Nuclear Information System (INIS)

    High selective tumor uptake and retention of I-131 MIBG (MIBG) is known as a prerequisite for successful treatment of pheochromocytoma. We evaluated the relationship of absorbed dose of MIBG in tumor and therapeutic effects in twelve selected patients gained over a period of more than 5 years. All patients were diagnosed as malignant adrenal or extra-adrenal pheochromocytoma clinically. The metastases were identified in 10 patients on tracer dose images prior to therapy. Except for 4 patients, all others were symptomatic and had raised hormones indicative of tumor hyper-secretion at the time of enrolment. The number of doses of MIBG ranged from 1 to 3 times with 3.7 GBq per course and a cumulative activity from 3.7 to 11.1 GBq. The estimation of the therapeutic MIBG absorbed dose was performed on the basis of measurement after a therapy by using SPECT on day 1,3,and 5. The absorbed dose was calculated from MIRD data. None of the patients had a complete remission to I-131 MIBG therapy. In one patient, died with DIC 4 months after therapy. Of the 11 patients evaluated, a partial remission (PR) and stable disease was observed in one case individually. A dramatic improvement of the symptoms was noticed in this PR patient and maintained well condition now, 12.0 years after initial MIBG therapy. The cumulated absorbed dose with 11.1 GBq of MIBG calculated in lung and lymph node metastases was exceeded over 150Gy. MIBG uptake in each tumor was thought to be homogeneous. The other nine patients, however, showed little effects, and five were died with disease in 2.6 to 4.1 years after therapy. MIBG therapy is an effective palliative treatment for malignant pheochromocytoma, although a complete tumor response rate is low. It is sufficient in the therapy of these difficult tumors that response of tumors is partial remission or the tumor arrest. Criteria of patient selection with therapeutic modalities should be estimated including the absorbed dose and also the distribution

  19. 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)

  20. 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)

  1. 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

  2. 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

  3. I131 application method in mutual feeding tests on honey bees (Apis mellifica L.)

    International Nuclear Information System (INIS)

    In order to avoid outward contamination with tracers it is necessary to check the bee's external radioactivity and not to use externally radioactive animals for experiments. For radioactive feeding and sorting out of contaminated bees a method is being suggested which enables to achieve only 0.6% of the radioactivity of the whole bee's body on the feet. This contamination of the bee's body surface is of no practical importance while investigating mutual feeding in the insects of the given species. Bees fed with radioactive feed did not belch it while being mortified in the refrigerator at 0 deg C, but belched it under chloroform. In the bee's body I131 is distributed in the following way: in the head - 3.6, in the chest -8.1, in the abdomen - 86.8, in the feet - 0.7 and in the wings - 0.2% on the average. These amounts change with time: they increase in some parts of the body, while decrease in some other

  4. I-131 therapy for hyperthyroidism in carbimazole induced acute aplastic anaemia

    International Nuclear Information System (INIS)

    Full text: We present a case of a 39 year old previously well woman who developed carbimazole-induced acute aplastic anaemia. Following 6 weeks of carbimazole for Grave's disease she presented with fever, sore throat and lethargy and was found to be pancytopaenic. Haemoglobin fell to 79g/l (normal>120g/l), neutrophils to an undetectable level and platelets to 4,000/ml (normal>150,000/ml). From the MIRD schema it was estimated that a therapeutic dose of 444 MBq (12mCi) to treat her hyperthyroidism would deliver a red marrow radiation dose of about 30 mSv, at least an order of magnitude below any expected demonstrable deleterious effect on the marrow. Subsequently a dose of 444 MBq of I-131 was given and within 2 weeks the marrow had begun to recover, eventually to normal. This case would support the use of 1-131 for hyperthyroidism in carbimazole-induced marrow aplasia, even in profoundly depressed marrow

  5. Radiation protection of thyroid cancer patients receiving I-131 therapy: Some considerations

    International Nuclear Information System (INIS)

    As a preliminary step to investigating the potential usefulness of external thermoluminescence dosimetry (TLD) in estimating parameters of radiation dose to the bladder and the gastric mucosa, 27 inpatients treated with Iodine 131 (60-200 mCi or 2.22-7.4 GBq) for differentiated thyroid carcinoma (19 receiving the iodine in a capsule and 8 in solution form) were studied. Doses and ages were similar in both group as was fluid intake (ad lib but carefully recorded for each case). The TLDs were placed over the urinary bladder and in standard positions in the epigastrium (xiphoid and left subcostal area) and total doses for 22 hours (bladder) as well as total doses and dose rates (epigastrium) at various times from 5 to 90 minutes were recorded. Both bladder dose and integral dose for 90 minutes over the stomach showed statistically significant positive linear correlation with the administered I-131 activity. No correlation with the amount of fluid intake was found. The 90 minute integral dose at the epigastrium per mCi administered was found to be higher in the capsule group by 70%. Six out of 27 patients reported some discomfort (6/19 and 0/8 for capsule and liquid group respectively, p=0.13). The possible significance of these findings is discussed. (author)

  6. Early prediction for necessity of 2nd I-131 ablation therapy with serum thyroglobulin levels in patients with differentiated thyroid cancer

    International Nuclear Information System (INIS)

    The aim of our study was to evaluate the predictive value of serum thyroglobulin levels, measured at preoperative status and just before 1st I-131 ablation therapy with high serum TSH, for necessity of 2nd I-131 ablation therapy in differentiated thyroid cancer patients. 111 patients with DTC who underwent total or near total thyroidectomy followed by immediate I-131 ablation therapy, were enrolled in this study. TSH, Tg and anti-Tg autoantibody were measured before thyroidectomy (TSHpreop, Tgpreop and Anti-Tgpreop) and just before 1st I-131 ablation therapy (TSHabl, Tgabl and Anti-Tgabl). All TSHabl levels were above 30mU/liter, ATg [(Tgpreop-Tgabl)X100/(Tgpreop)] was calculated. 29 patients(26.1%, 29/111) had to receive 2nd I-131 ablation therapy. Of 70 patients whose Tgabl were under 10 ng/ml, only 11 patients had received 2nd I-131 ablation therapy (15.7%). Patients with Tgabl greater than or equal to 10 ng/ml had received 2nd I-131 ablation therapy (18/41, 43.9%) than patients with lower Tgabl level. There was a disparity of necessity of 2nd I-131 ablation therapy between two groups(Tgabl <10 ng/ml and Tgabl =10 ng/ml, two by two /2 test p=0.0016). Of 41 patients with Tgabl greater than or equal to 10 ng/ml, 19 patients showed increased Tg levels (ATg<0). Patients with negative ATg and Tgabl greater than or equal to 10 ng/ml showed a strikingly high necessity of 2nd I-131 ablation therapy (11/19, 57.9%). There was also a significant disparity of necessity of 2nd I-131 ablation therapy between two groups(ATg<0 + Tgabl =10 ng/ml and the others, two by two /2 test, p=0.0012). These results suggest that high Tgabl level just before 1st I-131 ablation therapy can forecast the necessity of 2nd I-131 ablation therapy. Moreover, Difference of Tg level between preoperative status and just before 1st I-131 ablation therapy could also suggest necessity of 2nd I-131 ablation therapy at early period of DTC patients surveillance

  7. 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.

  8. Synthesis of I-131 labelled iodine species relevant during severe nuclear accidents in light water reactors

    International Nuclear Information System (INIS)

    Methods for the small scale synthesis of I-131 labelled iodine species relevant to severe nuclear accidents in light water reactors have been developed. The introduced methods allow the synthesis of impurity free, volatile, inorganic elemental iodine and volatile, organic iodides such as methyl- and ethyl iodide, as well as butyl iodide, chloroiodomethane, allyl iodide and benzyl iodide with ease. The radioactive iodine containing products are sufficiently stable to allow their storage for later use. Due to their volatility the liquid species can be easily converted into gaseous species and thus can be used in research in liquid and gaseous phase. The primary motivation for the development of these synthesis methods is to study the behaviour of volatile iodine species under the conditions of a severe nuclear accident in a light water reactor. Thus, the chemicals involved in the synthesis are chosen in a way to not generate impurities (chlorine and organic solvents) in the products which interfere with competing reactions relevant during a severe nuclear accident. Teknopox Aqua VA epoxy paint, which is used in Swedish light water reactor containments, and its reactions with the produced iodine species are described. The synthesised iodine species undergo chemisorption on paint films. Different to elemental iodine, the organic iodides are non-reactive with copper surfaces. The sorbed iodine species are partly re-released mainly in form of organic iodides and not as elemental iodine when the exposed paint films are heat treated. The partitioning and hydrolysis behaviour of gaseous methyl- and ethyl iodide between containment gas phase and water pools is found to be similar. The methods have been designed to minimise the use of harmful materials and the production of radioactive waste. (orig.)

  9. Radiolocalization of colon cancer with I-131 B72.3 monoclonal antibody

    International Nuclear Information System (INIS)

    I-131 labeled monoclonal antibody B72.3 (IgGl) which targets a tumor-associated antigen present in breast and 80% of colon carcinomas was utilized to image 19 patients (pts) with metastatic colon cancer. B72.3 was labeled via the iodogen method, and administered as a 1h infusion. Pts were studied at .27 mg (range .16-.46) and 1.3 mCi (11 pts), 3.8 mg (range 3.7-4) and 1.5 mcl (3 pts) and 1.19 mg (range 1.1-l.4) and 9 mCi (5 pts) in order to asses the effect of B72.3 dose(mg) on biodistribution as well as the effect of improved counting statistics on the scintigrams. 10 of 19 patients had positive scans. In this limited study no dose related effect on tumor uptake was found. Optimal images were obtained at 7 days when background levels had dropped. The scans showed no concentration in normal organs. The blood pool clearance was prolonged with a mean T 1/2 of 31-52h and not significantly different for the various dose levels. The total body clearance determined by NaI crystal probe counts was approximately 3-4 days for all groups. The route of excretion was predominantly renal. No toxicity was observed. An antimouse immune response was seen in 5 of 16 patients tested. This data indicate the feasibility of targetting colon cancer B72.3. The prolonged retention in the blood pool requiring delayed images for optimal target to non target ratios and the high levels of antimouse immune response suggest that the use of Fab or F(ab')/sub 2/ should be explored

  10. Simple Synthesis, Halogenation, and Rearrangement of closo-1,6-C2B8H10

    Czech Academy of Sciences Publication Activity Database

    Bakardjiev, Mario; Štíbr, Bohumil; Holub, Josef; Padělková, Z.; Růžička, A.

    2015-01-01

    Roč. 34, č. 2 (2015), s. 450-454. ISSN 0276-7333 R&D Projects: GA ČR(CZ) GAP207/11/0705 Institutional support: RVO:61388980 Keywords : MAGNETIC-RESONANCE-SPECTROSCOPY * ORGANOELEMENTAL DERIVATIVES * CLOSO-BORANES * CARBORANES * 5,6-DICARBA-NIDO-DECABORANE(12) Subject RIV: CA - Inorganic Chemistry Impact factor: 4.126, year: 2014

  11. 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

  12. 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.)

  13. 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

  14. Problem on estimation of the content of I 131 in milk in the 'iodine' period of the Chernobyl accident

    International Nuclear Information System (INIS)

    Measurements of the beta-activity of milk, serving as the main source of information on the radioactive contamination of the environment by the iodine isotope I 131, carried out on a DP-100 radiometer in the early post-Chernobyl period (1986) in Belarus, have been mathematically simulated. The results obtained allow the conclusion that the indicated measurements should be analyzed again with consideration for all of the nuclides present in milk. (authors)

  15. Multimodality treatment of primary nonresectable intrahepatic cholangiocarcinoma with I-131 anti-CEA: A radiation therapy oncology group study

    International Nuclear Information System (INIS)

    Thirty-seven patients (57% with metastasis and/or who has previously undergone chemotherapy) with primary unresectable intrahepatic cholangiocarcinoma were prospectively treated with external beam radiation therapy, chemotherapy, and I-131 anti-carcinoembryonic antigen (CEA) antibody. The regimen led to partial remission in 26.6% of patients, according to CT scan digitized tumor volume analysis, and in 33.3% (25.9% with partial remission, 7.4% with complete emission) according to physical examination findings. Therapy began with whole liver irradiation (2.1 Gy, 0.3 Gy per fraction, delivered 4 days a week, with 10-MV photons) and, on alternate days, chemotherapy (Adriamycin, 15 mg, + 5-fluorouracil [5-FU], 500 mg). One month later, Adriamycin, 15 mg, + 5-FU, 500 mg, was administered on day 0; 20 mCi of I-131 anti-CEA on day 1; and 10 mCi of I-131 anti-CEA on day 6. Tumor effective half-life was 3-5 days. Median tumor dose (20 mCi + 10 mCi) was 6.2 Gy. Antibody therapy was administered in 2-month cycles. Grade IV thrombocytopenia and leukopenia each occurred in 3.2% of patient administrations. Median survival for the entire group was 6.5 months; for responders, it was 15.2 months. The longest partial remission is presently more than 4 years

  16. 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).

  17. Radioiodine (I-131) application in the management of differentiated thyroid cancer (DTC) audit

    International Nuclear Information System (INIS)

    Full text: Differentiated thyroid cancer (DTC) remains one of the curable of all cancers. All literature reviews and clinical experiences regarding I131 use in DTC conclude the beneficial effects, better prognosis, longer survival time and an assurance for cure. The Overall prognosis of patients with DTC is excellent if treat scientifically, adequately and timely. The management of thyroid cancer depends on the resources available in different institutions. Nuclear Medicine unit (NMU), Faculty of Medicine Peradeniya, Sri Lanka is in the process of uplifting the services for thyroid cancer management. Clinical audit was carried out in NMU on patients who utilized the Nuclear Medicine facilities in the management of DTC. It is important to identify deficiencies in current practice to improve our services. During January 2004 to March 2005, 126 DTC patients were referred for radioiodine Whole body scan (WBS) and therapy. Their age, sex, histology, extent of surgery, adequacy of thyroxine suppression treatment, monitoring with serum thyroglobulin levels (Tg), WBS results and radioiodine therapy were analyzed. There were 104(82.5%) females and 22(17.5%) males giving sex ratio of 4.7: 1. The Mean age was 35.5 years (range 9-58 years). The commonest histological types were papillary carcinoma 55.5% (n=70), follicular carcinoma 35% (n=44) and follicular variant of papillary carcinoma 9.5% (n=12). Seventy five percent (n=95) had total thyroidectomy (TT), 17 %(n=21) had near total thyroidectomy (NTT) and 8%(n=10) had subtotal thyroidectomy (STT). Sixty-nine patients (54.8%) were on thyroid suppression therapy. Thirty-six patients (28.6%) were referred to the WBS soon after surgery without initiation of thyroxine treatment. Another twenty-one patients (16.6%) were not on thyroxine therapy since surgery. Serum thyroglobulin was assessed on 20.6% (n=26). WBS done using 3-4 mCi liquid radioiodine showed residual functioning thyroid tissues in 41% (n=52). Lymph nodes or bone

  18. 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

  19. 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)

  20. 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

  1. Phase 1 study of monoclonal antibody I-131 3F8 targeted radiation therapy of human neuroblastoma

    International Nuclear Information System (INIS)

    This study is phase I of monoclonal antibody 131-I 3F8 targeted radiotherapy of human neuroblastoma. A murine IgG3 monoclonal antibody specific for ganglioside GD2(3F8), has unusually high (0.08% ID/g) tumor localization in patients and restricted distribution in normal tissues. Nine patients with refractory neuroblastoma (seven with soft tissue masses, four with bone disease, and three with bone marrow disease) have been treated with intravenous I-131 3F8 (10 μg 3F8) and oral saturated solution of potassium iodide and potassium perchlorate. Results are presented

  2. Calibration of the IRD Mobile Whole Body Counter for in vivo estimation of I-131 in thyroid and whole body

    International Nuclear Information System (INIS)

    Full text: In Brazil there are approximately 280 Nuclear Medicine Services in operation, resulting in a significant number of workers exposed to various radionuclides including I-131 which represents the highest risk of internal exposure. Therefore, with the aim of monitoring such workers, a mobile whole body counter was developed in the IRD. The system was mounted in a light truck with internal dimensions of 3,30 m x 1,60 m x 1,70 m and loading capacity of 2 tons. The Unit was projected to be used for routine monitoring as well as in emergency situations and is an important and useful tool to attend the increasing demand for individual monitoring services in several types of Installations where non-sealed sources are routinely manipulated. The use of a Mobile Unit allows the execution of the in vivo measurement on site, immediately after the work day of a specific task involving a potential risk of internal contamination. The thyroid monitoring system consists on a NaI(Tl)3x3 detector calibrated with a phantom containing a 18,099 KBq I-131 standard solution. The Mobile Unit can also be used in studies of iodine metabolism in patients submitted to thyroid surgery followed by iodotherapy. In this case it is used also a NaI(Tl)8x4 calibrated for whole body in vivo measurements with a phantom containing a 481241 Bq I-131 standard solutions uniformly distributed among the various sections of the phantom. Both standard - solutions were prepared and certified by the National laboratory for Metrology of Ionizing Radiation (LNMRI-IRD). The calibration of the detectors was performed through a series of measurements applying each of the phantoms positioned in the standard geometries of thyroid and whole body. The calibration factors and the detection limits were obtained for a 10- minutes counting time. Based on the comparison of the calibration parameters obtained with the derived limits of incorporation for I-131 it was concluded that the system sensitivity is suitable for

  3. 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

  4. Retention time of I 131 loaded human wastes in the disposal system at the nuclear medicine service, Camaguey, Cuba

    International Nuclear Information System (INIS)

    The direct disposal of refuse liquids and excrements from patients operated on for thyroid cancer into the city sewerage poses an important environmental problem. Such patients has been administered therapeutic doses of pharmaceuticals labeled with I 131 and they are known to eliminate 80% of the total activity received through their urine and excrements in only 24 hours. This represents between 50 and 100 mCi per patient. This treatment is one of the regular procedures used by the nuclear medicine service at the Maria Curie Oncological Hospital, Camaguey. The treatment mandates the admission and isolation of patients in order to prevent other people from being exposed to radiation. It also requires carefully controlled disposal of the patients' refuse before it is carried off by sewage. This will help to reduce pollution in the San Pedro Basin, thought to be the most contaminated basin in Camaguey. All the city's sewage is carried off into this basin and then on into the Jimaguayu Reservoir, which is mainly used for fish production. The paper evaluates retention time of I 131 loaded human wastes in the disposal system to be built at Maria Curie Hospital. The evaluation is based on an average of six patients a day treated with 100 mCi. The model used is described in the paper

  5. Estimation of time history of I-131 concentration in air using NaI(Tl) detector pulse height distribution at monitoring post in Fukushima prefecture

    International Nuclear Information System (INIS)

    Time histories of the I-131 concentration in air at monitoring posts in Fukushima prefecture in March 2011 were estimated using the pulse height distribution of a NaI(Tl) detector, which was opened to the public. Several corrections to the pulse height distribution were necessary owing to high count rates. The contribution to the count rates from I-131 accumulated around the monitoring post was estimated on the basis of the time history of the peak count rate by the method proposed by the authors. The concentrations of I-131 in air were converted from the peak count rates using the calculated response of the NaI(Tl) detector with egs5 for a model of a plume containing I-131 uniformly. The obtained time histories of the I-131 concentration in air at a fixed point in March 2011 were the first ones for Fukushima prefecture. The results at 3 monitoring posts, Naraha Town Shoukan, Hirono Town Futatsunuma and Fukushima City Momijiyama, which can be analyzed during almost all of March, show that a plume including I-131 arrived after March 15. The results at other monitoring posts near Fukushima Daiichi Nuclear Power Station are used to characterize plume diffusion at the early period of the accident before March 15. The I-131 time-integrated concentrations in air at several monitoring posts were compared with those given in UNSCEAR 2013 ANNEX A, which were obtained using estimated time-dependent rates of release to the atmosphere. The agreement between the two results varies depending on the places compared, owing to the large uncertainties in the estimated release rate used in UNSCEAR. The results obtained in this study can be used to increase the accuracy of the time-dependent release rate estimation. (author)

  6. Physicochemical and Functional Comparability Between the Proposed Biosimilar Rituximab GP2013 and Originator Rituximab

    OpenAIRE

    Visser, Jan; Feuerstein, Isabel; Stangler, Thomas; Schmiederer, Timo; Fritsch, Cornelius; Schiestl, Martin

    2013-01-01

    Background Regulatory approval for a biosimilar product is provided on the basis of its comparability to an originator product. A thorough physicochemical and functional comparability exercise is a key element in demonstrating biosimilarity. Here we report the characterization of a proposed biosimilar rituximab (GP2013) and originator rituximab. Objective To compare GP2013 with originator rituximab using an extensive array of routine analytical and extended characterization methods. Methods P...

  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. 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

  9. The influence of single low dose of recombinant human thyrotropin on I-131 treatment of large multi-nodular goitre

    International Nuclear Information System (INIS)

    Full text of publication follows. Recombinant human thyrotropin (rhTSH) is a substance that after single intramuscular injection can increase thyroid radioiodine uptake (RAIU) and improve the results of radioiodine therapy (RIT) in patients with nontoxic multi-nodular goitre (MNG). These effects are very important especially in cases of large MNG with relatively low RAIU or contraindications to surgery. The aim of the study: the evaluation of the influence of the single low dose of rhTSH to RAIU and the effects of RIT in patients with benign large nontoxic MNG. Material and methods: 40 patients (14 male, 26 female, age 41-80 yr) with large MNG > 100 grams and with baseline RAIU < 40% (33,37±7,96%) were included to the study and divided into two groups. First group received the single intramuscular injection of 0,03 mg rhTSH and the second received placebo. The RAIU were measured again 48 hours after the rhTSH (24 hours after diagnostic dose of I-131). After this, all the patients were administered the therapeutic doses of I-131 recalculated according to new RAIU. The patients follow up was continued for minimum 12 months. Results: the mean RAIU after rhTSH increased more than twice, to 75% from 33%. One year after RIT the mean volume goitre reduction were significantly greater in group with rhTSH than in patients with placebo (48±16% vs. 37±18%). Decrease of compression symptoms has taken place earlier and was more important in patients after rhTSH. 12 months after RIT two patients stay in hypothyroid state (from the group with rhTSH), other patients are euthyroid. Conclusions: even the single very low dose of rhTSH increases the values of RAIU in significant way. Efficacy of rhTSH-augmented RIT in patients with large nontoxic MNG is greater than standard RIT. It allows to reduce administered doses of I-131, decreases the need of repeating RIT, makes the radiation adsorbed doses for whole body lower and the RIT shorter. (authors)

  10. 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.

  11. Multiple model testing of I-131 and Cs-137 in forage and milk, data from Tranvik, Studsvik

    International Nuclear Information System (INIS)

    Data from measurements of I-131 and Cs-137 concentrations in air, pasturage and milk from the farm Tranvik close to Studsvik were used in the large evaluation of food chain models carried out within the BIOMOVS study. The blind test comprised of 13 locations in the northern hemisphere for which the participants were asked to predict total deposition and radionuclide concentrations in forage, milk, beef and grain. Results for the Tranvik site from 23 participating models are presented. These models represent different degrees of complexity, from a simple steady-state factor approach to multicompartment dynamic models. Most models produced time-integrated concentrations within a factor of 10 of the observations. Models using multicompartment cow models did not simulate the predictions more accurately for milk than those using the simple Fm approach. (au)

  12. High-dose I-131 MIBG treatment for young children with high-risk neuroblastoma, and its practical problem. From the experience of the youngest case in Japan

    International Nuclear Information System (INIS)

    High-dose I-131 MIBG (metaiodobenzylguanidine) therapy combined with auto- or allo-hematopoietic stem cell transplantation is becoming a potential treatment for patients with high-risk neuroblastoma worldwide. However, only older children, who can perform personal care, had been given high-dose I-131 MIBG treatment to avoid the needless radiation exposure to caregivers and medical staff in Japan. In this case report, we have used the high dose MIBG therapy followed by autologous PBSCT (peripheral blood stem cell transplantation) for a 1-year-old boy with a newly diagnosed high-risk neuroblastoma with MYCN amplifications. The total radiation exposure to all parties involved was very limited, even in the youngest case in Japan, probably due to adequate preparations. This encouraging experience may remove the age limit for high-dose I-131 MIBG treatment for the patients with high-risk neuroblastoma in Japan. (author)

  13. 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

  14. 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

  15. 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)

  16. 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)

  17. 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

  18. 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...

  19. 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.

  20. 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

  1. 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

  2. Outcome of radioiodine (I-131) therapy in primary thyrotoxicosis in young (21-40 years) Bangladeshi population - A 10 years study in 482 patients

    International Nuclear Information System (INIS)

    The purpose of this study was to evaluate the outcome of I- 131 therapy (single/ double/multiple doses) in young adults suffering from thyrotoxicosis. A total of 482 patients, 290 females and 192 males, were evaluated over a period of 10 years (1993-2003). The age range was 21-40 years (mean 27.3 ±4.2 years). All patients were diagnosed to have primary thyrotoxicosis clinically, and confirmed biochemically by laboratory investigations. Patients with thyroiditis and those, who were non-compliant to regular treatment, were excluded from this study. Patients unresponsive to at least six months of anti-thyroid drug therapy or patients with disease recurrence after a three months remission period were treated with 8-15 mCi of radio iodine. All patients were followed up at regular intervals over several years following I-131 therapy, with a mean follow up period of 3±0.3 years. All patients who became either euthyroid or hypothyroid following I-131 therapy and showed no evidence of recurrence of thyrotoxicosis for at least three years were considered disease free. Out of 482, 398 patients (82.57 %) achieved remission by single doses of radio iodine (I-131), 70 patients (14.53 %) achieved remission by two doses. A total of 468 patients (97%) achieved complete remission by either one or two doses of radio iodine. Subsequently 92.73% (N=447) of patients became hypothyroid, and only 4.36% (N=21 patients) remained euthyroid without any supplement after radio iodine therapy. A total number of 14 patients (3%) required multiple (more than two) doses of I- 131. No drug reaction or disease recurrence observed in our patients during the follow up period. (author)

  3. 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

  4. 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.

  5. RITUXIMAB DANS LA POLYARTHRITE RHUMATOÏDE

    OpenAIRE

    ABABOU, Hadjer; DAFFI, SOUMIA

    2012-01-01

    La polyarthrite rhumatoïde est un rhumatisme inflammatoire chronique. Les biothérapies mises au point ont révolutionné la prise en charge du patient, parmi ceux-ci, on peut citer le Rituximab: est un anticorps monoclonal inhibant spécifiquement le récepteur CD20 des lymphocytes B. Notre travail a pour buts d'évaluer l'efficacité de Rituximab dans le traitement de polyarthrite rhumatoïde chez les patients suivis dans le service de rééducation CHU Tlemcen. Il s'agit d'une étud...

  6. 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

  7. 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

  8. Tumor dosimetry for I-131 trastuzumab therapy in a Her2+ NCI N87 xenograft mouse model using the Siemens SYMBIA E gamma camera with a pinhole collimator

    Science.gov (United States)

    Lee, Young Sub; Kim, Jin Su; Deuk Cho, Kyung; Kang, Joo Hyun; Moo Lim, Sang

    2015-07-01

    We performed imaging and therapy using I-131 trastuzumab and a pinhole collimator attached to a conventional gamma camera for human use in a mouse model. The conventional clinical gamma camera with a 2-mm radius-sized pinhole collimator was used for monitoring the animal model after administration of I-131 trastuzumab The highest and lowest radiation-received organs were osteogenic cells (0.349 mSv/MBq) and skin (0.137 mSv/MBq), respectively. The mean coefficients of variation (%CV) of the effective dose equivalent and effective dose were 0.091 and 0.093 mSv/MBq respectively. We showed the feasibility of the pinholeattached conventional gamma camera for human use for the assessment of dosimetry. Mouse dosimetry and prediction of human dosimetry could be used to provide data for the safety and efficacy of newly developed therapeutic schemes.

  9. Tumor dosimetry for I-131 trastuzumab therapy in a Her2+ NCI N87 xenograft mouse model using the Siemens SYMBIA E gamma camera with a pinhole collimator

    International Nuclear Information System (INIS)

    We performed imaging and therapy using I-131 trastuzumab and a pinhole collimator attached to a conventional gamma camera for human use in a mouse model. The conventional clinical gamma camera with a 2-mm radius-sized pinhole collimator was used for monitoring the animal model after administration of I-131 trastuzumab The highest and lowest radiation-received organs were osteogenic cells (0.349 mSv/MBq) and skin (0.137 mSv/MBq), respectively. The mean coefficients of variation (%CV) of the effective dose equivalent and effective dose were 0.091 and 0.093 mSv/MBq respectively. We showed the feasibility of the pinholeattached conventional gamma camera for human use for the assessment of dosimetry. Mouse dosimetry and prediction of human dosimetry could be used to provide data for the safety and efficacy of newly developed therapeutic schemes

  10. Preliminary report of a fetal-thyroid overexposure case due to the administration of I-131 during the second trimester of pregnancy

    International Nuclear Information System (INIS)

    Sixty to eighty percent of patients with Graves's disease have antibodies directed against thyroglobulin or against thyroid microsomes. A contemporary interpretation is that thyroid stimulatory inmunoglobuline TSI mimics the action of TSH and stimulate the synthesis and release of thyroid hormone. In patient whose thyroids are capable of responding to such a trophic stimulus, TSI may be the mediator of hyperthyroxinemia. TSI cross the placenta and cause transient hyperthyroidism in some neonates (0,5-1 %) born to mothers who have high circulating levels of the antibodies. As regards adults aged 25 and up, administering I-131 radioactive iodine seems to be a satisfactory treatment for Graves' disease. Such a treatment, however, is to be avoided when treating either pregnant or breast-feeding women due to the effects that irradiation is likely to cause to the fetus or the suckling child. Even though such effects depend on the intrauterine developmental stage, the principal effects are as follows: (a) The embryo may be lethally affected; (b) Malformations and structure changes, or changes in the child's development are likely to occur; (3) The child may be mentally retarded; (4) An induction to cancer and leukemia is possible, and (e) Hereditary effect, may be expected. Moreover, it is a well-known fact that the fetal thyroid is able to capture and integrate iodine as of the 10th/12th gestation week. Thus, administering I-131 according to prescribed doses may define or suppress the thyroid function. Therefore, the highest precautions must be taken in order not to carelessly administer I-131 therapeutic doses to pregnant women. Any woman within the reproductive capacity range should be strongly advised that the pregnancy test is to be performed to avoid her fetus being irradiated. Precisely, the present paper deals with the inadvertent administering an I-131 therapeutic dose to pregnant woman with Graves disease whose child -unexpectedly enough- turned out to be

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

    International Nuclear Information System (INIS)

    In routine radiopharmaceutical Iodine-131 (131I) 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 131I liquid lead pot will lead into low cost production, less maintenance and low dose received by the personnel that prepared the 131I. The new fabricated of low cost 131I 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 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 131I. 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 131I 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

  12. 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.

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

    Science.gov (United States)

    Said, M. A.; Ashhar, Z. N.; Suhaimi, N. E. F.; Zainon, R.

    2016-01-01

    In routine radiopharmaceutical Iodine-131 (131I) 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 131I liquid lead pot will lead into low cost production, less maintenance and low dose received by the personnel that prepared the 131I. The new fabricated of low cost 131I 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 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 131I. 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 131I 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.

  14. 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.

  15. 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

    International Nuclear Information System (INIS)

    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)

  16. 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

  17. 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

  18. 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

  19. 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

  20. 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.

  1. 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

  2. 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)

  3. Distant metastases of differentiated thyroid cancer. Diagnosis by 131 iodine and treatment; Metastases a distance des cancers thyroidiens differencies. Diagnostic par l`iode 131 (I 131) et traitement

    Energy Technology Data Exchange (ETDEWEB)

    Leger, A.F. [Hopital Necker-Enfants-Malades, 75 - Paris (France)

    1995-12-31

    Distant metastases in differentiated thyroid cancer involve mainly lung and bone. Lung metastases were found in 5% of papillary forms and 10% of follicular forms respectively. I 131 uptake was found in 55% of the cases irrespective of histology. Bone metastases were found in 20% of follicular and 3.5% of papillary forms, respectively. Ablation of post-operative thyroid remnants is obtained by administering 3.7 GBq I 131; I 131 (.2 to .4 GBq) is then used to localize distant metastases and a further 3.7 to 7.4 GBq is administered for therapy. Results are good in lung metastases, with a survival of 72% at 5 years. Bone metastases cannot be cured with I 131 alone. Surgery is indicated as a first line therapy if possible. In order to reduce the vascularization of the metastases a pre-operative embolization should be attempted. After bone surgery a therapeutic dose of I 131 is given if a post-operative I 131 uptake is found. Others treatments of bone metastases are palliative surgery, external radiotherapy, cementing of the metastases. (author). 6 refs.

  4. 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.)

  5. 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

  6. 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

  7. 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

  8. 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.

  9. 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.

  10. 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...

  11. The initial investigation of radiation dose rate at X-ray department and patients treating thyroid by I-131 at nuclear medicine department

    International Nuclear Information System (INIS)

    Survey meter NSM 150 Fuji with detector Geiger Muller has been used to assess for average annual exposure dose which affect radiographer ≤ 2 mSv per year, the staff involved with Fluoroscopy ≤ 19 mSv per year. Dose rate in waiting area of patient is a range from 0.2 to 0.8 μSv/h. Patients who have been treated by radioiodine, may be only discharged when the remaining activity is 400.2 ±368.8 MBq. Radioactivity of I-131 and Tc-99m in the sewage system of hospital is 0.4x10-11 Ci/l. (author)

  12. 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.

  13. 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

  14. 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)

  15. Evaluation of the absorbed dose during studies of the renal function due to I123 / I131 (hippuran) and In111 (DTPA)

    International Nuclear Information System (INIS)

    Using the methodology MIRD and representation Cristy-Eckerman for kidneys, bladder, and whole body as organs of the bio-kinetics of I123 / I131 (hippuran) and the In111 (D PTA), the absorbed dose for studies of the renal function of adults due to the I123 is 0,0071 mGy/MBq where 88.16% corresponds to its auto-dose and 11,96% to the organs of their bio-kinetics; while for the I131 their dose is 0,032 mGy/MBq where 95,03% corresponds to its auto-dose and 4,97% to the organs of their bio-kinetics. For the In111 their dose is 0,0168 mGy/MBq where 71,68% corresponds to their auto-dose and 28,32% to the organs of their bio-kinetics. In all the cases the dosimetric contributions of the organs of the bio-kinetics (whole body and urinary bladder) are very significant, and this fundamentally is due to the photons of the whole body. (Author)

  16. 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.

  17. 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.

  18. 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)

  19. 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

  20. 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

    International Nuclear Information System (INIS)

    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

  1. 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.

  2. 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

  3. Evaluation of radiation exposure of workers caring for the patient after administration of radionuclide I-131 based on the Monte Carlo

    International Nuclear Information System (INIS)

    In the paper using the Monte Carlo method ( code MCNPX) were calculated absorbed doses in organs caregivers, from which thereafter was set the value of the equivalent dose in these organs by appropriate formulas and then effective doses in selected geometries using protective shielding devices. The results show that using of shielding aprons equivalent of 1 mm of lead will reduce the exposure of workers caring for patients after administration of the radionuclide I-131 by about 30%. If the caregiver without protective shielding aprons is located between two patients, the gamma rays will be reduced by about 18% due to averted body of caregiver, while the worker's personal dosimeter located at the chest will register approximately 40% lower value of personal dose equivalent. (authors)

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

    DEFF Research Database (Denmark)

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

    2012-01-01

    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...... 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 by...... 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 of...

  5. 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)

  6. 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

  7. 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.

  8. 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

  9. 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 ...

  10. 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

  11. 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)

  12. 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

  13. 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.

  14. 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

  15. 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

  16. 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

  17. 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.

  18. 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

  19. 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

  20. 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...

  1. 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.

  2. 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.

  3. Preparation & in vitro evaluation of 90 Y-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...

  4. 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.

  5. 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

  6. 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.

  7. 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.

  8. 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

  9. 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...

  10. 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

  11. 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...

  12. Quantities of I-131 and Cs-137 in accumulated water in the basements of reactor buildings in process of core cooling at Fukushima Daiichi nuclear power plants accident and its influence on late phase source terms

    International Nuclear Information System (INIS)

    During the process of core cooling at Fukushima Daiichi nuclear power plants accident, large amount of contaminated water was accumulated in the basements of the reactor buildings at Units 1-4. The present study estimated the quantities of I-131 and Cs-137 in the water as of late March based on the press-opened data. The estimated ratios of I-131 and Cs-137 quantities to the core inventories are 0.51%, 0.85% at Unit 1, 74%, 38% at Unit 2 and 26%, 18% at Unit 3, respectively. According to the Henry's law, certain fraction of iodine in water could be released to atmosphere due to gas-liquid partition and contribute to increase in the release to environment. A lot of evaluations for I-131 release have been performed so far by the MELCOR calculation or the SPEEDI reverse estimation. The SPEEDI reverse predicted significant release until 26 March, while no prediction in MELCOR after 17 March. The present study showed that iodine release from accumulated water may explain the release between 17 and 26 March. This strongly suggests a need for improvement of current MELCOR approach which treats the release only from containment breaks for several days after the core melt. (author)

  13. 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...

  14. 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.)

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

    OpenAIRE

    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 ...

  17. Rituximab for Non-Hodgkin’s Lymphoma: A Story of Rapid Success in Translation

    OpenAIRE

    Harrison, Andrew M.; Thalji, Nassir M.; Greenberg, Alexandra J.; Tapia, Carmen J.; Windebank, Anthony J.

    2013-01-01

    Translational stories range from straightforward to complex. In this commentary, the story of the rapid and successful translation of rituximab therapy for the treatment of non-Hodgkin’s lymphoma (NHL) is examined. Development of this monoclonal antibody therapy began in the late 1980s. In 1994, rituximab received its first approval for the treatment of NHL by the United States Food and Drug Administration (FDA). Rituximab has since been approved for additional indications and has transformed...

  18. 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.

  19. 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.

  20. 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...

  1. Successful Treatment of Type B Insulin Resistance With Rituximab

    OpenAIRE

    Manikas, Emmanouil-Dimitrios; Isaac, Iona; Semple, Robert K.; Malek, Rana; Führer, Dagmar; Moeller, Lars C.

    2015-01-01

    Context: Type B insulin resistance is a very rare disease caused by autoantibodies against the insulin receptor. The mortality of type B insulin resistance is high (>50%), and management of this disease is not yet standardized. We report the successful treatment of a patient with type B insulin resistance with rituximab, cyclophosphamide, and prednisone. Case Description: A 45-year-old woman presented with unintended weight loss of 20 kg, unusually widespread acanthosis nigricans, and glucose...

  2. Rituximab-Induced Splenic Rupture and Cytokine Release

    Science.gov (United States)

    Nair, Ranjit; Gheith, Shereen; Lamparella, Nicholas

    2016-01-01

    Patient: Female, 55 Final Diagnosis: Mantle cell lymphoma Symptoms: Cytokine release syndrome • hypoglycemia • hypotension • splenic rupture • splenomegaly • vision loss Medication: — Clinical Procedure: Case Report Specialty: Oncology Objective: Unusual clinical course Background: Rituximab is a therapeutic monoclonal antibody that is used for many different lymphomas. Post-marketing surveillance has revealed that the risk of fatal reaction with rituximab use is extremely low. Splenic rupture and cytokine release syndrome are rare fatal adverse events related to the use of therapeutic monoclonal antibodies, especially in aggressive malignancies with high tumor burden. Case Report: A 55-year-old woman presented with abdominal pain and type B symptoms and was diagnosed with mantle cell lymphoma. Initial peripheral blood flow cytometry showed findings that mimicked features of chronic lymphocytic leukemia. Further treatment with rituximab led to catastrophic treatment complications that proved to be fatal for the patient. Conclusions: Severe cytokine release syndrome associated with biologics carries a very high morbidity and case fatality rate. With this case report we aim to present the diagnostic challenge with small B-cell neoplasms, especially mantle cell lymphoma and chronic lymphocytic lymphomas, and underscore the importance of thorough risk assessment for reactions prior to treatment initiation. PMID:26972227

  3. Carbon Insertion into arachno-6,9-C2B8H14 via Acyl Chlorides. Skeletal Alkylcarbonation (SAC) Reactions: A New Route for Tricarbollides

    Czech Academy of Sciences Publication Activity Database

    Bakardjiev, Mario; Štíbr, Bohumil; Holub, Josef; Padělková, Z.; Růžička, A.

    2013-01-01

    Roč. 52, č. 15 (2013), s. 9087-9093. ISSN 0020-1669 R&D Projects: GA ČR(CZ) GAP207/11/0705 Institutional support: RVO:61388980 Keywords : MAGNETIC-RESONANCE-SPECTROSCOPY * STRUCTURAL CHARACTERIZATIONS * 12-VERTEX FERRATRICARBOLLIDES Subject RIV: CA - Inorganic Chemistry Impact factor: 4.794, year: 2013

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

    International Nuclear Information System (INIS)

    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 131I. 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 the

  6. 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, ...

  7. E-selectin, L-selectin, ICAM-1 and IL-6 concentrations changes in the serum of patients with hyperthyroidism in the early period of radioiodine I-131 therapy

    International Nuclear Information System (INIS)

    Among cytokines- interleukins: -6 and -8 (IL-6, IL-8) and E-selectin (E-sel.), L-selectin (L-sel.) and intercellular cell adhesion molecule-1 (ICAM-1) are the most important links in the initiation of the inflammatory process. Taking into account that the inflammatory process is the basic stage of effective radioiodine therapy, we tried to compare the behaviour of the initial inflammatory factors in the early period of I-131 therapy (RAI) of hyperthyroidism. The aim of the study was to estimate the behaviour of IL-6, ICAM-1, E-selectin and L-selectin concentrations in the serum of patients with hyperthyroidism before and during I-131 therapy. The groups of 26 patients with Graves' disease (GD) and 18 patients with toxic nodular goiter (TNG), aged 34-77, were studied. Control group (C) consisted of 10 healthy volunteers. For estimation of thyroid function serum concentrations of TSH, free T4 and free T3 were measured by IRMA or RIA kits (Polatom, Poland). IL-6, ICAM-1, E-selectin and L-selectin serum concentrations were determined using ELISA method by Bender kits (USA). Blood samples for all estimations were taken 10-12 days before and in 6th week after I-131 administration. Treatment dose of radioiodine was calculated, basing on modified equation for absorbed dose compared to. control, no statistical differences in the levels of E-selectin (C - 44.4 ± 11 ng/ml) and L-selectin (C - 842 ± 168.9 ng/ml) were observed before treatment in the patients with GD (E-sel. - 59.8 ± 19.6 ng/ml; L-sel. - 1288.2 ± 273.5 ng/ml) and with TNG (E-sel. - 61.5 ± 18.4 ng/ml, L-sel. - 1247.0 ± 273.5 ng/ml) as well as in the 6th week after I-131 administration; values in GD group were: E-sel. - 57.3 ± 19.5 ng/ml, L-sel. - 1142.4 ± 193.4 ng/ml; in TNG group: E-sel. - 62.1 ± 20.6 ng/ml, L-sel. - 1113.5 ± 236.3 ng/ml. In comparison to control there was no difference in initial IL-6 levels either in GD or in TNG group, but a statistically important decrease was observed in the 6th

  8. 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.

  9. 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...

  10. 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

  11. 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.

  12. 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)

  13. A systematic review of the use of rituximab as induction therapy in renal transplantation.

    Science.gov (United States)

    Macklin, Philip S; Morris, Peter J; Knight, Simon R

    2015-04-01

    Rituximab is a B-lymphocyte depleting agent used to treat lymphoma and autoimmune diseases. There has been recent interest in its use both for management of highly-sensitised and ABO-incompatible recipients but also for induction therapy before transplantation. This systematic review evaluates the evidence for its use as part of induction protocols in ABO-compatible, non-sensitised recipients. 4 databases and 3 trial registries were searched for studies of the use of rituximab as part of induction protocols. The small number of identified studies precluded meta-analysis and thus a narrative review was conducted. 12 manuscripts met the inclusion criteria, relating to 5 individual studies. No significant improvements in patient and graft survival or acute rejection rates were identified with rituximab induction. A single small study reported a trend towards improved graft function with the addition of rituximab induction to a standard immunosuppressive regimen. Rituximab was not found to be associated with increased infectious complications in any study but concerns were raised over possible associations with leukopaenia and cardiovascular mortality. Overall, no convincing benefit of rituximab induction was found and some safety concerns were identified. The results of on-going trials are awaited but further studies may be required before we can draw firm conclusions regarding the efficacy and safety of rituximab in this setting. PMID:25555541

  14. 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

    International Nuclear Information System (INIS)

    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). 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. 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. 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

  15. Rituximab maintenance after autologous stem cell transplantation prolongs response duration in non-naive rituximab follicular lymphoma patients: a single institution experience.

    Science.gov (United States)

    Bourcier, J; Gastinne, T; Leux, C; Moreau, A; Bossard, C; Mahé, B; Blin, N; Dubruille, V; Touzeau, C; Voldoire, M; Guillaume, T; Peterlin, P; Gallas, P; Garnier, A; Maisonneuve, H; Moreau, P; Juge-Morineau, N; Jardel, H; Chevallier, P; Moreau, P; Le Gouill, S

    2016-08-01

    We retrospectively evaluated the role of rituximab (R) in maintenance treatment after autologous stem cell transplantation performed in patients with relapsed follicular lymphoma. We compared the outcome of 67 follicular lymphoma (FL) patients according to the use of rituximab maintenance (RM) or not. All patients received rituximab plus chemotherapy before autologous stem-cell transplantation (ASCT). Patients received median of two lines of prior therapy. The RM schedule was one injection of rituximab every 3 months for 2 years. Median follow-up is 4.6 years. The 3-year progression-free survival (PFS) after ASCT was 86 % with RM vs. 46 % without (p = 0.0045). Median is not reached in the RM arm vs. 31 months in non-RM arm. The 3-year OS was 96 % with RM vs. 78 % without (p = 0.059). The present monocentric study shows that 2 years of RM after ASCT significantly increases response duration for non-naive rituximab relapsed FL patients compared with observation. PMID:27297970

  16. 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.

  17. Clinical responses to rituximab in a case of neuroblastoma with refractory opsoclonus myoclonus ataxia syndrome.

    Science.gov (United States)

    Alavi, Samin; Kord Valeshabad, Ali; Moradveisi, Borhan; Aminasnafi, Ali; Arzanian, Mohammad Taghi

    2012-01-01

    Opsoclonus myoclonus ataxia syndrome (OMS) is a rare neurologic syndrome. In a high proportion of children, it is associated with neuroblastoma. The etiology of this condition is thought to be immune mediated. In children, immunotherapy with conventional treatments such as corticosteroids, intravenous immunoglobulin, adrenocorticotropic hormone, and even antiepileptic drugs has been tried. Recently rituximab has been used safely for refractory OMS in children with neuroblastoma. Our patient was a 3.5-year-old girl referred for ataxia and dancing eye movements starting since 1.5 years ago. She was diagnosed with neuroblastoma on imaging studies on admission. The OMS was refractory to surgical resection, chemotherapy, corticosteroids, and intravenous immunoglobulin. Patient received rituximab simultaneously with chemotherapy. The total severity score decreased by 61.1% after rituximab. Patient's ataxia markedly improved that she was able to walk independently after 6 months. Our case confirmed the clinical efficacy and safety of rituximab in a refractory case of OMS. PMID:23198199

  18. Clinical Responses to Rituximab in a Case of Neuroblastoma with Refractory Opsoclonus Myoclonus Ataxia Syndrome

    Directory of Open Access Journals (Sweden)

    Samin Alavi

    2012-01-01

    Full Text Available Opsoclonus myoclonus ataxia syndrome (OMS is a rare neurologic syndrome. In a high proportion of children, it is associated with neuroblastoma. The etiology of this condition is thought to be immune mediated. In children, immunotherapy with conventional treatments such as corticosteroids, intravenous immunoglobulin, adrenocorticotropic hormone, and even antiepileptic drugs has been tried. Recently rituximab has been used safely for refractory OMS in children with neuroblastoma. Our patient was a 3.5-year-old girl referred for ataxia and dancing eye movements starting since 1.5 years ago. She was diagnosed with neuroblastoma on imaging studies on admission. The OMS was refractory to surgical resection, chemotherapy, corticosteroids, and intravenous immunoglobulin. Patient received rituximab simultaneously with chemotherapy. The total severity score decreased by 61.1% after rituximab. Patient's ataxia markedly improved that she was able to walk independently after 6 months. Our case confirmed the clinical efficacy and safety of rituximab in a refractory case of OMS.

  19. USE OF RITUXIMAB IN AUTOIMMUNE DISEASES: NEW ASPECTS

    Directory of Open Access Journals (Sweden)

    Dmitry Evgenyevich Karateyev

    2010-09-01

    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.

  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. 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

  2. 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...

  3. 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...

  4. Rituximab is Indispensable for Pediatric Heart Transplant Recipients Developing Post Transplant Lymphoproliferative Disorders

    OpenAIRE

    Taheri S MD; Karbasi-Afshar R MD

    2013-01-01

    Abstract Rituximab, an anti-CD20 agent, has been suggested as an effective strategy to deal with post transplant lymphoproliferative disorders (PTLD). In the current study, we aim to evaluate the efficacy of rituximab therapy in heart transplant population developing PTLD. A comprehensive search of the literature was performed to gather the available data on lymphoproliferative disorders occurring in heart transplant patients. Finally, data of 125 patients from 26 previously published studies...

  5. Efficacy and safety of rituximab in the treatment of refractory pemfigus vulgaris

    Directory of Open Access Journals (Sweden)

    Aslı Bilgiç Temel

    2015-06-01

    Full Text Available Background and Design: Pemphigus vulgaris (PV is a severe, chronic, potentially life-threatening autoimmune blistering disease that affects the skin and mucous membranes, associated with the loss of cell-cell adhesion and blister formation. Systemic steroids in combination with immunosuppressive agents are the mainstay of therapy in pemphigus. Rituximab is a chimeric monoclonal anti- CD20 antibody, has been tried increasingly for the treatment of PV. Objective: We sought to test the efficacy and safety of rituximab as an adjuvant therapy by retrospective analysis of clinical and immunological data of patients. Method: A retrospective analysis is presented of 13 patients with refractory pemphigus vulgaris who were treated with rituximab at Akdeniz University Hospital, Dermatology and Venereology Department, Bullous Disease Unit. We evaluated clinical and immunological data with last treatments. Results: Patients were treated with one cycle of two biweekly infusions of rituximab at a dose of 1000 mg on days 1 and 15, except one received four doses of 375 mg / m2 intravenously weekly. The mean follow-up time was 18.5 months. All patients had a decrease in antibody titers or antibodies were completely undetected after treatment. Rituximab use resulted in a significant reduction in steroid dosage during follow-up. At the end of the follow-up period, 7 patients achieved complete disease remission without therapy, 1 patient achieved partial disease remission without therapy, 2 patients achieved complete remission on minimal therapy, 1 patient achieved complete remission on therapy, 1 patient achieved partial remission on minimal therapy, and one patient had no follow-up. Rituximab was well tolerated by all patients. Clinical relapse had seen 53.8% by the mean period of 13.8 months. Relapses have been managed with additional infusions of rituximab. Conclusion: Rituximab is beneficial in the management of refractory PV, induces prolonged clinical

  6. 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

  7. 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.

  8. Persistence of babesiosis for >2 years in a patient on rituximab for rheumatoid arthritis.

    Science.gov (United States)

    Raffalli, John; Wormser, Gary P

    2016-06-01

    We report a patient who was being treated with rituximab for rheumatoid arthritis who developed Babesia microti infection that persisted for 26 months despite prolonged anti-babesia drug therapy. The explanation for the persistence was likely to have been the long-term immunocompromising effects of rituximab, as evidenced by seronegativity for B. microti antibodies that lasted for more than 1 year after onset of infection. PMID:27036977

  9. 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

  10. 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...

  11. 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)

  12. Combination of cyclophosphamide, rituximab, and intratumoral CpG oligodeoxynucleotide successfully eradicates established B cell lymphoma.

    Science.gov (United States)

    Betting, David J; Hurvitz, Sara A; Steward, Kristopher K; Yamada, Reiko E; Kafi, Kamran; van Rooijen, Nico; Timmerman, John M

    2012-09-01

    Rituximab plus chemotherapy is standard therapy for patients with non-Hodgkin B cell lymphoma, but often complete response or cure is not achieved. Toll-like receptor 9 agonist CpG oligodeoxynucleotides (CpG) can improve antibody-dependent cellular cytotoxicity and adaptive antitumor immune responses. Using a syngeneic murine B cell lymphoma expressing human CD20 (38C13-huCD20), we previously demonstrated that rituximab plus intratumoral CpG, but not systemic CpG, could eradicate up to half of 7-day established 38C13-huCD20 tumors. However, larger 10-day established tumors could not be cured with this regimen. We thus hypothesized that cytoreduction with cyclophosphamide (Cy) before immunotherapy might permit eradication of these more advanced tumor burdens. Pretreatment with Cy resulted in tumor eradication from 83% of animals treated with rituximab/CpG, whereas Cy/CpG or Cy/rituximab treatments only cured 30% or 17%, respectively (P<0.005). Tumor eradication depended on natural killer cells, but not T cells, macrophages, or complement. Only mice treated with Cy/rituximab/CpG partially resisted rechallenge with tumor cells. Foxp3 Treg and CD11bGr1 myeloid suppressor cells persisted within lymphoid organs after therapy, possibly influencing the ability to establish adaptive tumor immunity. In conclusion, cytoreduction with Cy permitted the cure of large, established lymphomas not otherwise responsive to rituximab plus intratumoral CpG immunotherapy. PMID:22892450

  13. 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

  14. 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.

  15. 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.

  16. Rituximab prophylaxis prevents corticosteroid-requiring chronic GVHD after allogeneic peripheral blood stem cell transplantation: results of a phase 2 trial

    OpenAIRE

    Cutler, Corey; Kim, Haesook T.; Bindra, Bhavjot; Sarantopoulos, Stefanie; Ho, Vincent T.; Chen, Yi-Bin; Rosenblatt, Jacalyn; McDonough, Sean; Watanaboonyongcharoen, Phandee; Armand, Philippe; Koreth, John; Glotzbecker, Brett; Alyea, Edwin; Blazar, Bruce R; Soiffer, Robert J.

    2013-01-01

    Rituximab prevents steroid-requiring chronic graft-vs-host disease when given after peripheral blood stem cell transplantation.Overall survival is improved with rituximab after allogeneic peripheral blood stem cell transplantation when compared with a control cohort.

  17. Intercomparison Of Activity Measurements Of Co-58, Y-88, Ho-166m, Tc-99m, dan I-131 Between P3KRBiN and Laboratory Within BATAN And Hospitals

    International Nuclear Information System (INIS)

    One way to maintain traceability and to keep consistency of the measurement result of radioactivity was intercomparison program. According with Surat Keputusan Kepala BATAN No.73/KA/IV/99, one of tasks and functions of standardization laboratory is to coordinate an intercomparison program of radioactivity measurement. In the year of 2000, intercomparison program of activity measurements between P3KRBiN and 10 laboratories within BATAN and 12 hospitals were carried out. For intercomparison of Co-58, Y-88, and Ho-166m, there were 3 laboratories within BATAN which have more than 50% difference compared with P3KRBiN measurements and for intercomparison of Tc-99m, dan I-131, there were 2 Dose-Calibrators belongs to hospitals which have more than 30% difference compared with P3KRBiN measurements. From that result it can be concluded that intercomparison of activity measurements are very important and needs continuously to maintain traceability and to keep consistency of measurement result. (author)

  18. 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

  19. Successful Rituximab Therapy in Steroid-Resistant, Cryptogenic Organizing Pneumonia: A Case Series.

    Science.gov (United States)

    Shitenberg, Dorit; Fruchter, Oren; Fridel, Ludmila; Kramer, Mordechai R

    2015-01-01

    Cryptogenic organizing pneumonia (COP) is an interstitial lung disease that is usually responsive to corticosteroid treatment. The treatment of COP has not been studied in randomized controlled trials; thus, treatment decisions are based on practice guidelines. We herein present, for the first time, 4 cases of patients with biopsy-proven COP who did not respond to corticosteroids but benefited from rituximab therapy. This report consists of a retrospective case series of patients who experienced steroid-resistant, biopsy-proven COP. Patients included in this case series suffered from acute or chronic COP and did not respond to corticosteroid treatment for a few weeks to months but later responded to rituximab. In a series of 4 patients, 1 patient had a complete radiological and clinical response after rituximab therapy, and the steroids could be gradually tapered. Three patients had a chronic course but had been able to lower steroid dosage or even discontinue the drug after being treated with rituximab. Since 40% of the patients with COP do not respond to or stay dependent on steroids, we think that even the ability to lower the steroid dosage by using rituximab as a steroid-sparing agent with a good safety profile is worth the effort. However, further studies are warranted. PMID:26045243

  20. 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

    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......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...... 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...

  1. EXPERIENCE WITH RITUXIMAB IN PATIENTS WITH ANKYLOSING SPONDYLITIS

    Directory of Open Access Journals (Sweden)

    Mikhail Sergeyevich Protopopov

    2013-02-01

    Full Text Available Objective: to analyze the efficacy of rituximab (RTM in patients with active ankylosing spondylitis (AS resistant to conventional therapy. Subjects and methods. The trial enrolled 10 male patients with the reliable and valid diagnosis of AS who received therapy with RTM used in cases of steadily high AS activity, resistance to standard therapy, and contraindications to the use of tumor necrosis factor-α inhibitors. The number of patients meeting the Assessment of Spondyloarthritis International Society (ASAS criteria for 20% improvements 24 weeks after treatment initiation was the main indicator of therapeutic effectiveness. Results. After 24-week therapy, 7 and 4 of the 10 patients showed 20 and 40% improvements, respectively; and 2 patients had partial remission according to the ASAS criteria. During the treatment, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI significantly decreased (p = 0.046, the Bath Ankylosing Spondylitis Functional Index (BASFI remained substantially unchanged. Treatment response did not depend on the development of an early (at 2 weeks complete depletion of CD20 lymphocytes. No significant effect could be achieved in patients with high baseline BASDAI and BASFI scores. Conclusion. RTM used patients with AS can ensure clinical improvement and even remission in a number of cases; however, it is unpromising in cases of high disease activity and severe functional failure.

  2. 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

  3. 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 .

  4. 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.

  5. Determination of I-131 in milk samples

    International Nuclear Information System (INIS)

    In our country, in the near future, an isotope center will be in operation, and due to its characteristics, it is possible the discharge of radionuclides to the atmosphere during its normal exploitation, as well as in case of accident. Considering the kind and the concentration of the radioactive material released to the atmosphere, the possible ways of contamination were determined, playing the milk the most significant role, because the Iodine-131 is in the radionuclide inventory of this center, being possible to pass to the food-chain soil-grass-milk, due to the fact that the center is located in a cattle zone. Owing to these facts, it is necessary to rely on a method for determining Iodine-131 that allows to control its presence in milk samples, when the isotope center start to operate. The direct absorption of Iodine-131 in an anionic exchange resin and the subsequent analysis of this resin for gamma spectrometry with a Nal (Tl) detector is a cheap, simple and fast method with a recovery average greater than the 95%. (authors). 5 refs., 3 tabs

  6. 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...

  7. 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

  8. Recurrent inflammatory pseudotumor of the jaw with perineural intracranial invasion demonstrating sustained response to Rituximab.

    Science.gov (United States)

    Garcia, Bryan A; Tinsley, Sarah; Schellenberger, Thomas; Bobustuc, George C

    2012-12-01

    Corticosteroids are the mainstay of treatment of inflammatory pseudotumor (IPT) of the head and neck; however, involvement of the skull base and mandible can be unresponsive to steroids and require surgical resection. IPT is known to usually contain a CD20+ lymphocyte subgroup. Rituximab, a chimeric anti-CD20 antibody, has been successfully utilized in the treatment of other CD20+ diseases, including the similar idiopathic orbital inflammatory disease. This is the first report to describe successful treatment with Rituximab of a recurrent IPT of the mandible with trigeminal spread and leptomeningeal involvement with clinical and radiologic evidence demonstrating a sustained response to therapy. PMID:22161155

  9. 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.

  10. Positive experience of the usage of Rituximab in management of refractory myasthenia gravis in Russia

    OpenAIRE

    N. I. Shcherbakova; N. A. Suponeva; V. V. Shvedkov; A. A. Shabalina; M. V. Kostyreva; V. A. Rudnichenko; O. I. Galkina

    2015-01-01

    A subset of patients (15 to 20%) with myasthenia gravis (MG) remains refractory to standard types of treatment. Analysis of efficiency of rituximab, a chimeric monoclonal antibody to surface antigen of B lymphocytes (CD20), in 16 patients suffering from refractory MG was performed. In all cases, the drug was injected weekly and intravenously in the dosage of 375 mg/m2, for 4 weeks. All patients were dependent on intake of corticosteroids and cyclosporin. During rituximab therapy, the gradatio...

  11. Positive experience of the usage of Rituximab in management of refractory myasthenia gravis in Russia

    Directory of Open Access Journals (Sweden)

    N. I. Shcherbakova

    2015-09-01

    Full Text Available A subset of patients (15 to 20% with myasthenia gravis (MG remains refractory to standard types of treatment. Analysis of efficiency of rituximab, a chimeric monoclonal antibody to surface antigen of B lymphocytes (CD20, in 16 patients suffering from refractory MG was performed. In all cases, the drug was injected weekly and intravenously in the dosage of 375 mg/m2, for 4 weeks. All patients were dependent on intake of corticosteroids and cyclosporin. During rituximab therapy, the gradation of MG has significantly changed, being transformed from severe forms (IV and V MGFA class into moderate and mild forms (III, II, and I MGFA class. Improvement of the clinical state included cease of myasthenic exacerbation, increased respiratory muscle strength; significant reduction of dosages (and even canceling of basic pathogenetic and symptomatic treatment. Complete remission with cancellation of basic therapy was recorded in 4 (25 % of patients within 2-year period. However, 2 of them manifested with aggravation of MG after the first course of rituximab, in 9 and 24 months, correspondingly, which required resumption of corticosteroid therapy and repeating of courses of rituximab, with positive result. In 9 (56.25 % cases, pharmacological remission was recorded; in 3 (18.75 % cases, there was a significant improvement of initially severe forms. In all patients rituximab therapy lead to the clinical improvement: prior to completion of the course, after the 1st and the 2nd infusion - in 12 (75 % patients; 1 to 3 weeks after completion of the course – in 4 (25 % patients. Maximal improvement was registered in 1 to 12 month after completion of the course of rituximab intake (at the terms of 4. ± 2.0 months. There were the following stages of basic therapy cancellation: during first 1 to 3 months of rituximab treatment, pyridostigmine and cyclosporine were cancelled; corticosteroids were dropped off gradually, according to the clinical status of

  12. Preparation and biological evaluation of 177Lu-labeled rituximab for B-lymphoma treatment

    OpenAIRE

    Edalat Radfar; Azim Arbabi; Dariush Sardari

    2010-01-01

    Introduction: 177Lu is a beta emitter with suitable decay mode [T1/2=6.7 d, Eβmax=497 keV, EΥ=112keV (6.4%) & 208 keV (11%)] for using in radio therapy. Various radiolabeled monoclonal antibodies have been developed in treatment. Rituximab is a chimeric mouse-human monoclonal antibody. Rituximab binds with human B-lymphocate-restricted differentiation antigen: CD20. Rituxsimab was used successfully as an anti-CD20 radiolabeled antibody before. Methods: 177Lu was p...

  13. 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...

  14. Rituximab is an effective and safe treatment of relapse in elderly patients with resistant warm AIHA.

    Science.gov (United States)

    Laribi, Kamel; Bolle, Delphine; Ghnaya, Habib; Sandu, Andrea; Besançon, Anne; Denizon, Nathalie; Truong, Catherine; Pineau-Vincent, Fabienne; de Materre, Alix Baugier

    2016-04-01

    We evaluated the efficacy and safety of rituximab for the treatment of 23 elderly patients (median age 78 years) with warm autoimmune haemolytic anaemia (AIHA). The median follow-up was 31 months. Patients had received one to five previous treatments. Rituximab was administered by intravenous infusion at a dose of 375 mg/m(2) once weekly for 4 weeks. The OR rate was 86.9 % (CR = 39.1 %, PR = 47.8 %). Median OS was 87 months. The median OS of patients who reached CR could not be calculated, and that of patients with PR was 67 months. At last follow-up, eight of the 20 responding patients, including one patient in CR and seven in PR, had relapsed after a median of 6 months. Failure to achieve CR was a risk factor for relapse (p = 0.028). We did not identify any pretreatment characteristics predictive of response to rituximab. In conclusion, rituximab is an effective treatment for elderly patients with refractory warm AIHA. PMID:26858026

  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. 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.

  17. 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; Hasselbalch, Hans K; Hegedüs, Laszlo

    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...

  18. 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.

  19. The identification of irreversible rituximab-resistant lymphoma caused by CD20 gene mutations

    International Nuclear Information System (INIS)

    C-terminal mutations of CD20 constitute part of the mechanisms that resist rituximab therapy. Most CD20 having a C-terminal mutation was not recognized by L26 antibody. As the exact epitope of L26 has not been determined, expression and localization of mutated CD20 have not been completely elucidated. In this study, we revealed that the binding site of L26 monoclonal antibody is located in the C-terminal cytoplasmic region of CD20 molecule, which was often lost in mutated CD20 molecules. This indicates that it is difficult to distinguish the mutation of CD20 from under expression of the CD20 protein. To detect comprehensive CD20 molecules including the resistant mutants, we developed a novel monoclonal antibody that recognizes the N-terminal cytoplasm region of CD20 molecule. We screened L26-negative cases with our antibody and found several mutations. A rituximab-binding analysis using the cryopreserved specimen that mutation was identified in CD20 molecules indicated that the C-terminal region of CD20 undertakes a critical role in presentation of the large loop in which the rituximab-binding site locates. Thus, combination of antibodies of two kinds of epitope permits the identification of C-terminal CD20 mutations associated with irreversible resistance to rituximab and may help the decision of the treatment strategy

  20. 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...

  1. 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; Hasselbalch, Hans C; Hegedüs, Laszlo

    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 b...

  2. 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 lymphoma...

  3. 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).

  4. 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

  5. RITUXIMAB TREATMENT FOR INTERSTITIAL LUNG INJURY IN SCLERODERMA SYSTEMATICA

    Directory of Open Access Journals (Sweden)

    Lidia Petrovna Ananieva

    2013-12-01

    Full Text Available Objective: to study the efficiency and tolerance of rituximab (RTM treatment in patients with scleroderma systematica (SDS with interstitial lung injury (ILI.Subjects and methods. The trial included 27 patients (26 women and 1 man (mean age 45.7±13.0 years, with diffuse (n=13 and circumscribed (n = 14 forms and a disease duration of > 5 years in 63%. All the patients underwent chestcomputed tomography; examination of external respiratory function, including forced vital capacity (FVC and diffusing capacity of the lung (DCL, as well as echocardiographic study. The efficiency of the treatment was evaluated from changes in FVC, skin score, and disease activity index. The indicators were compared prior to the treatment and one year after the first administration of RTM. The latter was injected with premedication (125–500 mg of methylprednisolone intravenously 500–1000 mg per administration. The mean dose of RTM was low and amounted to 1.3 g per year.Results. As estimated by the physician, good, satisfactory, no effects were seen in 81.5, 14.8, and 3.7% of the patients, respectively. There was a significant increase in mean FVC one year after the first administration of RTM and a reduction in the total activity of the disease, including skin syndrome. DCL was substantially unchanged in the entire group. In the diffuse and circumscribed forms of the disease, FVC increased significantly and to the same extent. A clinically significant increase in FVC (by 11% was achieved in patients with a disease duration of ≤5 years and mild lung injury. In people with a more than 5-year disease duration, FVC was initially decreased to a greater extent and the treatment-induced increase was only 3.7%. A significant and permanent decline in peripheral blood B lymphocytes was noted when both the standard dose (2 g of RTM and its lower doses (0.5–1 g were administered. RTM treatment was well tolerated, but complicated by mild intercurrent infections

  6. Placebo-controlled trial of rituximab in IgM anti-myelin–associated glycoprotein neuropathy

    Science.gov (United States)

    Viala, Karine; Nicolas, Guillaume; Créange, Alain; Vallat, Jean-Michel; Pouget, Jean; Clavelou, Pierre; Vial, Christophe; Steck, Andreas; Musset, Lucile; Marin, Benoit

    2013-01-01

    Objective: To determine whether rituximab 375 mg/m2 was efficacious in patients with immunoglobulin M (IgM) anti-myelin–associated glycoprotein antibody demyelinating neuropathy (IgM anti-MAG demyelinating neuropathy). Methods: Fifty-four patients with IgM anti-MAG demyelinating neuropathy were enrolled in this randomized, double-blind, placebo-controlled trial. The inclusion criteria were inflammatory neuropathy cause and treatment (INCAT) sensory score (ISS) ≥4 and visual analog pain scale >4 or ataxia score ≥2. The primary outcome was mean change in ISS at 12 months. Results: Twenty-six patients were randomized to a group receiving 4 weekly infusions of 375 mg/m2 rituximab, and 28 patients to placebo. Intention-to-treat analysis, with imputation of missing ISS values by the last observation carried forward method, showed a lack of mean change in ISS at 12 months, 1.0 ± 2.7 in the rituximab group, and 1.0 ± 2.8 in the placebo group. However, changes were observed, in per protocol analysis at 12 months, for the number of patients with an improvement of at least 2 points in the INCAT disability scale (p = 0.027), the self-evaluation scale (p = 0.016), and 2 subscores of the Short Form–36 questionnaire. Conclusions: Although primary outcome measures provide no evidence to support the use of rituximab in IgM anti-MAG demyelinating neuropathy, there were improvements in several secondary outcomes in per protocol analysis. Level of evidence: This study provides Class I evidence that rituximab is ineffective in improving ISS in patients with IgM anti-MAG demyelinating neuropathy. PMID:23667063

  7. 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

  8. 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.

  9. 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. PMID:26986816

  10. Standard Operating Procedure for In-house Preparation of 131I-rituximab for Radioimmunotherapy of Non-Hodgkin's Lymphoma

    OpenAIRE

    Pickford, Matthew D.; Turner, J. Harvey

    2012-01-01

    A Standard Operating Procedure (SOP) has been formulated for in-house preparation, quality control, dispensing and administration of 131I-rituximab appropriate for the safe, effective, radioimmunotherapy of non-Hodgkin lymphoma. A decade of experience of semi-automated radioiodination of rituximab in our hospital radiopharmaceutical laboratory was analysed. The methodology was then refined for safe, practical, affordable application to radioimmunotherapy of lymphoma in departments of nuclear ...

  11. 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...

  12. 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...

  13. 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.

  14. 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.

  15. 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.)

  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. 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

  18. 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

  19. Clinical Responses to Rituximab in a Case of Neuroblastoma with Refractory Opsoclonus Myoclonus Ataxia Syndrome

    OpenAIRE

    Samin Alavi; Ali Kord Valeshabad; Borhan Moradveisi; Ali Aminasnafi; Mohammad Taghi Arzanian

    2012-01-01

    Opsoclonus myoclonus ataxia syndrome (OMS) is a rare neurologic syndrome. In a high proportion of children, it is associated with neuroblastoma. The etiology of this condition is thought to be immune mediated. In children, immunotherapy with conventional treatments such as corticosteroids, intravenous immunoglobulin, adrenocorticotropic hormone, and even antiepileptic drugs has been tried. Recently rituximab has been used safely for refractory OMS in children with neuroblastoma. Our patient w...

  20. 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...

  1. 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.

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

    OpenAIRE

    Subramanian Murali; Manjunath R; Kilara Nalini; Mohan Rao K

    2010-01-01

    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.

  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. 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...

  5. Successful corticosteroid-sparing effect of rituximab in the treatment of refractory idiopathic orbital inflammatory disease.

    OpenAIRE

    Shao, EH; Karydis, A; Gemenetzi, M; Taylor, SR

    2013-01-01

    Idiopathic orbital inflammatory disease (IOID) is an idiopathic inflammatory process within the orbit that can result in permanent visual impairment. Although high-dose oral corticosteroids are currently the mainstay of therapy, their long-term usage can cause significant toxicity. We present a case of IOID that was successfully treated with the anti-CD20 monoclonal antibody rituximab following failed steroid sparing with conventional second-line immunosuppressive agents.

  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. Recurrence of light chain deposit disease after renal allograft transplantation: potential role of rituximab?

    Science.gov (United States)

    Kuypers, Dirk R J; Lerut, Evelyne; Claes, Kathleen; Evenepoel, Pieter; Vanrenterghem, Yves

    2007-04-01

    Light chain deposit disease (LCDD) is a monoclonal plasma cell disorder characterized by tissue deposition of nonamyloid immunoglobulin light chains, predominantly kappa chains, causing renal insufficiency. LCDD reoccurs almost invariably after renal grafting, leading to early graft loss, usually within a time span of months to years. We describe a female patient with LCDD who lost her first living donor graft after 1 year due to extensive recurrence of kappa chain deposition. Rituximab was administered on the seventh day after her second transplantation with a graft from a deceased donor, in order to prevent early recurrence of LCDD. The 2-year protocol biopsy - similarly to the completely normal 1-year protocol biopsy - revealed persistent absence of light chain deposition on light microscopy but immunohistochemical staining and electron microscopy showed very mild recurrence of light chain deposits. A second 4-week course of rituximab was repeated because of these electron microscopic findings. Subsequently, free kappa light chain concentration decreased from 693 to 74 mg/l and remained low 4 months after completion of therapy. Rituximab could be considered for delaying early LCDD recurrence in patients in whom treatment of the underlying bone marrow disorder failed or is contraindicated, but maintenance therapy is apparently necessary to consolidate this response. PMID:17326779

  8. 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.

  9. 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.

  10. 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) in...

  11. 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

  12. Anti-Apoptotic Effects of Lentiviral Vector Transduction Promote Increased Rituximab Tolerance in Cancerous B-Cells

    Science.gov (United States)

    Ranjbar, Benyamin; Krogh, Louise Bechmann; Laursen, Maria Bach; Primo, Maria Nascimento; Marques, Sara Correia; Dybkær, Karen; Mikkelsen, Jacob Giehm

    2016-01-01

    Diffuse large B-cell lymphoma (DLBCL) is characterized by great genetic and clinical heterogeneity which complicates prognostic prediction and influences treatment efficacy. The most common regimen, R-CHOP, consists of a combination of anthracycline- and immuno-based drugs including Rituximab. It remains elusive how and to which extent genetic variability impacts the response and potential tolerance to R-CHOP. Hence, an improved understanding of mechanisms leading to drug tolerance in B-cells is crucial, and modelling by genetic intervention directly in B-cells is fundamental in such investigations. Lentivirus-based gene vectors are widely used gene vehicles, which in B-cells are an attractive alternative to potentially toxic transfection-based methodologies. Here, we investigate the use of VSV-G-pseudotyped lentiviral vectors in B-cells for exploring the impact of microRNAs on tolerance to Rituximab. Notably, we find that robust lentiviral transduction of cancerous B-cell lines markedly and specifically enhances the resistance of transduced germinal center B-cells (GCBs) to Rituximab. Although Rituximab works partially through complement-mediated cell lysis, increased tolerance is not achieved through effects of lentiviral transduction on cell death mediated by complement. Rather, reduced levels of PARP1 and persistent high levels of CD43 in Rituximab-treated GCBs demonstrate anti-apoptotic effects of lentiviral transduction that may interfere with the outcome and interpretation of Rituximab tolerance studies. Our findings stress that caution should be exercised exploiting lentiviral vectors in studies of tolerance to therapeutics in DLBCL. Importantly, however, we demonstrate the feasibility of using the lentiviral gene delivery platform in studies addressing the impact of specific microRNAs on Rituximab responsiveness. PMID:27045839

  13. 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

  14. 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

  15. 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.

  16. 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

  17. 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....

  18. 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.

  19. 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

  20. 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

  1. 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.

  2. Standard Operating Procedure for In-house Preparation of (131)I-rituximab for Radioimmunotherapy of Non-Hodgkin's Lymphoma.

    Science.gov (United States)

    Pickford, Matthew D; Turner, J Harvey

    2012-09-01

    A Standard Operating Procedure (SOP) has been formulated for in-house preparation, quality control, dispensing and administration of (131)I-rituximab appropriate for the safe, effective, radioimmunotherapy of non-Hodgkin lymphoma. A decade of experience of semi-automated radioiodination of rituximab in our hospital radiopharmaceutical laboratory was analysed. The methodology was then refined for safe, practical, affordable application to radioimmunotherapy of lymphoma in departments of nuclear medicine in developing countries. This SOP has the potential to be incorporated into good laboratory practice conditions appropriate for local regulatory agency requirements. PMID:23372447

  3. 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.

  4. 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...

  5. 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

  6. 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

  7. 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

  8. 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.

  9. Newcastle disease virus, rituximab, and doxorubicin combination as anti-hematological malignancy therapy

    Directory of Open Access Journals (Sweden)

    Al-Shammari AM

    2016-04-01

    Full Text Available Ahmed Majeed Al-Shammari,1 Huda Rameez,2 Maha F Al-Taee2 1Department of Experimental Therapy, Iraqi Center for Cancer and Medical Genetic Research, Mustansiriyah University, 2Department of Biotechnology, College of Science, Baghdad University, Baghdad, IraqAbstract: Hematological malignancies are important diseases that need more powerful therapeutics. Even with current targeting therapies, such as rituximab and other chemotherapeutic agents, there is a need to develop new treatment strategies. Combination therapy seems the best option to target the tumor cells by different mechanisms. Virotherapy is a very promising treatment modality, as it is selective, safe, and causes cancer destruction. The Iraqi strain of Newcastle disease virus (NDV has proved to be effective both in vitro and in vivo. In the current work, we tested its ability on anti-hematological tumors and enhanced current treatments with combination therapy, and studied this combination using Chou–Talalay analysis. p53 concentration was measured to evaluate the mechanism of this proposed synergism. The results showed that NDV was synergistic with doxorubicin in low doses on plasmacytoma cells, with no involvement of p53 pathways, but involved p53 when the combination was used on non-Hodgkin lymphoma cells. NDV in combination with rituximab showed enhanced cytotoxicity that was p53-independent. In conclusion, this work proposes a novel combination modality for treatment of some hematological malignancies.Keywords: oncolytic viruses, virotherapy, combination therapy

  10. 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

  11. Pretreatment with rituximab enhances radiosensitivity of non-Hodgkin's lymphoma cells

    International Nuclear Information System (INIS)

    The present study examines the effects of ionizing radiation in combination with rituximab (RTX), a chimeric human anti-CD20 monoclonal antibody, on proliferation, cell cycle distribution and apoptosis in B-lymphoma RL and Raji cells. Exposure to ionizing radiation (9 Gy) induced cell growth delay and apoptosis in RL cells, whereas Raji cells showed moderate radio-resistance. The simultaneous exposure of lymphoma cells to ionizing radiation and RTX (10 μg/mL) markedly enhanced apoptosis and cell growth delay in RL and Raji cells. Cooperative antiproliferative and apoptotic effects of RTX and radiation were achieved through the inhibition of c-myc and bcl-XL expression. Furthermore, RTX-modulated expression of cell cycle regulating proteins, such as p53, p21/WAF1, p27/KIP1, contributed to the development of radiation-induced cell killing and growth arrest. Each NHL cell line that underwent apoptosis induced by combination treatment revealed enhanced caspase-3 and poly (ADP-ribose) polymerase (PARP) cleavage as compared to only irradiated cells. These findings show that rituximab synergistically enhances radiation-induced apoptosis and cell growth delay through the expression of proteins involved in the programmed cell death and cell cycle regulation pathways. (author)

  12. 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

  13. 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.

  14. 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...

  15. Standard Operating Procedure for Prospective Individualised Dosimetry for ([131])I-rituximab Radioimmunotherapy of Non-Hodgkin's Lymphoma.

    Science.gov (United States)

    Calais, Phillipe J; Turner, J Harvey

    2012-09-01

    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 personalized prospective dosimetry for safe, effective outpatient (131)I-rituximab RIT of NHL. Over five years, experience of treatment of outpatients with (131)I-rituximab was analyzed with respect to critical organ radiation dose in patients and radiation exposure of their carers. This radiation safety methodology has been refined; and offers the potential for safe, practical application to outpatient (131)I-rituximab RIT of lymphoma in general and in developing countries in particular. Given endorsement and sanction of this SOP by local regulatory authorities the personalized dosimetry paradigm will facilitate incorporation of RIT into the routine clinical practice of therapeutic nuclear oncology worldwide. PMID:23372448

  16. Plitidepsin (Aplidin) is a potent inhibitor of diffuse large cell and Burkitt lymphoma and is synergistic with rituximab.

    Science.gov (United States)

    Barboza, Nora M; Medina, Daniel J; Budak-Alpdogan, Tulin; Aracil, Miguel; Jimeno, José M; Bertino, Joseph R; Banerjee, Debabrata

    2012-01-15

    Plitidepsin (Aplidin), an antitumor agent of marine origin, presently is undergoing phase II/III clinical trials, and has shown promise for the treatment of lymphoma. Here, we describe the antitumor effects of plitidepsin alone and in combination with rituximab and investigated the effects of each drug and the combination on the cell cycle and mechanism of cell death. Several Diffuse Large Cell Lymphoma (DLCL) lines and Burkitt cell lines were tested for sensitivity to plitidepsin and rituximab. All DLCL and Burkitt lymphoma cell lines were inhibited by plitidepsin in nanomolar concentrations, while rituximab sensitivity varied among different cell lines. Ramos and the RL cell lines proved sensitive to rituximab and were used to test the effects of each of the two drugs. The two agents exhibited synergism at all tested concentrations. For in vivo studies, irradiated athymic nude mice were engrafted with the Ramos lymphoma. Treatment was initiated when the tumors were ~0.5 cm in diameter, and toxic and therapeutic effects were monitored. In the in vivo study, additive effects of the combined two drugs, was demonstrated without an increase in host toxicity. The in vitro synergy and the in vivo additive antitumor effects without an increase in host toxicity with two relatively non-marrow suppressive agents encourages further development of this combination for treatment of aggressive B-cell lymphomas. PMID:22336911

  17. 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

  18. 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...

  19. Anti-Apoptotic Effects of Lentiviral Vector Transduction Promote Increased Rituximab Tolerance in Cancerous B-Cells

    DEFF Research Database (Denmark)

    Ranjbar, Benyamin; Krogh, Louise Bechmann; Laursen, Maria Bach; Primo, Maria Nascimento; Marques, Sara Correia; Dybkær, Karen; Mikkelsen, Jacob Giehm

    2016-01-01

    achieved through effects of lentiviral transduction on cell death mediated by complement. Rather, reduced levels of PARP1 and persistent high levels of CD43 in Rituximab-treated GCBs demonstrate anti-apoptotic effects of lentiviral transduction that may interfere with the outcome and interpretation of...

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

    DEFF Research Database (Denmark)

    Birgens, Henrik Sverre; Frederiksen, Henrik; Hasselbalch, Hans C;

    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...

  1. Rituximab is more effective than second anti-TNF therapy in rheumatoid arthritis patients and previous TNFα blocker failure

    Directory of Open Access Journals (Sweden)

    Kekow J

    2012-07-01

    Full Text Available Joern Kekow,1 Ulf Mueller-Ladner,2 Hendrik Schulze-Koops31Clinic of Rheumatology and Orthopedics, Otto-von-Guericke University of Magdeburg, Vogelsang-Gommern; 2Department of Rheumatology and Clinical Immunology, Kerckhoff Clinic, Bad Nauheim; 3Division of Rheumatology, University of Munich, Munich, GermanyPurpose: To assess the efficacy of one course of rituximab (two 1-g doses compared to an alternative tumor necrosis factor-α (TNFα blocker in rheumatoid arthritis patients who had experienced one previous TNFα blocker failure (eg, etanercept, adalimumab, or infliximab.Patients and methods: The efficacy of both treatments was studied in this retrospective, multicenter, noninterventional cohort study with 196 patients. All patients had active rheumatoid arthritis defined by a Disease Activity Score-28 of ≥3.2 despite having TNFα blocker therapy, and were followed over 6.6 months on average after switching to rituximab versus a second TNFα blocker (ie, switching to etanercept, adalimumab, or infliximab at baseline.Results: At baseline, both cohorts showed similar demographic and disease-related characteristics (including Disease Activity Score-28. At the end of observation, mean Disease Activity Score-28 was significantly lower after treatment with rituximab than with a second TNFα blocker (-1.64 [95% confidence interval: -1.92; -1.36] versus -1.19 [95% confidence interval: -1.42; -0.96], P = 0.013. This difference between the two groups was even more pronounced when patients were seropositive for rheumatoid factor (-1.66 versus -1.17, P = 0.018 and anti-cyclic citrullinated peptide antibodies (-1.75 versus -1.06, P = 0.002. More rituximab-treated patients achieved good European League Against Rheumatism response than TNFα blocker-treated patients (30% versus 15%, and less patients were nonresponders (22% versus 35% according to European League Against Rheumatism criteria (P = 0.022, chi-squared test.Conclusion: Treatment with rituximab

  2. 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

  3. 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

  4. 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.

  5. 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

    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...

  6. 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.

  7. 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

  8. {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.)

  9. Rituximab in Combination with Corticosteroids for the Treatment of Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis: A NICE Single Technology Appraisal

    OpenAIRE

    Latimer, Nicholas R.; Carroll, Christopher; Wong, Ruth; Tappenden, Paul; Venning, Michael C.; Luqmani, Raashid

    2014-01-01

    As part of its single technology appraisal (STA) process, the National Institute for Health and Care Excellence (NICE) invited the manufacturer of rituximab (Roche Products) to submit evidence of the clinical and cost effectiveness of rituximab in combination with corticosteroids for treatment of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). The School of Health and Related Research Technology Appraisal Group at the University of Sheffield was commissioned to act as...

  10. 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...

  11. Treatment of limited stage follicular lymphoma with Rituximab immunotherapy and involved field radiotherapy in a prospective multicenter Phase II trial-MIR trial

    International Nuclear Information System (INIS)

    The optimal treatment of early stage follicular Lymphoma is a matter of debate. Radiation therapy has frequently been applied with a curative approach beside watchful waiting. Involved field, extended field and total nodal radiation techniques are used in various protocols, but the optimal radiation field still has to be defined. Follicular lymphoma is characterized by stable expression of the CD20 antigen on the tumour cells surface. The anti CD20 antibody Rituximab (Mabthera®) has shown to be effective in systemic therapy of FL in primary treatment, relapse and maintenance therapy. The MIR (Mabthera® and Involved field Radiation) study is a prospective multicenter trial combining systemic treatment with the anti CD20 antibody Rituximab (Mabthera®) in combination with involved field radiotherapy (30 - 40 Gy). This trial aims at testing the combination's efficacy and safety with an accrual of 85 patients. Primary endpoint of the study is progression free survival. Secondary endpoints are response rate to Rituximab, complete remission rate at week 18, relapse rate, relapse pattern, relapse free survival, overall survival, toxicity and quality of life. The trial evaluates the efficacy of Rituximab to prevent out-filed recurrences in early stage nodal follicular lymphoma and the safety of the combination of Rituximab and involved field radiotherapy. It also might show additional risk factors for a later recurrence (e.g. remission state after Rituximab only). ClinicalTrials (NCT): http://www.clinicaltrials.gov/ct2/show/NCT00509184

  12. Successful Treatment of Life-Threatening Interstitial Lung Disease Secondary to Antisynthetase Syndrome Using Rituximab: A Case Report and Review of the Literature.

    Science.gov (United States)

    Dasa, Osama; Ruzieh, Mohammed; Oraibi, Omar

    2016-01-01

    We are presenting a case of antisynthetase syndrome (ASS) that manifested with severe interstitial pneumonitis in the presence of anti-Jo-1 and Ro (SSA) antibodies. Our patient developed respiratory failure with high oxygen requirements despite treatment by high-dose steroids. The patient was then treated with rituximab. This treatment led to significant improvement in the patient condition, with resolution of the ground glass opacities on high-resolution computerized tomography and near normalization of pulmonary function tests. In this communication, we performed a literature review and summarized previous reports pertinent to using of rituximab to treat interstitial lung disease (ILD) secondary to ASS by searching the PubMed database from 1980 to 2014. We were able to find 14 reports that included total of 45 patients with ILD secondary to ASS. A significant improvement in ILD was reported in the majority of reported patients who received rituximab, while there was only 1 mortality-related to Pneumocystis jirovecii pneumonia. Rituximab treatment was tolerated well in the majority of cases. It is our conclusion that rituximab can be considered a therapeutic option in ILD secondary to ASS based on our experience with this case and the currently available evidence in the literature. Nevertheless, there is a need for additional controlled studies to assess the efficacy and safety of rituximab in ILD secondary to ASS compared with other immunosuppressive regimens. PMID:25830868

  13. 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...

  14. Dermatomiositis refractaria asociada a neumonía en organización tratada con rituximab: Reporte de un caso Refractory dermatomyositis associated with chronic organizing pneumonia treated with rituximab: Report of one case

    Directory of Open Access Journals (Sweden)

    Jorge Yáñez V

    2009-01-01

    Full Text Available Chronic organizing pneumonia (COP has often been reported as a pulmonary manifestation of collagen vascular diseases, mainly rheumatoid arhritis, but the association of COP and dermatomyositis (DM has rarely been documented. We report a 55 year-old woman with well-documented DM and a COP. She was refractory to steroids and two other immunosuppressive agents therapy (cyclophosphamide and azathioprine. Therefore, rituximab (2 x 1 g infusions was used for treatment. During the following weeks her strength gradually increased while creatine kinase (CK, C reactive protein and erythrocyte sedimentation rate normalized. After 6 months, she had a relapse with increased muscle enzymes, fever and modérate muscle weakness. After a second course of rituximab (2 x 1 g infusions, the patient demonstrated a remarkable clinical response as indicated by an increase in muscle strength and moderate decline in creatine kinase levels. Lung abnormalities resolved significantly on high resolution chest CT sean. Thus, B-cell depletion therapy with rituximab used alone or in combination with other immunosuppressants may be a viable option in patients with polymyositis-dermatomyositis and pneumonia refractory to current therapies.

  15. 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

  16. 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

  17. Low-Dose Rituximab Therapy for Antibody-Mediated Rejection in a Highly Sensitized Heart-Transplant Recipient

    OpenAIRE

    Aggarwal, Ashim; Pyle, Joseph; Hamilton, John; Bhat, Geetha

    2012-01-01

    Antibody-mediated rejection is the B-cell–mediated production of immunoglobulin G antibody against the transplanted heart. The currently available therapies for antibody-mediated rejection have had marginal success, and chronic manifestations of rejection can result in an increased risk of graft vasculopathy and perhaps require repeat transplantation. Rituximab, a monoclonal antibody directed against the CD20 receptor of B-lymphocytes and approved as therapy for lymphoma, can be used in heart...

  18. B-cell depletion in SLE: clinical and trial experience with rituximab and ocrelizumab and implications for study design

    OpenAIRE

    Reddy, V; Jayne, D; Close, D.; Isenberg, D

    2013-01-01

    B cells are believed to be central to the disease process in systemic lupus erythematosus (SLE), making them a target for new therapeutic intervention. In recent years there have been many publications regarding the experience in SLE of B-cell depletion utilising rituximab, an anti-CD20 mAb that temporarily depletes B cells, reporting promising results in uncontrolled open studies and in routine clinical use. However, the two large randomised controlled trials in extra-renal lupus (EXPLORER s...

  19. Formulation and Characterization of “Ready to Use” 1B4M-DTPA-rituximab for Lu-177 Labeling

    OpenAIRE

    Gorgieva, Darinka; Smilkov, Katarina; Janevik-Ivanovska, Emilija

    2014-01-01

    Investigations for NHL treatment are oriented towards radiolabelled therapeutics. This research focuses on formulation and characterization of a new, ready to label immunoconjugate, 1B4M-DTPA-rituximab, which is suitable for labeling with Lu-177. The conjugation was performed using 20-fold molar excess of the bifunctional chelating agent, 1B4M-DTPA and subsequent lyophilization. The characterization of the (radio)immunoconjugate was performed using SE-HPLC, SDS-PAGE and MALDI-TOF-...

  20. 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 ...

  1. Plitidepsin (Aplidin) is a potent inhibitor of diffuse large cell and Burkitt lymphoma and is synergistic with rituximab

    OpenAIRE

    Barboza, Nora M.; Medina, Daniel J; Budak-Alpdogan, Tulin; Aracil, Miguel; Jimeno, José M; Bertino, Joseph R.; Banerjee, Debabrata

    2012-01-01

    Plitidepsin (Aplidin), an antitumor agent of marine origin, presently is undergoing phase II/III clinical trials, and has shown promise for the treatment of lymphoma. Here, we describe the antitumor effects of plitidepsin alone and in combination with rituximab and investigated the effects of each drug and the combination on the cell cycle and mechanism of cell death. Several Diffuse Large Cell Lymphoma (DLCL) lines and Burkitt cell lines were tested for sensitivity to plitidepsin and rituxim...

  2. Relationship of T regulatory cells content, activity and serum autoantibodies level in patients with systemic lupus erythematosus receiving rituximab

    Directory of Open Access Journals (Sweden)

    A V Torgashina

    2009-04-01

    Full Text Available Objective. To reveal changes of CD+CD25+FoxP3+ T-regulatory cells (T-reg number in pts with systemic lupus erythematosus (SLE receiving rituximab and to assess relationship T reg content with changes of disease activity and serum autoantibodies level during treatment. Material and methods. 12 pts with definite SLE were included. Pts were examined before treatment, after 1, 3 and 6 months. Besides routine laboratory tests anti-double-stranded DNA antibodies, B lymphocytes and T reg cells number was evaluated with flow-cytometry. SLE activity was assessed with SLEDAI 2K scale. Rituximab 500 mg was administered every week iv during 4 weeks. 4 pts received combined treatment with cyclophosphan. Results. Mean age of pts was 30,5±9,8 years (Me 31 years, varied from 18 to 49 years, disease duration varied from 7 to 148 months. T reg number before treatment was not decreased and did not correlated with anti-DNA antibodies level. T reg markers (Foxp3+, CD25+, CD4+CD25+ changes and values of SLE activity on SLEDAI 2K after the end of treatment correlated with presence of clinical response to treatment with rituximab in 3 months. Binary logistic regression model including 4 above mentioned predictors in total allows predicting correctly clinical response to therapy in 83% of cases. Conclusion. Changes of CD25+, CD4+CD25+, CD4+CD25+FoxP3+ T-cells number immediately after the end of treatment with rituximab correlated with clinical effect of the treatment and determined subsequent response to anti-B cell therapy.

  3. 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...

  4. 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

  5. Phase II trial of weekly bortezomib in combination with rituximab in untreated patients with Waldenström Macroglobulinemia.

    Science.gov (United States)

    Ghobrial, Irene M; Xie, Wanling; Padmanabhan, Swaminathan; Badros, Ashraf; Rourke, Meghan; Leduc, Renee; Chuma, Stacey; Kunsman, Janet; Warren, Diane; Poon, Tiffany; Harris, Brianna; Sam, Amy; Anderson, Kenneth C; Richardson, Paul G; Treon, Steven P; Weller, Edie; Matous, Jeffrey

    2010-09-01

    This study aimed to determine the activity and safety of weekly bortezomib and rituximab in patients with untreated Waldenström Macroglobulinemia (WM). Patients with no prior therapy and symptomatic disease were eligible. Patients received bortezomib IV weekly at 1.6 mg/m(2) on days 1, 8, 15, q 28 days × 6 cycles, and rituximab 375 mg/m(2) weekly on cycles 1 and 4. Primary endpoint was the percent of patients with at least a minor response (MR). Twenty-six patients were treated. At least MR was observed in 23/26 patients (88%) (95% CI: 70-98%) with 1 complete response (4%), 1 near-complete response (4%), 15 partial remission (58%), and 6 MR (23%). Using IgM response evaluated by nephlometry, all 26 patients (100%) achieved at least MR or better. The median time to progression has not been reached, with an estimated 1-year event free rate of 79% (95% CI: 53, 91%). Common grade 3 and 4 therapy related adverse events included reversible neutropenia in 12%, anemia in 8%, and thrombocytopenia in 8%. No grade 3 or 4 neuropathy occurred. The combination of weekly bortezomib and rituximab exhibited significant activity and minimal neurological toxicity in patients with untreated WM. PMID:20652865

  6. Low-Dose Rituximab Therapy for Antibody-Mediated Rejection in a Highly Sensitized Heart-Transplant Recipient

    Science.gov (United States)

    Aggarwal, Ashim; Pyle, Joseph; Hamilton, John; Bhat, Geetha

    2012-01-01

    Antibody-mediated rejection is the B-cell–mediated production of immunoglobulin G antibody against the transplanted heart. The currently available therapies for antibody-mediated rejection have had marginal success, and chronic manifestations of rejection can result in an increased risk of graft vasculopathy and perhaps require repeat transplantation. Rituximab, a monoclonal antibody directed against the CD20 receptor of B-lymphocytes and approved as therapy for lymphoma, can be used in heart-transplant patients for the management of antibody-mediated rejection. We present the case of a 52-year-old woman with high allosensitization (pre-transplantation panel reactive antibody level, 72%) who underwent successful orthotopic heart transplantation. Postoperatively, her acute antibody-mediated rejection with concomitant cellular rejection was successfully treated with low-dose rituximab. The patient died 5 months later because of multiple other medical problems. The present case suggests a role for low-dose rituximab as therapy for antibody-mediated rejection in heart-transplant patients. PMID:23304051

  7. 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

  8. Cost-effectiveness of adding rituximab to fludarabine and cyclophosphamide for treatment of chronic lymphocytic leukemia in Ukraine

    Directory of Open Access Journals (Sweden)

    Mandrik O

    2015-08-01

    Full Text Available Olena Mandrik,1 Isaac Corro Ramos,2 Saskia Knies,1,3 Maiwenn Al,1,2 Johan L Severens1,2 1Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands; 2Institute of Medical Technology Assessment (iMTA, Erasmus University Rotterdam, Rotterdam, the Netherlands; 3National Health Care Institute, Diemen, the Netherlands Abstract: The aim of this study was to assess the cost-effectiveness, from a health care perspective, of adding rituximab to fludarabine and cyclophosphamide scheme (FCR versus FC for treatment-naïve and refractory/relapsed Ukrainian patients with chronic lymphocytic leukemia. A decision-analytic Markov cohort model with three health states and 1-month cycle time was developed and run within a life time horizon. Data from two multinational, prospective, open-label Phase 3 studies were used to assess patients' survival. While utilities were generalized from UK data, local resource utilization and disease-associated treatment, hospitalization, and side effect costs were applied. The alternative scenario was performed to assess the impact of lower life expectancy of the general population in Ukraine on the incremental cost-effectiveness ratio (ICER for treatment-naïve patients. One-way, two-way, and probabilistic sensitivity analyses were conducted to assess the robustness of the results. The ICER (in US dollars of treating chronic lymphocytic leukemia patients with FCR versus FC is US$8,704 per quality-adjusted life year gained for treatment-naïve patients and US$11,056 for refractory/relapsed patients. When survival data were modified to the lower life expectancy of the general population in Ukraine, the ICER for treatment-naïve patients was higher than US$13,000. This value is higher than three times the current gross domestic product per capita in Ukraine. Sensitivity analyses have shown a high impact of rituximab costs and a moderate impact of differences in utilities on the ICER

  9. 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

  10. Assessment of long-term radiotoxicity after treatment with the low-dose-rate alpha-particle-emitting radioimmunoconjugate 227Th-rituximab

    International Nuclear Information System (INIS)

    The anti-CD20 antibody rituximab labelled with the α-particle-emitting radionuclide 227Th 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 227Th-rituximab has been observed. To evaluate possible late side effects of 227Th-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 227Th-rituximab and followed for up to 1 year. In addition, nude mice with Raji xenografts treated with various doses of 227Th-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 227Th-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 227Th-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 227Th-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 obtained with relatively safe dosage levels of the radioimmunoconjugate. (orig.)

  11. 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

  12. 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.

  13. Bone marrow infiltration of CD20-negative follicular lymphoma after rituximab therapy: a histological mimicker of hematogones and B-cell acute lymphoblastic leukemia/lymphoma

    Science.gov (United States)

    Matsuda, Ikuo; Hirota, Seiichi

    2015-01-01

    Rituximab is a monoclonal antibody against CD20. Rituximab combined with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy, termed R-CHOP, have improved the overall survival of patients with B-cell lymphoma in comparison with that of CHOP therapy. However, as with other molecularly-targeted therapies, resistance to rituximab could emerge sooner or later after rituximab administration. A number of mechanisms for rituximab resistance have been proposed, including downregulation of CD20 protein expression. Differential diagnosis of B-cell proliferation with reduced or lost CD20 expression includes not only B-cell lymphomas with CD20 downregulation, but also other tumorous and non-tumorous lesions. These include precursor B-cell neoplasms such as B acute lymphoblastic leukemia/lymphoblastic lymphoma (B-ALL/LBL) and hematogones, a normal precursor B-cell proliferation during regeneration of hematopoiesis, typically observed following bone marrow suppression by chemotherapy. It is important to distinguish these possibilities because distinct therapies are required for each. In this paper, we report a case where bone marrow infiltration of follicular lymphoma histopathologically mimicked hematogones or B-ALL/LBL when CD20 expression was downregulated in follicular lymphoma after R-CHOP therapy. PMID:26464748

  14. 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.

  15. Refractory thrombotic thrombocytopenic purpura associated with primary Sjogren syndrome treated with rituximab: a case report.

    Science.gov (United States)

    Toumeh, Anis; Josh, Navpreet; Narwal, Rawan; Assaly, Ragheb

    2014-01-01

    Thrombotic thrombocytopenic purpura (TTP) is an uncommon, serious disease that involves multiple organs and is rapidly fatal if left untreated. TTP is associated with multisystem symptoms, such as thrombocytopenia, microangiopathic hemolytic anemia, renal impairment, central nervous system involvement, and fever. TTP is idiopathic in about 37% of the cases and can be associated with autoimmune diseases in 13% of the cases. Autoimmune disease-associated TTP can be refractory to plasma exchange and requires immunosuppressive therapy. We report a case of a previously healthy 55-year-old African American female who presented with shortness of breath, hemolytic anemia, renal impairment, and thrombocytopenia. The diagnosis of TTP was made, and plasmapheresis was initiated. However, recurrence happened 48 hours after plasmapheresis was stopped. Autoimmune workup for refractory TTP revealed positive antinuclear antibodies, Anti-SSA, and Anti-SSB. Lip biopsy revealed findings consistent with Sjogren syndrome. Treatment with Rituximab was started, and significant clinical and laboratory response was achieved. The patient remained asymptomatic thereafter. A high clinical suspicion of autoimmune diseases is important as TTP tends to be refractory to plasma exchange in these cases, and immunosuppressive therapy is a key. PMID:23011161

  16. 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

  17. [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

  18. Radiolabelling rituximab with (99m)Tc in three steps procedure.

    Science.gov (United States)

    Fontan, Charlotte; Bezombes, Christine; Salabert, Anne Sophie; Costes, Julien; Lopez, Raphael; Fournie, Jean-Jacques; Avet-Loiseau, Hervé; Coulais, Yvon; Payoux, Pierre; Tafani, Mathieu

    2015-06-15

    Lymphomas are the most frequent haematological malignancy. In non-Hodgkin's lymphomas (NHL), more than 90% of tumor cells express the cluster of differentiation (CD) 20 antigen. At the end of frontline therapy, the evaluation of remission is based on computed tomography (CT) and positron emission tomography coupled with computer tomography (PET/CT) with [(18)F]-fluorodeoxyglucose ([(18)F]FDG). Unfortunately, these techniques are not specific and cannot distinguish residual active tumor from inflammation. The aim of this study was to develop a specific radiotracer of NHL CD 20+ cells for clinical applications. The radiolabelling technique presented, based on the use of tricarbonyl compound, does not include an antibody reduction because this step could damage the protein. Actually, rituximab, an anti-CD 20 chimeric antibody used for the treatment of these NHL, was radiolabelled with Isolink® (99m)Tc-tricarbonyl compound in a three-step procedure without using a specific antibody reducer. Radiolabelling yield was greater than 97%. In vitro experiments showed a conservation of antibody integrity. In vivo experiments using Single-photon emission computed tomography/CT showed significant tumor targeting 24 h after injection of the radiotracer. It was consequently possible to develop an immunoradiolabelling method to specifically detect the residual disease. As this procedure is fast, reproducible and gentle, it will be possible to comply with Good Manufacturing Practices. PMID:26017396

  19. Personal dosimetry of staff involved with I-131 therapeutic procedures

    International Nuclear Information System (INIS)

    Full text: Introduction: Therapeutic doses of liquid 131l (370 MBq) and 131l MIBG (3700 MBq) are frequently used in the treatment of patients with hyperthyroidism and neuroblastoma respectively. 131l is volatile and can be inhaled and accumulate in the thyroid of personnel responsible for the dispensing and administration of doses. The aim of this study was to report and assess the radiation doses to personnel involved with liquid 131l therapeutic procedures. Materials and methods: 131l liquid dispensing and administration: The uptake of 131l in the thyroid of the physicists responsible for dispensing, and medical doctors for administration of therapeutic doses was determined with a whole body counter. 131l MIBG dispensing and administration: The radiation doses received by the subjects have been monitored using calibrated lithium fluoride thermo luminescent dosimetry (TLD) discs and a direct reading pocket dosimeter. The TLD discs have been issued and worn by the physicists and the dedicated nurses doing duty at the patient. The dedicated nurses and voluntarily comforters of the patients were also issued with pocket dosimeters to measure the whole body dose received. Results: 131l liquid dispensing and administration: The activities in the thyroid of the personnel handling the therapeutic doses of liquid 131l varied from 49Bq -1466Bq. The activity that was handled varied from 370 - 3182 MBq / week. The limit set by the ICRP for 131l uptake in the thyroid is 2 MBq. 131l MIBG dispensing and administration: The whole body radiation doses received by the caregivers of 131l MIBG therapy patients varied from 0,13-.12 mSv. The ICRP whole body limit to the public is 1 mSv per year. The physicists' whole body radiation doses varied from 0.20 - 1.18 mSv per treatment. Their hand doses varied from 0.67 - 8.85 mSv. The ICRP whole body limit for radiation workers is 20 mSv per year (- 0.4 mSv per week) while the dose to the skin (hands) should not exceed 5O0mSv per year (10mSv per week). Conclusions: The radiation risk to personnel involved with liquid 131l therapeutic procedures is low. It is however important to adhere to strict safety regulations during the performance of 131l therapeutic procedures. A system of rotating personnel responsible for these procedures is important to enforce the ALARA principle. Routine and regular monitoring of personnel involved should be instituted. (author)

  20. Radiopharmacokinetics and radiation dose from I-131-metaiodobenzylguanidine

    International Nuclear Information System (INIS)

    Whole body retention measurements were performed in man and animals after intravenous injection of 131I-MIBG. In man determination of organ activity is problematic and difficult. Therefore organ accumulations were measured in mice and data transferred to standard man according to ICRP. From whole body profiles in man whole body retention was calculated: derived biokinetic data are reported. In mice radiopharmacokinetic data were collected from quantitative organ measurements: retention curves of different organs and of the whole body as well as the analyis of their components will be shown. The cumulated activities obtained in animal organs were transferred to the human organs allowing for different masses. Absorbed dose calculations were performed with these data according to MIRD. All organs except the thyroid (blocked) and adrenal medulla received doses of 2 to 3.5 mGy/20 MBq. The high dose to the adrenal medulla is compared to published data by Swanson and Kimmig, who used different measuring methods: Swanson only took biokinetic data from animals, Kimmig only performed measurements in man, while we used biokinetic data both from man and animals. (Author)

  1. 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...

  2. 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 ...

  3. 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)

  4. On-line monitoring system for I-131 manufacturing labs

    International Nuclear Information System (INIS)

    An on-line monitoring and safety system has been installed in a lab for manufacturing 1-131 capsules for nuclear medicine use. Production of up to 100mCi batches is performed in shielded glove boxes. The safety system is based on a unique, 'Medi SMARTS' system (Medical Survey Mapping Automatic Radiation Tracing System), that collects continuously the radiation measurements for processing, display, and storage for future retrieval. Radiation is measured by GM tubes, data is transferred to a data processing unit, and then via a RS-485 communication line to a computer. In addition to the operational advantages and radiation levels storage, the system is being evaluated for the purpose of identifying risky stages in the process. (authors)

  5. 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

  6. Production and quality assurance of I-131 capsules

    International Nuclear Information System (INIS)

    The Radiochemistry Department produces two radioactive products for human use: 131I-Sodium Iodide as a solution and as capsules dosage forms which are used for the diagnosis and treatment of various thyroid disorders including toxic nodules, thyroid hypofunction, carcinoma of the thyroid gland and hyperthyroidism, for nearly 50 years. As such, the Radiochemistry Department is considered as a 'mini' pharmaceutical enterprise, and therefore has to obey, under law, the rules of the Israeli ministry of Health. GMP requirements have been implemented in all our production and packaging units. A computerized system which is now an integral part of the whole process, starting from the stage of requested orders and ending with delivery to the hospitals, was developed and its features are presented here along with quality assurance policy. (author)

  7. 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.

  8. 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

  9. 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)

  10. B-cell depletion in SLE: clinical and trial experience with rituximab and ocrelizumab and implications for study design.

    Science.gov (United States)

    Reddy, Venkat; Jayne, David; Close, David; Isenberg, David

    2013-01-01

    B cells are believed to be central to the disease process in systemic lupus erythematosus (SLE), making them a target for new therapeutic intervention. In recent years there have been many publications regarding the experience in SLE of B-cell depletion utilising rituximab, an anti-CD20 mAb that temporarily depletes B cells,reporting promising results in uncontrolled open studies and in routine clinical use. However, the two large randomised controlled trials in extra-renal lupus (EXPLORER study) and lupus nephritis (LUNAR study) failed to achieve their primary endpoints. Based on the clinical experience with rituximab this failure was somewhat unexpected and raised a number of questions and concerns, not only into the true level of benefit of B-cell depletion in a broad population but also how to test the true level of effectiveness of an investigational agent as we seek to improve the design of therapeutic trials in SLE. A better understanding of what went wrong in these trials is essential to elucidate the underlying reasons for the disparate observations noted in open studies and controlled trials. In this review, we focus on various factors that may affect the ability to accurately and confidently establish the level of treatment effect of the investigational agent, in this case rituximab, in the tw studies and explore hurdles faced in the randomised controlled trials investigating the efficacy of ocrelizumab, the humanised anti-CD20 mAb, in SLE. Further, based on the lessons learned from the clinical trials, we make suggestions that could be implemented in future clinical trial design to overcome the hurdles faced. PMID:23566295

  11. 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

    . In the present study of a large cohort of DLBCL patients treated with rituximab plus CHOP (R-CHOP), we show that those with TP53 mutations had worse overall and progression-free survival compared with those without. Unlike earlier studies of patients treated with CHOP, TP53 mutation has predictive value for R......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...

  12. Regulation of serum matrix metalloproteinases and tissue inhibitor of metalloproteinases-1 following rituximab therapy in patients with rheumatoid arthritis refractory to anti-tumor necrosis factor blockers

    OpenAIRE

    Klimiuk, Piotr Adrian; Domysławska, Izabela; Sierakowski, Stanisław; Chwiećko, Justyna

    2014-01-01

    In our article, we evaluated the regulatory effects of the infusions of rituximab, a monoclonal antibody directed against CD20+ B cells, on the serum matrix metalloproteinases (MMPs) and tissue inhibitor of metalloproteinases-1 (TIMP-1) levels in patients with active rheumatoid arthritis (RA) not responding to anti-tumor necrosis factor (anti-TNF) therapy. Twelve RA patients were planned to receive four infusions of 1,000 mg of rituximab at weeks 0, 2, 24 and 26. The therapy was combined with...

  13. Targeted biological therapies for Graves' disease and thyroid-associated ophthalmopathy. Focus on B-cell depletion with Rituximab

    DEFF Research Database (Denmark)

    Hegedüs, Laszlo; Douglas, Raymond S; Nielsen, Claus H; Smith, Terry J

    2011-01-01

    Based on experience from the treatment of other autoimmune diseases and because of the limitations imposed by existing therapeutic options for Graves' disease (GD) and thyroid-associated ophthalmopathy (TAO), rituximab (RTX) was recently proposed as a novel therapy option. Here, we summarize the...... respond favourably to conventional therapy. It is the first in what is likely to be a series of new and emerging treatments specifically targeting relevant components of the immune system. Further studies will hopefully lead to improved and better tailored, individualized therapy for GD and especially TAO....

  14. 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...

  15. 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...

  16. Factors correlated with improvement of endothelial dysfunction during rituximab therapy in patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Benucci M

    2013-03-01

    Full Text Available Maurizio Benucci,1 Gianantonio Saviola,2 Mariangela Manfredi,3 Piercarlo Sarzi-Puttini,4 Fabiola Atzeni41Rheumatology Unit, Department of Internal Medicine, Hospital di S Giovanni di Dio, Azienda Sanitaria di Firenze, Florence, Italy; 2Rheumatology and Rehabilitation Unit, Salvatore Maugeri Foundation IRCCS, Mantua, Italy; 3Immunology and Allergology Laboratory Unit, Hospital di S Giovanni di Dio, Azienda Sanitaria di Firenze, Florence, Italy; 4Rheumatology Unit, Sacco University Hospital, Milan, ItalyAbstract: Increased cardiovascular mortality has been associated with rheumatoid arthritis (RA. There are reports indicating that tumor necrosis factor (TNF blockers may exert favorable but transient effects on the lipid profile, flow-mediated vasodilatation (FMD of the brachial artery, and the common carotid intima–media thickness (ccIMT in RA. We evaluated 38 RA patients (33 females and five males with a mean age of 66.7 ± 10.2 years who were unresponsive to TNF blockers. The patients received one or more courses of two rituximab (RTX 1000 mg infusions. Disease activity was evaluated at each visit. Investigations included erythrocyte sedimentation rate, C-reactive protein (CRP levels, the 28-joint disease activity score (DAS28, DAS28CRP, the Health Assessment Questionnaire, the FMD percent change from baseline (FMD%, and the postnitroglycerine endothelium-independent vasodilatation. In comparison with the baseline, there was a significant improvement in clinical variables and acute-phase reactants 24 months after the start of RTX therapy. There was also a major improvement in FMD% (from baseline 5.24 ± 1.12 to 5.43 ± 1.16; P = -0.03 and a smaller change in the ccIMT (from baseline 0.69 ± 0.16 to 0.67 ± 0.12 mm P = 0.25. Univariate analysis showed that global health (P < 0.034 was associated with the improvement in FMD%. Multivariate models showed that GH (odds ratio [OR] 0.91; 95% CI: 0.99–0.83; P = 0.032, CD19+ cells (OR 1.024; 95% CI

  17. 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.)

  18. A phase 2 study of idelalisib plus rituximab in treatment-naïve older patients with chronic lymphocytic leukemia.

    Science.gov (United States)

    O'Brien, Susan M; Lamanna, Nicole; Kipps, Thomas J; Flinn, Ian; Zelenetz, Andrew D; Burger, Jan A; Keating, Michael; Mitra, Siddhartha; Holes, Leanne; Yu, Albert S; Johnson, David M; Miller, Langdon L; Kim, Yeonhee; Dansey, Roger D; Dubowy, Ronald L; Coutre, Steven E

    2015-12-17

    Idelalisib is a first-in-class oral inhibitor of PI3Kδ that has shown substantial activity in patients with relapsed/refractory chronic lymphocytic leukemia (CLL). To evaluate idelalisib as initial therapy, 64 treatment-naïve older patients with CLL or small lymphocytic leukemia (median age, 71 years; range, 65-90) were treated with rituximab 375 mg/m(2) weekly ×8 and idelalisib 150 mg twice daily continuously for 48 weeks. Patients completing 48 weeks without progression could continue to receive idelalisib on an extension study. The median time on treatment was 22.4 months (range, 0.8-45.8+). The overall response rate (ORR) was 97%, including 19% complete responses. The ORR was 100% in patients with del(17p)/TP53 mutations and 97% in those with unmutated IGHV. Progression-free survival was 83% at 36 months. The most frequent (>30%) adverse events (any grade) were diarrhea (including colitis) (64%), rash (58%), pyrexia (42%), nausea (38%), chills (36%), cough (33%), and fatigue (31%). Elevated alanine transaminase/aspartate transaminase was seen in 67% of patients (23% grade ≥3). The combination of idelalisib and rituximab was highly active, resulting in durable disease control in treatment-naïve older patients with CLL. These results support the further development of idelalisib as initial treatment of CLL. This study is registered at ClinicalTrials.gov as #NCT01203930. PMID:26472751

  19. 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.)

  20. 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 ...

  1. 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...

  2. 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

  3. 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

  4. CD20-positive primary gastric T-cell lymphoma poorly responding to initial treatment with rituximab plus CHOP, and a literature review.

    Science.gov (United States)

    Kakinoki, Yasutaka; Hashiguchi, Junichi; Ishio, Takashi; Chiba, Koji; Niino, Daisuke; Ohshima, Koichi

    2015-12-01

    There have been rare reported cases of peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) that co-expressed CD20. A 44-year-old Japanese male was initially misdiagnosed as CD20-positive diffuse large B-cell lymphoma with a background of reactive CD3-positive T-cells in the stomach. After four cycles of R-CHOP [rituximab plus cyclophosphamide (CY), doxorubicin, vincristine, and prednisolone (PSL)], total gastrectomy with regional lymph node dissection was performed due to the poor response to R-CHOP. A final diagnosis of CD20-positive primary gastric PTCL-NOS was made based on the immunohistochemical, flow cytometric, and molecular genetic findings. In the present case, CD20 immunostaining for T-cell lymphoma cells in tumor tissue varied; in a large part, these were strong to weak-positive, and in some parts, absent. We additionally reviewed the literature focusing on CD20-positive PTCL-NOS treated with rituximab. The administration of rituximab has been performed as an initial treatment in 11 cases, including the case reported here. The response was good in cases with high expression of CD20, while it was poor in cases with variable intensity in CD20 staining, which is consistent with our experience in the present case. The efficacy of rituximab may be associated with intensity of CD20 expression in T cells and its homogeneity in the tumor tissue. PMID:26251099

  5. 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...

  6. 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.

  7. 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. ...

  8. 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.

  9. 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.)

  10. 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

  11. Effects of rituximab in two patients with dysferlin-deficient muscular dystrophy

    Directory of Open Access Journals (Sweden)

    Porretti Laura

    2010-07-01

    Full Text Available Abstract Background The administration of rituximab (RTX in vivo results in B-cell depletion, but evidence for multiple mechanisms of action have been reported. Surprisingly, B cell depletion produced a response in patients with polymyositis, which is characterized as a T cell-mediated autoimmune disorder with biopsy findings similar to Miyoshi myopathy (MM. Indeed, in dysferlinopathies, there is evidence of immune system involvement including the presence of muscle inflammation and a down regulation of the complement inhibitory factor, CD55. Methods Two patients were treated with four weekly infusions of RTX 375 mg/m2. To measure the improvement in muscle strength after treatment, the isometric hand grip maximal voluntary contraction (MVC was measured by load cell four times during treatment, and again after one year. In order to assess the reproducibility of our grip assessment, we determined the hand MVC analysis in 16 healthy subjects. Moreover, we measured the number of B cells present in patients by flow cytometric analysis during the course of treatment. Results The analysis of B cell number during the course of treatment showed that CD20- and CD19-positive cells were depleted to 0-0.01%. The decrease in B cells was followed by an improvement in the mobility of the pelvic and shoulder girdles as shown by the MRC%. The MVC values of both patients began at values lower than normal whereas during treatment patients had improved percentage of muscle strength. The strength peak in both patients coincided with the minimum B cell values. There were no severe adverse events associated with an infusion of RTX. Conclusion We consider the increase in muscle strength observed in both treated patients to be a consequence of their treatment with RTX. To our knowledge, these are the first cases of increased muscle strength in patients with MM. Furthermore, the results of this study indicate that B cell depletion with RTX may be useful in the treatment

  12. 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

  13. De novo CD5+ diffuse large B-cell lymphoma: Adverse outcomes with and without stem cell transplantation in a large, multicenter, rituximab treated cohort.

    Science.gov (United States)

    Alinari, Lapo; Gru, Alejandro; Quinion, Carl; Huang, Ying; Lozanski, Arletta; Lozanski, Gerard; Poston, Jacqueline; Venkataraman, Girish; Oak, Eunhye; Kreisel, Friederike; Park, Steven I; Matthews, Stephanie; Abramson, Jeremy S; Iris Lim, Hana; Martin, Peter; Cohen, Jonathon B; Evens, Andrew; Al-Mansour, Zeina; Singavi, Arun; Fenske, Timothy S; Blum, Kristie A

    2016-06-01

    De novo CD5+ diffuse large B-cell lymphomas (DLBCL) are a distinct subgroup of DLBCL with poor prognosis. However the role of rituximab-containing therapy and salvage stem cell transplantation in this patients' population remain to be defined. We retrospectively reviewed clinical features and outcomes of 102 patients with de novo CD5+ DLBCL treated with rituximab-containing therapy at nine different institutions. By Hans' criteria, 64 patients had activated B-cell (ABC) subtype, 24 germinal center B-cell (GCB) subtype, and 14 were not evaluated. No patients had a myc translocation. Eighty-three patients were treated with rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP), 7 with rituximab, etoposide, cyclophosphamide, doxorubicin, vincristine, prednisone (R-EPOCH), and 6 with R-CHOP with methotrexate, 3 g/m(2) . The overall response rate to front-line therapy was 85%. The 3-year progression free survival (PFS) and overall survival (OS) for all patients were 40 and 65%, respectively. The 3-year PFS for ABC- and GCB-subtypes was 34 and 45%, respectively. The 3-year OS for ABC- and GCB-subtypes was 62 and 67%, respectively. The median time to second treatment failure was 3 months and 1 month for ABC- and GCB-subtypes, respectively. Twenty of 28 (71%) transplanted patients with autologous, allogeneic, or both, relapsed. This study confirms the poor prognosis of de novo CD5+ DLBCL in a large multi-center cohort despite initial rituximab-containing chemotherapy and suggests that stem cell transplantation fails to salvage the majority of these patients. Approaches to prevent recurrence and/or novel therapies for relapsed disease are needed for this subgroup of DLBCL patients. Am. J. Hematol. 91:395-399, 2016. © 2016 Wiley Periodicals, Inc. PMID:26800311

  14. 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)

  15. 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

  16. 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

  17. 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.

  18. 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.

  19. Multicenter Retrospective Analysis of the Effectiveness and Safety of Rituximab in Korean Patients with Refractory Systemic Lupus Erythematosus

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    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.

  20. 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.

  1. 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

  2. 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...

  3. 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

  4. Rituximab in combination with platinum-containing chemotherapy in patients with relapsed or primary refractory diffuse large B-cell lymphoma.

    Science.gov (United States)

    Bieker, Ralf; Kessler, Torsten; Berdel, Wolfgang E; Mesters, Rolf M

    2003-01-01

    The aim of the study was to evaluate the efficacy of a regimen consisting of rituximab and a platinum-containing chemotherapy with either Ifosfamide, Carboplatin and Etoposide (ICE) or Cisplatin, high-dose Ara-C and Dexamethasone (DHAP) in patients with relapsed or primary refractory diffuse large B-cell lymphoma. Ten patients with relapsed or primary refractory diffuse large B-cell lymphoma were treated from June 2000 until May 2001 with a platinum-containing chemotherapy regimen according to the ICE- or DHAP-protocol in combination with rituximab at the University of Muenster. Two cycles of ICE or DHAP and rituximab were given. In case of at least a minor response after 2 cycles, 2 additional cycles of the same combination were applied. Response rate, remission duration and duration of survival were evaluated. All 10 patients could be analysed with respect to these endpoints. No treatment related mortality was observed. The response rate (CR/PR) was 60% (10/50%). Twenty percent of the patients had progressive disease. The median duration of remission and survival was 3 and 3.5 months, respectively (range: 1-6 and 1-7 months, respectively), the survival rate was 10%. Eight of 10 patients died because of their underlying disease with short remission duration, 1 patient died of complications of allogeneic transplantation in CR. In conclusion, the combination of platinum-containing chemotherapy (ICE or DHAP) with rituximab demonstrates significant activity in intensively pretreated patients with relapsed or primary refractory diffuse large B-cell lymphoma. Considering the short duration of remission and survival, respectively, other experimental therapeutic approaches (e.g. allogeneic stem cell transplantation, radioimmunotherapy) should be pursued following this treatment in order to induce long-term remission. PMID:14534718

  5. 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.

  6. Overcoming bortezomib resistance in human B cells by anti-CD20/rituximab-mediated complement-dependent cytotoxicity and epoxyketone-based irreversible proteasome inhibitors

    Directory of Open Access Journals (Sweden)

    Verbrugge Sue Ellen

    2013-01-01

    Full Text Available Abstract Background In clinical and experimental settings, antibody-based anti-CD20/rituximab and small molecule proteasome inhibitor (PI bortezomib (BTZ treatment proved effective modalities for B cell depletion in lymphoproliferative disorders as well as autoimmune diseases. However, the chronic nature of these diseases requires either prolonged or re-treatment, often with acquired resistance as a consequence. Methods Here we studied the molecular basis of acquired resistance to BTZ in JY human B lymphoblastic cells following prolonged exposure to this drug and examined possibilities to overcome resistance by next generation PIs and anti-CD20/rituximab-mediated complement-dependent cytotoxicity (CDC. Results Characterization of BTZ-resistant JY/BTZ cells compared to parental JY/WT cells revealed the following features: (a 10–12 fold resistance to BTZ associated with the acquisition of a mutation in the PSMB5 gene (encoding the constitutive β5 proteasome subunit introducing an amino acid substitution (Met45Ile in the BTZ-binding pocket, (b a significant 2–4 fold increase in the mRNA and protein levels of the constitutive β5 proteasome subunit along with unaltered immunoproteasome expression, (c full sensitivity to the irreversible epoxyketone-based PIs carfilzomib and (to a lesser extent the immunoproteasome inhibitor ONX 0914. Finally, in association with impaired ubiquitination and attenuated breakdown of CD20, JY/BTZ cells harbored a net 3-fold increase in CD20 cell surface expression, which was functionally implicated in conferring a significantly increased anti-CD20/rituximab-mediated CDC. Conclusions These results demonstrate that acquired resistance to BTZ in B cells can be overcome by next generation PIs and by anti-CD20/rituximab-induced CDC, thereby paving the way for salvage therapy in BTZ-resistant disease.

  7. Positron Emission Tomography of (64)Cu-DOTA-Rituximab in a Transgenic Mouse Model Expressing Human CD20 for Clinical Translation to Image NHL

    DEFF Research Database (Denmark)

    Natarajan, Arutselvan; Gowrishankar, Gayatri; Nielsen, Carsten Haagen;

    2012-01-01

    PURPOSE: This study aims to evaluate (64)Cu-DOTA-rituximab (PETRIT) in a preclinical transgenic mouse model expressing human CD20 for potential clinical translation. PROCEDURES: (64)Cu was chelated to DOTA-rituximab. Multiple radiolabeling, quality assurance, and imaging experiments were performed....... The human CD20 antigen was expressed in B cells of transgenic mice (CD20TM). The mice groups studied were: (a) control (nude mice, n¿=¿3) that received 7.4 MBq/dose, (b) with pre-dose (CD20TM, n¿=¿6) received 2 mg/kg pre-dose of cold rituximab prior to PETRIT of 7.4 MBq/dose, and (c) without pre......-dose (CD20TM, n¿=¿6) PETRIT alone received 7.4 MBq/dose. Small animal PET was used to image mice at various time points (0, 1, 2, 4, 24, 48, and 72 h). The OLINDA/EXM software was used to determine the human equivalent dose for individual organs. RESULTS: PETRIT was obtained with a specific activity of 545...

  8. 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.

  9. 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

  10. 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.

  11. 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.

  12. 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)

  13. Long-term efficacy of rituximab in IgM anti-myelin-associated glycoprotein neuropathy: RIMAG follow-up study.

    Science.gov (United States)

    Iancu Ferfoglia, Ruxandra; Guimarães-Costa, Raquel; Viala, Karine; Musset, Lucile; Neil, Jean; Marin, Benoit; Léger, Jean-Marc

    2016-03-01

    The Rituximab vs. Placebo in Polyneuropathy Associated With Anti-MAG IgM Monoclonal Gammopathy (RIMAG) study showed no improvement using the inflammatory neuropathy cause and treatment sensory score (ISS) as primary outcome in patients with IgM anti-myelin-associated glycoprotein neuropathy (IgM anti-MAG neuropathy) treated with rituximab, when compared with placebo. However, some secondary outcomes seemed to improve in the per protocol analysis. Patients from one participating center in the RIMAG study underwent a new evaluation after a median follow-up of 6 (interquartile range (IQR) 4.9; 6.5) years, using the same outcome measures used in the original study. Data were recorded in seven rituximab patients (group 1) and in eight placebo patients (group 2). In group 2, six of eight patients received immunotherapy during follow-up, while only two of seven did in group 1. No significant change was observed in either the ISS or the secondary outcomes in both groups, with the exception of worsening in the 10-m walk time in group 2 (p = 0.016). The RIMAG follow-up study failed to find any significant change in most outcome measures in patients from the RIMAG study, some of them having received new immunotherapies. This study stresses the lack of useful clinical scales sensitive enough to capture small, even meaningful, improvement in IgM anti-MAG neuropathy. PMID:26748872

  14. 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.

  15. 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

  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. 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.)

  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. Targeting intratumoral B cells with rituximab in addition to CHOP in angioimmunoblastic T-cell lymphoma. A clinicobiological study of the GELA

    Science.gov (United States)

    Delfau-Larue, Marie-Hélène; de Leval, Laurence; Joly, Bertrand; Plonquet, Anne; Challine, Dominique; Parrens, Marie; Delmer, Alain; Salles, Gilles; Morschhauser, Franck; Delarue, Richard; Brice, Pauline; Bouabdallah, Reda; Casasnovas, Olivier; Tilly, Hervé; Gaulard, Philippe; Haioun, Corinne

    2012-01-01

    Background In angioimmunoblastic T-cell lymphoma, symptoms linked to B-lymphocyte activation are common, and variable numbers of CD20+ large B-blasts, often infected by Epstein-Barr virus, are found in tumor tissues. We postulated that the disruption of putative B-T interactions and/or depletion of the Epstein-Barr virus reservoir by an anti-CD20 monoclonal antibody (rituximab) could improve the clinical outcome produced by conventional chemotherapy. Design and Methods Twenty-five newly diagnosed patients were treated, in a phase II study, with eight cycles of rituximab + chemotherapy (R-CHOP21). Tumor infiltration, B-blasts and Epstein-Barr virus status in tumor tissue and peripheral blood were fully characterized at diagnosis and were correlated with clinical outcome. Results A complete response rate of 44% (95% CI, 24% to 65%) was observed. With a median follow-up of 24 months, the 2-year progression-free survival rate was 42% (95% CI, 22% to 61%) and overall survival rate was 62% (95% CI, 40% to 78%). The presence of Epstein-Barr virus DNA in peripheral blood mononuclear cells (14/21 patients) correlated with Epstein-Barr virus score in lymph nodes (P100 copy/μg DNA) was associated with shorter progression-free survival (P=0.06). Conclusions We report here the results of the first clinical trial targeting both the neoplastic T cells and the microenvironment-associated CD20+ B lymphocytes in angioimmunoblastic T-cell lymphoma, showing no clear benefit of adding rituximab to conventional chemotherapy. A strong relationship, not previously described, between circulating Epstein-Barr virus and circulating tumor cells is highlighted. PMID:22371178

  20. 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.

  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. SpeB proteolysis with imaged capillary isoelectric focusing for the characterization of domain-specific charge heterogeneities of reference and biosimilar Rituximab.

    Science.gov (United States)

    Zhang, Zichuan; Perrault, Ronel; Zhao, Yun; Ding, Julia

    2016-05-01

    The charge variations of therapeutic monoclonal antibody reveal important information of the post-translational modifications that may potentially impact the potency and safety of pharmaceutical products, especially during the evaluation of biosimilarity of therapeutic proteins. In this work, a novel SpeB-based proteolysis strategy coupling with imaged capillary isoelectric focusing was developed for the determination of domain-specific charge heterogeneities of innovator and generic Rituximab drug products from United States, European and Indian markets. It was observed that innovator Rituximab from the United States and Europe share highly similar peak distributions and charge heterogeneities with 26.2-26.6% Fc/2, 28.9-29.3% LC and 44.4-44.5% Fd peak areas detected, respectively, while multiple basic variations of Fc/2 and less acidic LC and Fd species were found from generic Rituximab from India with 20.9% Fc/2, 32.3% LC and 46.9% Fd peak areas detected. It was also demonstrated that structural changes caused by Carboxypeptidase B treatment and deamidation study at pH extremes could be sensitively captured with the established method, with the results further indicating that the generic product's basic variations of Fc/2 were un-cleaved Lysine residues, while the lack of certain acidic peaks on LC and Fd probably was due to the lower level of deamidation. This new strategy could become a useful tool to reveal domain-specific charge heterogeneities profiles of a variety of therapeutic monoclonal antibodies in regulated environments. PMID:27038651

  3. Predictors of Local Recurrence After Rituximab-Based Chemotherapy Alone in Stage III and IV Diffuse Large B-Cell Lymphoma: Guiding Decisions for Consolidative Radiation

    International Nuclear Information System (INIS)

    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

  4. 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 ...

  5. 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 ...

  6. 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...

  7. 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...

  8. The Effects of Rituximab on Lipids, Arterial Stiffness and Carotid Intima-Media Thickness in Rheumatoid Arthritis.

    Science.gov (United States)

    Novikova, Diana S; Popkova, Tatiana V; Lukina, Galina V; Luchikhina, Elena L; Karateev, Dmitry E; Volkov, Alexander V; Novikov, Alexander A; Aleksandrova, Elena N; Nasonov, Evgeny L

    2016-02-01

    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 < 0.05). There were not significant changes in lipid profile, AS parameters, and cIMT in group 2. Two infusions of RTX in case of moderate/good EULAR effect of therapy exerted favorable effects on lipid profile, AS and cIMT in women with RA without overt CVD. PMID:26839473

  9. Ultrasound-detected joint inflammation and B cell count: related variables for rituximab-treated RA patients?

    Science.gov (United States)

    Valor, Lara; Martínez-Estupiñán, Lina; Janta, Iustina; Nieto, Juan Carlos; Ovalles-Bonilla, Juan Gabriel; González-Fernández, Carlos; Del Rio, Tamara; Hernández-Flórez, Diana; Monteagudo, Indalecio; López-Longo, Francisco Javier; Naredo, Esperanza

    2016-06-01

    This cross-sectional observational study aimed to explore the relationship between B cell count and ultrasound (US)-detected synovitis, in patients with rheumatoid arthritis treated with rituximab. Thirty-seven consecutive RA patients treated with RTX were recruited for the study. The patients underwent clinical [i.e., Disease Activity Score 28 joints (DAS28)], laboratory, and US assessment of 12 joints. Each joint was semiquantitatively (0-3) scored on B-mode and power Doppler mode. The scores were summed, and a global index was created for BM (BMS) and PD scores (PDI) synovitis. BM subclinical synovitis was evident in all patients, with PD synovial signal detected in 16 patients (43.2 %). No correlation was found between DAS28 and US scores. B cells were detected in 27 (72.9 %) patients, but there was no association in the mean B cell count and disease activity as measured by DAS28 (DAS28  2.6 = 49.45, p = 0.52) and PDI score (PDI  1 = 35.44, p = 0.54). There was no correlation between the B cell count and DAS28, BMS, and PDI (r = 0.020, p = 0.907; r = -0.151, p = 0.371; r = -0.099, p = 0.558, respectively). In RTX-treated RA patients, no relationship could be established between US-detected synovitis and peripheral blood B cell count. PMID:27072348

  10. 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)

  11. Radiation Therapy in Primary Mediastinal B-Cell Lymphoma With Positron Emission Tomography Positivity After Rituximab Chemotherapy

    International Nuclear Information System (INIS)

    Purpose: To investigate the role of radiation therapy (RT) in patients affected with primary mediastinal B-cell lymphoma (PMBCL) with residual 18fluorodeoxyglucose positron emission tomography (18FDG-PET)-positive disease after rituximab chemotherapy (R-CT). Methods and Materials: Thirty-seven patients treated with R-CT and RT, all with 18FDG-PET scan at diagnosis and before RT, were included. All 18FDG-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 18FDG-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, P18FDG-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

  12. Histological analysis on adhesive molecules of renal intravascular large B cell lymphoma treated with CHOP chemotherapy and rituximab.

    Science.gov (United States)

    Kusaba, T; Hatta, T; Tanda, S; Kameyama, H; Tamagaki, K; Okigaki, M; Inaba, T; Shimazaki, C; Sasaki, S

    2006-03-01

    A 48-year-old man was admitted to our hospital for investigation of mild renal dysfunction. A blood examination revealed mild elevation of creatinine level (1.77 mg/dl). Urinary examination revealed mild protein excretion (0.54 g/day) and microhematuria; renal biopsy revealed the focal proliferation of large mononuclear cells with mitosis in glomerular capillaries. According to immunohistochemical analysis, the intravascular lymphomatous cells stained positively with anti-leukocyte common antigen (LCA: CD45) and CD20, indicating a B lymphocyte lineage. In electron microscopy, the glomerular capillary was filled with lymphoma cells and epithelial foot process fusion was noted. Immunohistochemical analysis on adhesive molecules revealed a lack of CD11a expression on lymphoma cells, but positive CD54 expression on endothelial cells. Systemic 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) revealed no abnormal uptake of isotopes. On the basis of these findings, we diagnosed intravascular diffuse large B cell lymphoma localized in the kidney. Despite treatment with rituximab and CHOP (prednisolone, doxorubicin, vincristine, cyclophosphamide) for 3 cycles at 1-month intervals, the renal dysfunction did not change. In histopathological analysis of the second biopsy, lymphoma cells disappeared, but focal segmental glomerulosclerosis and moderate interstitial fibrosis were noted. Electron microscopic findings revealed severe subendothelial edema with mesangial interposition, indicating severe endothelial damage. Epithelial foot process fusion was improved. These pathological analyses let us conclude that a lack of CD11a could be a candidate factor for prevention of the extravasation of lymphoma cells from blood vessels in our patient. We also presumed that the intraglomerular endothelial damage occurred due to chemotherapy-associated cell injury. PMID:16550755

  13. 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.

  14. Rituximab-conjugated and doxorubicin-loaded microbubbles combined with ultrasound irradiation inhibits proliferation and induces apoptosis in Raji cell lines.

    Science.gov (United States)

    Zhou, Shoubing; Zheng, Shiya; Shan, Yongfeng; Li, Lulu; Zhang, Xiu; Wang, Cailian

    2016-02-01

    Doxorubicin (DOX) is one of the most important medicines used for the treatment for B cell lymphoma, yet its clinical efficacy is often limited by severe adverse effects. Drug-loaded microbubbles, combined with ultrasound (US) irradiation, has shown great promise in reducing DOX-induced side effects and improving therapeutic efficacy. Nevertheless, these drug-loaded microbubbles are non-targeted microbubbles with comparatively suboptimal efficiency. Therefore, we synthesized targeted and DOX-loaded microbubbles (DMs), combined with US irradiation, for triggering drug release in lymphoma B cells. DMs were coated with rituximab via a biotin-avidin linkage to target Raji cells that overexpress the CD-20 antigen. In the present study, the cell viability after treatment with rituximab-conjugated DMs (RDMs) containing 0.25, 0.5 and 1.0 µg/ml DOX + US was 45.69±6.85, 25.31±2.60 and 15.67±2.83%, respectively, which demonstrated that RDMs + US produced significantly higher cytotoxicity than the other treatments. The early apoptosis ratio in the Raji cells at 48 h after the treatment was 32.4±2.84%, which was notably higher than the ratio in the other treatment groups. The results confirm the hypothesis that US-mediated targeting of CD-20-positive B cell lymphoma and the use of DMs may improve the DOX therapeutic efficiency. PMID:26718487

  15. 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.

  16. B cell depletion with rituximab in patients with rheumatoid arthritis: Multiplex bead array reveals the kinetics of IgG and IgA antibodies to citrullinated antigens.

    Science.gov (United States)

    Cambridge, Geraldine; Leandro, Maria J; Lahey, Lauren J; Fairhead, Thomas; Robinson, William H; Sokolove, Jeremy

    2016-06-01

    The serology of patients with Rheumatoid arthritis (RA) is characterized by persistently raised levels of autoantibodies: Rheumatoid Factors (RhF) against Fc of IgG, and to citrullinated (Cit) protein/peptide sequences: ACPA, recognizing multiple Cit-sequences. B cell depletion therapy based on rituximab delivers good clinical responses in RA patients, particularly in the seropositive group, with responses sometimes lasting beyond the phase of B cell reconstitution. In general, ACPA levels fall following rituximab, but fluctuations with respect to predicting relapse have proved disappointing. In order to identify possible immunodominant specificities within either IgG- or IgA-ACPA we used a Multiplex bead-based array consisting of 30 Cit-peptides/proteins and 22 corresponding native sequences. The kinetics of the serum ACPA response to individual specificities was measured at key points (Baseline, B cell depletion phase, Relapse) within an initial cycle of rituximab therapy in 16 consecutive patients with severe, active RA. All had achieved significant decreases in Disease Activity Scores-28 and maintained B cell depletion in the peripheral blood (<5 CD19+cells/μl) for at least 3 months. At Baseline, mean fluorescence intensity shown by individual IgG- and IgA-ACPA were strongly correlated (R(2) = 0.75; p < 0.0001) but IgA-ACPA were approximately 10-fold lower. Data were Z-normalised in order to compare serial results and antibody classes. At Baseline, a total of 68 IgG- and 51 IgA-ACPA had Z-scores ≥ 1 (above population mean) were identified, with at least one Cit-antigen identified in each serum. ACPA to individual specificities subsequently fluctuated with 3 different patterns. Most 51/68 (75%) IgG- and 48/51 IgA-ACPA (94%) fell between Baseline and Depletion, of which 57% IgG- and 65% IgA-ACPA rebounded pre-Relapse. Interestingly, 17/68 IgG-ACPA (25%) and some IgA-ACPA (3/51; 6%) transiently increased from Baseline, subsequently falling pre

  17. 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.

  18. 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

  19. 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.

  20. 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.

  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

    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

  2. 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)

  3. 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...

  4. Improvement of recurrent urticaria in a patient with Schnitzler syndrome associated with B-cell lymphoma with combination rituximab and radiotherapy.

    Science.gov (United States)

    Murota, Hiroyuki; Shoda, Yukiko; Ishibashi, Tomohiko; Sugahara, Hiroyuki; Matsumura, Itaru; Katayama, Ichiro

    2009-12-01

    Schnitzler syndrome is a rare condition defined by chronic urticaria, osteosclerotic bone lesions, and monoclonal IgM gammopathy. Schnitzler syndrome can precede the onset of a true lymphoproliferative disorder including Waldenström macroglobulinemia and rarely systemic marginal zone B-cell lymphoma. We describe a case of intractable chronic urticaria accompanied by a retroperitoneal neoplasm. IgM monoclonal gammopathy, lumber pain, intermittent fever, and elevation of C-reactive protein were the clues for the diagnosis of Schnitzler syndrome. An evaluation for malignancy using systemic computed tomography scan and fluorodeoxyglucose positron emission tomography revealed the retroperitoneal tumor, and a subsequent bone-marrow aspirate confirmed the diagnosis of B-cell lymphoma. Combined rituximab and radiotherapy ameliorated the skin symptoms. This case indicates that a detailed search for malignant neoplasms might be required for the long-term management of Schnitzler syndrome, and that B-cell lymphomas may contribute to the pathogenesis of this condition. PMID:19632739

  5. Prédicteurs d’infection chez de patients traités par rituximab pour des maladies autoimmunes y compris la polyarthrite rhumatoïde

    OpenAIRE

    Lazarou, Ilias

    2015-01-01

    Le rituximab (RTX) est de plus en plus utilisé chez les patients souffrant de polyarthrite rhumatoïde (PR) et autres maladies autoimmunes systémiques (MAS). Souvent sa prescription est reportée ou complètement évitée en cas de lymphopénie B. Cette étude rétrospective de 161 patients traités par du RTX pour PR et autres MAS dans les Hôpitaux Universitaires de Genève visait à investiguer si le compte des LyB avant le traitement est prédictif du risque d’infection ultérieure et à identifier les ...

  6. 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

  7. Preclinical Evaluation of 90Y Labelled Rituximab and ERIC-1: Two Antibodies for Tumour Therapy. Chapter 5

    International Nuclear Information System (INIS)

    The project described in this chapter focuses on harnessing the great potential of radionuclide therapy, using various vehicles to transport radionuclides into tumour tissues. The main aim of the project was to make specific vehicle molecules whose tumour affinity and suitability for radioactive coupling have been proven through laboratory trials on animals and cell cultures at the Department of Nuclear Medicine, University of Cologne, Germany, and to label them with 90Y. The vectors to transport radionuclides into tumour tissue for treatment were antibodies against lymphomas and neuroblastomas. Tumour pretargeting has shown clear advantages over the direct application of labelled antibodies with regard to tumour to background ratios. The pretargeting strategy would be first evaluated on cell cultures and the results then transferred to in vivo experiments on tumour bearing mice. Briefly, the first component of a three step pretargeting strategy would consist of the biotinylated antibody. This would include the protocol for determination of the number of biotin molecules per antibody. Using this technique, a stock of biotinylated antibody in lyophilized form can be built up, ready for further experiments. In the second step, commercially available avidin streptavidin would be used. The third and final step is the binding of radiolabelled (188Re, 90Y) biotin to the tumour cells through the avidin antibody bridge, after administration of a clearing agent. Initial evaluations of the potential radiopharmaceuticals have been carried out by in vitro experiments on cell lines expressing the corresponding antigen. The work done so far for the three step pretargeting method can be summarized as follows: —— Yttrium-90 labelling of biotin DOTA; —— Coupling of biotinylated rituximab to CD20 positive Raji cells; —— Successful labelling of cells conjugated with a complex of biotinylated antibody and avidin with 90Y DOTA biotin; —— First animal experiments with

  8. 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

  9. 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

  10. 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

  11. O rituximabe como uma opção para pacientes com vasculite sistêmica grave refratária à terapia convencional: relato de sete casos e revisão de literatura

    Directory of Open Access Journals (Sweden)

    Leonardo Sales da Silva

    2015-12-01

    Full Text Available 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, especialmente pacientes refratários ou intolerantes à terapia-padrão com ciclofosfamida e corticosteroides. O presente artigo traz o relato de sete casos de vasculites sistêmicas com tratamento bem-sucedido com rituximabe.

  12. 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

  13. Synergistic anti-tumor activity of acadesine (AICAR) in combination with the anti-CD20 monoclonal antibody rituximab in in vivo and in vitro models of mantle cell lymphoma.

    Science.gov (United States)

    Montraveta, Arnau; Xargay-Torrent, Sílvia; López-Guerra, Mónica; Rosich, Laia; Pérez-Galán, Patricia; Salaverria, Itziar; Beà, Silvia; Kalko, Susana G; de Frias, Mercè; Campàs, Clara; Roué, Gaël; Colomer, Dolors

    2014-02-15

    Mantle cell lymphoma (MCL) is considered one of the most challenging lymphoma, with limited responses to current therapies. Acadesine, a nucleoside analogue has shown antitumoral effects in different preclinical cancer models as well as in a recent phase I/II clinical trial conducted in patients with chronic lymphocytic leukemia. Here we observed that acadesine exerted a selective antitumoral activity in the majority of MCL cell lines and primary MCL samples, independently of adverse cytogenetic factors. Moreover, acadesine was highly synergistic, both in vitro and in vivo, with the anti-CD20 monoclonal antibody rituximab, commonly used in combination therapy for MCL. Gene expression profiling analysis in harvested tumors suggested that acadesine modulates immune response, actin cytoskeleton organization and metal binding, pointing out a substantial impact on metabolic processes by the nucleoside analog. Rituximab also induced changes on metal binding and immune responses.The combination of both drugs enhanced the gene signature corresponding to each single agent, showing an enrichment of genes involved in inflammation, metabolic stress, apoptosis and proliferation. These effects could be important as aberrant apoptotic and proinflammatory pathways play a significant role in the pathogenesis of MCL. In summary, our results suggest that acadesine exerts a cytotoxic effect in MCL in combination with rituximab, by decreasing the proliferative and survival signatures of the disease, thus supporting the clinical examination of this strategy in MCL patients. PMID:24519895

  14. 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

  15. Value of Surveillance Studies for Patients With Stage I to II Diffuse Large B-Cell Lymphoma in the Rituximab Era

    International Nuclear Information System (INIS)

    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

  16. 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

  17. 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

  18. 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)

  19. 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

  20. Dosimetric comparison fixed-individualized activity in the treatment of serious disease with I -131

    International Nuclear Information System (INIS)

    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)

  1. 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.)

  2. 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)

  3. Calibration of CDTN-whole body counter for in vivo measurements of I-131

    International Nuclear Information System (INIS)

    Iodine-131 is frequently used in nuclear medicine services for diagnosis and therapy of thyroid diseases. Furthermore, the Nuclear Technology Development Centre (CDTN/CNEN), in Belo Horizonte, uses Iodine-131 for radiobiology and radiopharmacy researches. The increasing use of this radionuclide for medical and research purposes as well as its high volatility creates a demand for feasible methodologies to perform occupational control of internal contamination. Therefore the objective this work is to develop methods of in vivo bioassay for evaluation Iodine-131 incorporation by using NaI(Tl) 6'' x 4'' scintillation detector of the CDTN-Whole Body Counter (WBC). Such detector was calibrated for in vivo measurements with a neck-thyroid phantom, simulating Iodine-131 incorporation. The chosen counting geometry was lying under monitoring bed of CDTNWBC. A methodology for bioassay data interpretation, based on standard ICRP 56 model was established with software AIDE (activity internal dose estimate) version 6.0. It was concluded that in vivo measurements have sufficient sensitivity for the monitoring of Iodine-131 through CDTN-Whole Body Counter. Therefore, the CDTN-Whole Body Counter equipment of Belo Horizonte are ready to attend suspicion intake cases of Iodine- 131 (author)

  4. Calibration of CDTN-whole body counter for in vivo measurements of I-131

    Energy Technology Data Exchange (ETDEWEB)

    Oliveira, Cassio M.; Silva, Tania V. da; Alonso, Thessa C.; Squair, Peterson L. [Centro de Desenvolvimento da Tecnologia Nuclear (CDTN-CNEN/MG), Belo Horizonte, MG (Brazil)], e-mail: cmo@cdtn.br

    2009-07-01

    Iodine-131 is frequently used in nuclear medicine services for diagnosis and therapy of thyroid diseases. Furthermore, the Nuclear Technology Development Centre (CDTN/CNEN), in Belo Horizonte, uses Iodine-131 for radiobiology and radiopharmacy researches. The increasing use of this radionuclide for medical and research purposes as well as its high volatility creates a demand for feasible methodologies to perform occupational control of internal contamination. Therefore the objective this work is to develop methods of in vivo bioassay for evaluation Iodine-131 incorporation by using NaI(Tl) 6'' x 4'' scintillation detector of the CDTN-Whole Body Counter (WBC). Such detector was calibrated for in vivo measurements with a neck-thyroid phantom, simulating Iodine-131 incorporation. The chosen counting geometry was lying under monitoring bed of CDTNWBC. A methodology for bioassay data interpretation, based on standard ICRP 56 model was established with software AIDE (activity internal dose estimate) version 6.0. It was concluded that in vivo measurements have sufficient sensitivity for the monitoring of Iodine-131 through CDTN-Whole Body Counter. Therefore, the CDTN-Whole Body Counter equipment of Belo Horizonte are ready to attend suspicion intake cases of Iodine- 131 (author)

  5. Iodine I-131 With or Without Selumetinib in Treating Patients With Recurrent or Metastatic Thyroid Cancer

    Science.gov (United States)

    2016-07-12

    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

  6. 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.

  7. Decontamination of radioactive P32 and I131 from aircraft and car surfaces by detergent compositions

    International Nuclear Information System (INIS)

    Sheets from aircrafts and cars having the same surfaces were contaminated with solutions of radioactive phosphorus salts and solutions of radioactive iodine salts. Different compositions from synthetic detergents and locally available complexing salts were prepared and their efficiencies in decontaminating the sheets were measured under the same conditions. The most effective compositions were those in which 'Berol Lanco' and 'Nestabon' were used. (orig.)

  8. 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

  9. 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)

  10. The measurement of gastro-intestinal protein loss by means of I131-labelled protein

    International Nuclear Information System (INIS)

    Measurement of gastrointestinal protein loss is one of the major problems in the investigation of both the normal physiological leakage of plasma protein into the gastrointestinal tract and the abnormal loss in protein losing gastro-enteropathies. Protein loss in the alimentary tract cannot be measured in the stools, because the lost protein is digested and broken down into amino-acids which are re-absorbed. This paper outlines a search for an ideal labelled protein. This ideal would behave like endogenous protein after intravenous injection, would be not-toxic, easy to detect and measure and after passage into the gastrointestinal tract retain its label completely unabsorbed so that it can be measured in the stools. Finally, after degradation, wherever that takes place, the protein label would not be able to pass from the blood to the gastrointestinal tract. 2 figs, 1 tab

  11. 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)

  12. Analysis of elevated I-131 samples observed in 2011 over Europe

    Czech Academy of Sciences Publication Activity Database

    Hofman, Radek; Tichý, Ondřej; Šindelářová, Kateřina

    Göttingen: European Geosciences Union, 2016. ISSN 1607-7962. [EGU General Assembly 2016. 18.04.2016-22.04.2016, Vienna] R&D Projects: GA MŠk(CZ) 7F14287 Institutional support: RVO:67985556 Keywords : inverse modeling * source term location * Bayesian methods Subject RIV: BB - Applied Statistics, Operational Research http://library.utia.cas.cz/separaty/2016/AS/tichy-0458898.pdf

  13. 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)

  14. Fixed dose of I-131 therapy for the treatment of Graves' hyperthyroidism

    International Nuclear Information System (INIS)

    Objectives: To evaluate short-term (6 month) efficacy of fixed-dose (555 MBq, 15 mCi) approach in the treatment of Graves' hyperthyroidism and analyze the relationship between clinical outcome (hyperthyroidism, hypothyroidism, and euthyroidism) and variances (patient age, thyroid weight, absorbed activity per gram of thyroid tissue, and radioactive iodine uptake value). Methods: 38 patients of Graves' hyperthyroidism were treated with 555MBq of radioactive iodine (in the form of capsule). Follow-up was done 3 and 6 months post therapy and the following clinical outcome was monitored: persistent hyperthyroidism, hypothyroidism, and euthyroidism. Statistical analysis was performed with SPSS software (version 11.5). P<0.05 was taken as indicating a statistically significant effect. Results: Of the 38 subjects, 14 (36.8%) were identified as euthyroidism, 18 (47.4%) hypothyroidism, and 6 (15.8%) hyperthyroidism. Cure rate (euthyroidism+hypothyroidism) was 84.2%. Statistical analysis revealed that there is a statistically significant difference of absorbed activity per gram of thyroid tissue and thyroid weight (F=17.639, P=0.000; F=28.453, P=0.000), but there is no statistically significant difference in terms of patient age and RAIU (F=1.375, P-0.266; F=2.453, P=0.101) among euthyroidism, hypothyroidism, and hyperthyroidism patients. Conclusion: We concluded that fixed-dose approach is very effective in the quickly restoration of thyroid function. There is a statistically significant difference of absorbed activity per gram of thyroid tissue and thyroid weight, but there is no statistically significant difference in terms of patient age and RAIU among euthyroidism, hypothyroidism, and hyperthyroidism patients. (authors)

  15. External dose measurements for patients receiving therapeutic I-131 for thyroid cancer

    International Nuclear Information System (INIS)

    Iodine-131 is a well established and effective treatment, supplementing surgery, in differentiated thyroid carcinoma. Iodine-131 except from its β-emission, that generates a cell-killing effect in a small area, has also a γ-emission irradiating distant tissues and even people who are close enough with the treated patient. The International Commission on Radiation Protection, ICRP has estimated the probability of a radiation-induced fatal cancer for the whole population at 5.0 % per sievert for low doses and at low dose rates and at 1.3 % for serious genetic diseases. For elderly people the probability seems to be 3 to 10 times lower, whereas for children up to the age of 10 years, 2-3 times higher. These findings led the ICRP to recommend new dose limits, lower than the previous ones. The European Union has endorsed the ICRP recommendations and the Council issued two directives, with which the Greek legislation complied recently. The current annual public dose limit is 1 mSv, while in the new Greek legislation the concept of dose constrains (0.5 m Sv in Greece) has also been proposed as a goal to reach whenever possible

  16. Ascorbic acid stabilization of Re-188- and I-131-radiolabeled peptides for radiotherapy

    International Nuclear Information System (INIS)

    Re-188 labeled RC-160 [ cyclic NH2-(D)-Phe-Cys-Tyr-(D)-Trp-Lys-Val-Cys-Trp-NH2 ] 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 188Re-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, 188Re-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 NH2-(D)-Phe-CysTyr-(D)-Trp-Orn-Thr-Pen-Thr-ol], a μ-opiod-receptor antagonist used as a negative control compound, was also determined in vitro and in vivo using NCI-H69 cells as targets. 188Re-RC-160 demonstrated a higher amount of net binding in vitro and in vivo compared to 188ReCTOP. (orig.)

  17. 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)

  18. 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)

  19. Use of Br-82 and I-131 radionuclides in studies of thyrotoxic effects of exogenous bromide

    Czech Academy of Sciences Publication Activity Database

    Pavelka, Stanislav

    Vol.3. Kolkata: Saha Institute of Nuclear Physics, 2010 - (Lahiri, S.; Maiti, M.; Das, S.), s. 342-344 ISSN 0973-256X. [Application of Radiotracers in Chemical, Environmental and Biological Sciences. Kolkata (IN), 07.11.2010-13.11.2010] R&D Projects: GA ČR(CZ) GA304/08/0256 Institutional research plan: CEZ:AV0Z50110509 Keywords : bromide * metabolism of iodine * thyrotoxic Subject RIV: FB - Endocrinology, Diabetology, Metabolism, Nutrition

  20. Use of Br-82 and I-131 radionuclides in studies of goitrogenic effects of exogenous bromide

    Czech Academy of Sciences Publication Activity Database

    Pavelka, Stanislav

    2012-01-01

    Roč. 291, č. 2 (2012), s. 379-383. ISSN 0236-5731 R&D Projects: GA ČR(CZ) GA304/08/0256 Institutional research plan: CEZ:AV0Z50110509 Keywords : bromide * goitrogenic effect * iodine radionuclides * thyroid hormone Subject RIV: ED - Physiology Impact factor: 1.467, year: 2012