Most patients with lymphoid malignancies have a wide variety of therapeutic options available, thus, the resulting challenge of determining the appropriateness of using RIT for a given patient. This decision is to be carefully considered and a hematologist or medical oncologist should be involved to place this decision in its clinical context. At the present time, there are only two Food and Drug Administration (FDA)-approved radioimmunoconjugates in the United States, Y-90-ibritumomab-tiuxetan (Zevalin®) and I-131-tositumomab (Bexxar®). These are most appropriate for patients with relapsed or refractory low-grade or follicular lymphoma expressing CD20. It is also required that patients have less than 25% bone marrow involvement by bilateral bone marrow biopsy, a platelet count greater than 100,000/mL, and a neutrophil count greater than 1500/mL. Treatment alternatives to RIT include standard chemotherapy, unlabeled antibody therapy, external beam radiation, and high-dose therapy approaches and stem cell transplantation.
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