Ibritumomab (Zevalin)

Ibritumumab is a type of monoclonal antibody. Monoclonal antibodies are a type of biological therapy. It is also called 90Y ibritumomab tiuxetan (pronounced ib-ri-too-mow-mab tux-ee-tan). Its brand name is Zevalin. It is a treatment for follicular B cell non Hodgkins lymphoma (NHL).

You may have this treatment in the following situations

• If you have had rituximab on its own and it hasn’t worked
• If your NHL has come back after it was first treated
• As a maintenance treatment for follicular lymphoma that is in remission after the first course of chemotherapy
• As part of a clinical trial

Ibritumomab has a radioactive substance called yttrium (pronounced it-tree-um) attached to it. It targets a protein called CD20. Fully developed B lymphocytes, including B lymphoma cells, have this CD20 protein on their surface. The ibritumomab sticks to all the CD20 protein it finds and delivers the radiation to these cells, which then die. Because the treatment targets B cells, you only need to have a small amount of radioactive substance with each treatment. So you have fewer side effects than with standard radiotherapy.

Early B cells don’t have the CD20 protein and are not killed. This means they can produce more B cells to replace those that die. So you have a normal number of healthy B cells in the body within a few months of treatment.

You have ibritumomab through a drip into a vein (infusion). You may have it into a thin, short tube (a cannula) put into a vein in your arm. Or you may have it through a central line, a PICC line or a portacath. These lines give the drug into a major vein in the chest. 

The treatment schedule for lymphoma means that you have a dose of rituximab the first week. The following week you have another dose of rituximab followed by the ibritumomab. You have it over 10 minutes. You only have one dose.

The side effects associated with ibritumomab are listed below. You can find general information in our cancer drug side effects section. There is information about rituximab in our individual cancer drugs section.

After your treatment, you have a small amount of radioactive substance in your bodily fluids including your urine, stools, saliva, sperm and possibly vaginal fluids. This lasts for about a week after treatment. You should wash your hands carefully after going to the toilet and clear up any spills. You, or your partner, should also wear a condom during sex.

More than 10 in every 100 people have one or more of the side effects listed below.

Temporary drop in the number of blood cells made by the bone marrow, causing

• Increased risk of infection due to a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery
• Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
• Bruising easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. You should contact your hospital if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• Flu like symptoms, including fever and chills – taking paracetamol can help
• Feeling sick and occasionally being sick – this is usually well controlled with anti sickness medicines
• Feeling weak
• Loss of fertility – we don’t yet know exactly what effect ibritumomab may have on your fertility, so do talk to your doctor before starting treatment if having a baby is important to you
• Ibritumomab may have a harmful effect on a developing baby, so talk about contraception with your doctor or nurse before having the treatment and continue to use it for 12 months after treatment
• You should not breastfeed after having this drug as it may come through in the breast milk

Between 1 and 10 in every 100 people have one or more of these.

• Diarrhoea is usually mild but do tell your doctor or nurse as you can have medicines to control it
• Indigestion
• Abdominal pain and aching muscles, bones or joints
• A rash, which may be itchy
• Sweating
• A reaction to ibritumomab during infusion, causing flu like symptoms such as a fever, chills and shivering (rigors), a headache and feeling sick. Your doctor or nurse will give you medicines beforehand to try to prevent a reaction. If you have one, your nurse will slow or stop your drip for a while. Rarely some people have a more severe reaction, with wheezing, an itchy rash and a drop in blood pressure.
• Loss of appetite
• Dizziness
• A cough

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

• How many times you've had the drug before
• Your general health
• The amount of the drug you have (the dose)
• Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. Your specialist, clinic or ward nurse should give you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies – some drugs can react together.

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.