From Indranil Mallick, M.D.,
Your Guide to Lymphoma.
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About.com Health's Disease and Condition content is reviewed by V.K. Gadi, MD

What is Zevalin?

Zevalin is a type of radioimmunotherapy drug that's used for some types of non-Hodgkin lymphoma (NHL). Radioimmunotherapy is a special treatment that combines monoclonal antibody treatment and radiation therapy to kill cancer cells.

How Zevalin Works

Zevalin is also called Ibritumomab Tiuxetan. It has two parts:

• Ibritumomab – a monoclonal antibody that recognizes a special molecule called CD20 on the surface of lymphoma cells.
• Tiuxetan – a special molecule that acts as a binding site for a radioactive isotope (Yttrium 90 or Indium 111).

The monoclonal antibody portion of Zevalin recognizes the CD20 antigen on the surface of cancer cells. It binds to the molecule and the radiation emitted from the radioactive isotope damages the DNA in the cancer cells and kills them.

When Is Zevalin Used?

Zevalin is approved by the FDA for used in patients with follicular lymphoma whose disease has come back, or who have persistent disease after initial treatment. Those individuals whose slow growing follicular lymphoma has turned into an aggressive B-cell NHL can also be treated with Zevalin. Those who have previously been treated with Rituximab (another monoclonal antibody) also may receive Zevalin.

Zevalin is being studied for different stages of lymphoma, even as initial treatment. (Find more information on clinical trials with Zevalin in the US.)

How Effective Is Zevalin?

When used in patients who have relapsed after previous treatment in follicular lymphoma, or not responded well to standard treatment, Zevalin has shown a response in nearly 75% of cases. It is able to control the disease for 6 months or more. When compared to Rituximab treatment in patients, the Zevalin regimen produces substantially higher responses and also controls the disease for a longer time.

How is Zevalin Given?

Zevalin is given as an injection in the veins. It is usually administered along with Rituximab as the "Zevalin therapeutic regimen." This regimen has 2 steps:

• Step 1 includes a single infusion of Rituximab followed by an injection of Zevalin. A gamma scan (a special type of scan) is done after a couple of days to make sure that the drug has reached the correct areas of the body.
• If the gamma scan is fine, step 2 is administered 7 to 9 days later and consists of a second infusion of Rituximab and Zevalin.

Side Effects of Zevalin

The most important side effect of Zevalin is a decrease in white blood cell (WBC) and platelet counts. Low WBC counts increase the risk of getting infections. Low platelet counts can cause bleeding from some parts of the body. Nearly 60% patients may have a significant fall in blood counts.

Rituximab, a drug that is used as a part of the Zevalin therapeutic regimen, is known to cause allergic reactions. Many patients have allergic reactions, though the majority are mild in nature. See Allergic Reactions to Rituximab for more details.

Rarely, a severe skin reaction may occur with the Zevalin regimen. Only a few cases have been reported, though it can be quite serious if it occurs.

Mild nausea and vomiting, tiredness or chills and fever also may occur but are temporary and easily treated.

Precautions with Zevalin

Zevalin should only be given by doctors at hospitals that are allowed to use radioactive isotopes. This is because special precautions need to be taken to handle these radioactive compounds before they are given.

Precautions also must be taken to prevent and deal with allergic reactions to Rituximab. A patient may be asked to take some medications beforehand to minimize allergy.

Blood counts are monitored carefully after the treatment.

Zevalin may cause damage to the testes and ovaries –- the organs of reproduction. Fertility may be impaired, and all individuals are asked to use contraceptives during treatment and for one year after to lower the risk of birth defects.