A phase I study of ⁹⁰Y-2IT-BAD-Lym-1 in patients with non-Hodgkin's lymphoma

BACKGROUND: Prior clinical trials proved that all histologic grades of chemotherapy-resistant B-cell non-Hodgkin's lymphoma (NHL) could respond to radio-immunotherapy (RIT) with ¹³¹I-Lym- 1 and ⁶⁷Cu-2IT-BAT-Lym-1. This Phase I study was conducted to determine the safety and maximum tolerated dose (MTD) of ⁹⁰Y-2IT-BAD-Lym-1. Methods: Lym-1 is a mouse monoclonal antibody that preferentially targets malignant B-lymphocytes. ⁹⁰Y has β emissions suitable for therapy but no gamma emissions, therefore, ¹¹¹In-2IT-BAD-Lym-1 is used for imaging. The macrocyclic chelator, DOTA, bound ⁹⁰Y tightly to form a stable drug. Patients with chemotherapy-resistant NHL received ⁹⁰Y-2IT-BAD-Lym-1 at administered doses of: 0.185, 0.278, or 0.370 GBq/m². Results. Myelotoxicity, especially thrombocytopenia, was dose-limiting. No significant non-hematologic toxicity occurred. Human anti-mouse antibody (HAMA) developed in 3/8 patients. The mean radiation dose to the 33 imaged tumors was 7.0 Gy/GBq. Lung, kidney and liver received mean radiation doses of 1.3, 2.4, and 6.4 Gy/GBq, respectively from ⁹⁰Y-2IT-BAD-Lym-1. The tumor: body and tumor:bone marrow (by imaging) ratios were 16.4:1 and 5.8:1, respectively. In this Phase I study, 5/8 patients that failed prior chemotherapy had a partial response or stabilization of NHL after RIT. Conclusion: The safety and toxicity of ⁹⁰Y-2IT-BAD- Lym-1 were determined and the MTD was 0.370 GBq/m² a dose used in 4 patients. ⁹⁰Y-2IT-BAD- Lym-1 may be useful for future clinical trials because ⁹⁰Y is readily available and can deliver potent β emissions to NHL. Bone marrow support however, will be required for further dose escalation.