Scanomed - Nukleráis medicina központok

Y-90 Zevalin therapy

The Y-90 Zevalin therapy is used to treat adult patients suffering from recrudescent or therapy-resistant B-cellular non-Hodgkin lymphoma (NHL) intravenously.
The therapy lasts for 8 days, it is ambulatory and during it the patient is given a radioactive substance (radioisotope) attached to the so called monoclonal antibody that bounds to immune cells. The administered dose is calculated based on the patient’s body weight.

The monoclonal antibody of Zevalin (ibritumomab) bounds to the CD20 antigen found on the surface of the affected and the normal, mature B-cells. During the therapy a radioisotope, called Yttrium-90 is used which is a clearly beta radiation isotope with a half-life of 64 hours. The yttrium-90 is attached to a monoclonal antibody (tiuxetan, with the help of a chelating agent) bounds to B-cells and administered in a proper dose it has a therapeutic effect.

As Zevalin only bounds to certain types of cells due to the above described mechanism, it has minimal side effects concerning other tissues and organs. This means that contrary to chemotherapy nausea, vomiting and hairfall very rarely occur. But – as we mentioned earlier – because the radiation affects the surrounding, normal and mature B-cells (this is what we call cross-fire effect) occurrence of systemic side effects cannot be excluded completely.
But at the same time this cross-fire effect has also its advantages. As this way the radiation reaches the poorly vascularized and massive tumors and the surrounding cells that do not have CD20 antigen on the surface.


Course of the treatment

The therapy lasts for 8 days.

Az On the first day the patient is given rituximab in intravenous infusion. This bounds to the circulating CD20-positive B-cells, decreases their number and improves the distribution of Zevalin and thus it reaches the abnormal cells easier. The patient is given a rituximab infusion on the 8th day as well which is followed by a Zevalin infusion within 4 hours That is administered in 10 minutes.

After administration of the injection the infusion may leak into the surrounding tissues. If you experience pain, burning or stabbing sensation at the site of the administration, you have to inform the physician or the assistant immediately.


Side effects

The most frequent haematological side effects are: reduced number of white blood cells, platelets and red blood cells. The alterations of the haemogram usually occur within 6-8 weeks after the therapy, they are usually manageable and it takes 2-3 weeks until the haemogram becomes normal.

Besides the above mentioned other side effects may also occur: weakness, abdominal and back pain, muscle and joint pain, short of breath, cough, shivering with cold, throat irritation, fecer, headache, nausea, vomiting, other gastrointestinal problems, dizziness, rashes, itching, purpuras and abnormal blood pressure.

After the therapy for about 6 months the IgM serum level of the patient may be lower temporarily.

After the therapy in case of a small number of patients HAMA or HACA antibody-production may be observed. These patients may experience allergic or hypersensitivity reactions to administration of murine or chimera antibodies.


The patient cannot get the therapy if:

  • is allergic to any ingredients of the preparation or to murine (mouse) proteins
  • is pregnant or breast-feeding
  • more than 1/4 of the bone marrow is affected
  • more than 1/4 of the bone marrow was externally radiated
  • the number of thrombocytes (platelets) is less than 100 thousand/mm3
  • the number of thrombocytes (platelets) is less than 150 thousand/mm3 after chemotherapy
  • the number of leukocytes (white blood cells) is less than 1500/mm3
  • having a bone marrow transplantation or being given haemopoietic stem cells

If the patient got other proteins earlier (mainly murine proteins) the incidence of a hypersensitivity reaction is higher. Because of this before starting the therapy examinations has to be done to detect these antibodies.

The therapy is not recommended for those whose disease affects the brain or the spinal cord as these patients are not involved in clinical trials.

Treating children and patients under the age of 18 is also not recommended because of lack of available information.


Necessary precautions

  • After the examination the patient does not have to be isolated.
  • Thorough hand wash is very important after using the toilet.
  • For couples right after the examination contraception is recommended, with use of condoms for a while.
  • Breast-feeding is prohibited during the therapy and within the following year it is not recommended.
  • If you take any other medication during the therapy, please inform your therapist about it.
  • In 12 weeks following the therapy performing a blood test is necessary weekly.
  • If you have to get a vaccine after the therapy you have to tell anyway that you got Zevalid therapy.
  • Zevalin contains maximum 28 mg sodium per dosage depending on the dose. This fact has to be considered in case of a low-sodium diet.