Adult Dosing
Relapsed or refractory, low-grade or follicular B-cell non-Hodgkin's lymphoma
Day 1
- 5.0 mCi (1.6 mg total antibody dose) of indium-111 ibritumomab IV, preceded by rituximab 250 mg/m2 within 4 hrs
Day 2 to 6
- Assess biodistribution by a required scan 48-72 hours after indium-111 ibritumomab
Day 7,8 or 9
- If biodistribution is acceptable. 0.4 mCi/kg of yttrium-90 ibritumomab IV, preceded by rituximab 250 mg/m2 within 4 hrs
Premedicate
- Premedicate with acetaminophen 650 mg and diphenhydramine 50 mg PO
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
See Supplemental Patient Information
- Serious/fatal infusion reactions may occur within 24 hours of rituximab infusion. Incidences of prolonged and severe cytopenias, severe cutaneous and mucocutaneous reactions have also been reported [US Black Box Warning]
- Avoid administration in patients with altered biodistribution. Do not exceed dose to 32 mCi (1184 MBq) [US Black Box Warning]
- Immediately stop and permanently discontinue rituximab and ibritumomab if serious infusion reactions occur
- Events of prolonged and severe cytopenias have been reported in most of the patients treated with ibritumomab. Do not administer drug in patients with
25% lymphoma marrow involvement and/or impaired bone marrow reserve - Discontinue rituximab or ibritumomab infusions if patients develop severe cutaneous or mucocutaneous reactions
- Risk of developing acute myelogenous leukemia and myelodysplastic syndrome have been reported with the administration of therapy
- If administered during pregnancy, therapy may cause embryo-fetal toxicity
- Closely monitor patients for extravasation and discontinue therapy if it occurs. Reinstitute therapy in another limb
- Do not administer live viral vaccines to patients who recently received the therapy because the safety of immunization with live viral vaccines following therapy has not been studied
- Obtain complete blood counts (CBC) and platelet counts at least weekly following the therapy
Cautions: Use cautiously in
- Murine protein exposure history
- Concomitant drugs that alter platelet function or coagulation
Supplemental Patient Information
- Radiation precautions for 3 days following administration should be done. Wash hands thoroughly and clean up spilled body fluid contaminated material.
- Should use condoms for 1 week following administration
Pregnancy Category:D
Breastfeeding: Safety unknown. Due to the potential for serious adverse reactions in nursing infants, manufacturer recommends discontinuation of nursing or discontinuation of drug, taking into account the importance of the drug to the mother.
