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regimen-monograph
IBRI
A - Regimen Name
IBRI Regimen
Ibritumomab
Disease Site
Hematologic - Lymphoma - Non-Hodgkin's Low Grade
Intent
Palliative
Regimen Category
Standard : Standard therapy endorsed by the Disease Site Group or a regimen widely used by most Regional Cancer Centres in this disease site. The category is unrelated to the source or availability of funding.
Rationale and Uses
For the treatment of patients with relapsed or refractory low-grade or follicular, CD20 positive, B-cell non-Hodgkin's lymphoma (NHL), including patients with rituximab-refractory follicular non-Hodgkin’s lymphoma (Health Canada indication)
B - Drug Regimen
Step 1:
| riTUXimab | 250 mg /m² | IV ^ | Day 1 |
|
(^begin @ 50mg/hr, escalate every 30 minutes to max 400mg/hr) Step 2: |
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| riTUXimab | 250 mg /m² | IV * | Day 8 <u>or</u> 9 <u>or</u> 10 |
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(*if no reaction on day 1, begin @ 100mg/hr, escalate every 30 minutes to max 400mg/hr)
Followed within 4 hours by: |
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| ibritumomab tiuxetan | |||
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0.4 mCi/kg (15 MBq/kg)** IV push over 10 minutes*** Day 8 or 9 or 10 (**maximum dose is 32mCi (1200 MBq) regardless of body weight) |
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Radiopharmaceutical: Refer to the product monograph for complete dosing, preparation and administration information
D - Premedication and Supportive Measures
Antiemetic Regimen:
Minimal (infusion related events)
Other Supportive Care:
- Rituximab premedication:
- Acetaminophen 650mg po
- Diphenhydramine 50mg po
E - Dose Modifications
Refer to protocol by which patient is being treated. Do not use with other forms of irradiation. Do not treat if ANC < 1.5 x 109/L or platelets < 100 x 109/L, or in patients with failed stem cell collections or hypocellular marrows (including marrow infiltration ≥ 25%). Growth factors such as G-CSF should not be used 3 weeks before or 2 weeks after 90Y-ibritumomab.
This is a radiopharmaceutical: Full details of the prescribing and dosing recommendations are beyond the scope of this monograph and only a brief summary is provided; please consult the Product Monograph.
Doses should be modified for baseline thrombocytopenia as follows:
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Baseline Platelet Count (x 109/L)
|
90Y-ibritumomab dose |
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100 to 149
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0.3 mCi/kg (11 MBq/kg)
|
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<100
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Do not administer
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Dosage with toxicity
Ibritumomab tiuxetan (and rituximab) should be permanently discontinued in patients with severe mucocutaneous or hypersensitivity reactions.
Hepatic Impairment
No information found
Renal Impairment
No information found
F - Adverse Effects
Refer to riTUXimab, ibritumomab drug monograph(s) for additional details of adverse effects
| Most Common Side Effects | Less Common Side Effects, but may be |
|
|
H - Drug Administration and Special Precautions
Refer to riTUXimab, ibritumomab drug monograph(s) for additional details
I - Recommended Clinical Monitoring
Recommended Clinical Monitoring
- CBC and platelet counts; weekly until recovery and more frequently in patients who develop severe cytopenias, who are on antiplatelet drugs or are at risk of bleeding, or as clinically indicated
- Careful monitoring and management of cytopenias and their complications for up to three months after use of the ibritumomab tiuxetan therapeutic regimen
- Liver function tests; baseline and regular
- Hepatitis B screening; prior to treatment especially in high-risk patients; carriers of hepatitis B should be closely monitored for up to 12 months after the last rituximab infusion
- Renal function tests; baseline and regular
- Patients who have had prior exposure to murine proteins (murine or chimeric antibodies) should be screened for HAMA/HACA prior to treatment and may be at increased risk for hypersensitivity reactions
- Monitor for infusion-related or allergic reactions, infection, GI, hepatic, skin, bleeding, cardiac and pulmonary toxicity
- Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for Adverse Events) version
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K - References
Wiseman G, Gordon LI Multani P, et al. Ibritumomab tiuxetan radioimmunotherapy for patients with relapsed or refractory non-Hodgkin’s lymphoma and mild thrombocytopenia: a phase II multicenter trial. Blood 2002;99(12):4336-42.
Witzig T, Gordon L, Cabanillas R, Czuczman M, et al. Randomized controlled trial of Yttrium-90 – labeled ibritumomab tiuxetan radioimmunotherapy versus rituximab immunotherapy for patients with relapsed or refractory low-grade, follicular, or transformed B-cell non-Hodgkin’s lymphoma. J Clin Oncol 2002;20(10):2453-63.
Witzig T, Flinn I, Gordon L, et al. Treatment with ibritumomab tiuxetan radioimmunotherapy in patients with rituximab refractory follicular non-Hodgkin’s lymphoma. J Clin Oncol 2002;20(15):3262-9.
Witzig TE, White CA, Gordon LI, et al. Safety of yttrium-90 ibritumomab tiuxetan radioimmunotherapy for relapsed low-grade, follicular, or transformed non-Hodgkin's lymphoma. J Clin Oncol 2003;21(7):1263-70.
Witzig TE, White CA, Wiseman GA, Gordon LI, Emmanouilides C, Raubitschek A, et al. Phase I/II trial of IDEC-Y2B8 radioimmunotherapy for treatment of relapsed or refractory CD20(+) B-cell non-Hodgkin's lymphoma. J Clin Oncol 1999;17(12):3793-803.
October 2017 Removed archived PEBC link
M - Disclaimer
Regimen Abstracts
A Regimen Abstract is an abbreviated version of a Regimen Monograph and contains only top level information on usage, dosing, schedule, cycle length and special notes (if available). It is intended for healthcare providers and is to be used for informational purposes only. It is not intended to constitute or be a substitute for medical advice, and all uses of the Regimen Abstract are subject to clinical judgment. Such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability, and Cancer Care Ontario disclaims all liability for the use of this information, and for any claims, actions, demands or suits that arise from such use.
Information in regimen abstracts is accurate to the extent of the ST-QBP regimen master listings, and has not undergone the full review process of a regimen monograph. Full regimen monographs will be published for each ST-QBP regimen as they are developed.
Regimen Monographs
Refer to the New Drug Funding Program or Ontario Public Drug Programs websites for the most up-to-date public funding information.
The information set out in the drug monographs, regimen monographs, appendices and symptom management information (for health professionals) contained in the Drug Formulary (the "Formulary") is intended for healthcare providers and is to be used for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects of a particular drug, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for a given condition. The information in the Formulary is not intended to constitute or be a substitute for medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.
The format and content of the drug monographs, regimen monographs, appendices and symptom management information contained in the Formulary will change as they are reviewed and revised on a periodic basis. The date of last revision will be visible on each page of the monograph and regimen. Since standards of usage are constantly evolving, it is advised that the Formulary not be used as the sole source of information. It is strongly recommended that original references or product monograph be consulted prior to using a chemotherapy regimen for the first time.
Some Formulary documents, such as the medication information sheets, regimen information sheets and symptom management information (for patients), are intended for patients. Patients should always consult with their healthcare provider if they have questions regarding any information set out in the Formulary documents.
While care has been taken in the preparation of the information contained in the Formulary, such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability.
CCO and the Formulary’s content providers shall have no liability, whether direct, indirect, consequential, contingent, special, or incidental, related to or arising from the information in the Formulary or its use thereof, whether based on breach of contract or tort (including negligence), and even if advised of the possibility thereof. Anyone using the information in the Formulary does so at his or her own risk, and by using such information, agrees to indemnify CCO and its content providers from any and all liability, loss, damages, costs and expenses (including legal fees and expenses) arising from such person’s use of the information in the Formulary.
Last Updated: July 21, 2026
