Hematologic side effects of radiolabeled immunoglobulin therapy

Radiolabeled immunoglobulin therapy (RIT) is a new cancer treatment that is more selective than its predecessors. Its dose-limiting normal tissue side effect is bone marrow toxicity, and hematopoietic stem cell damage appears to be its most significant mechanism. Platelet consumption in irradiated normal liver tissues and apoptosis of circulating peripheral blood lymphocytes are other, less important, hematologic side effects. ¹³¹I and ⁹⁰Y are the radioisotopes most commonly used for RIT; in addition, animal toxicology and initial clinical studies of chelate immunoglobulins radiolabeled with ¹¹¹In (for diagnosis) or ⁹⁰Y (for therapy) are reviewed. The bone-seeking properties of free ⁹⁰Y are not considered to be a major component of the hematologic damage caused by yttrium-labeled immunoglobulins. The microenvironment of the bone marrow system is not significantly damaged by current RIT protocols. Moreover, granulocyte colony-stimulating factor (G-CSF) can open the blood-marrow barrier. Bone marrow toxicity after RIT can be corrected by bone marrow transplantation, growth factors, blood products, or fractionation of RIT. Selection of the appropriate corrective regimen depends on the severity of the bone marrow damage and will further enhance the therapeutic ratio of RIT.