Learn About Follicular Lymphoma

At diagnosis, it’s important to understand that there are many different types of lymphoma. Knowing more about your specific type of lymphoma is the first step in planning treatment that’s right for you. Remember: ZEVALIN is not FDA-approved to treat all types of lymphoma. See which types of lymphoma ZEVALIN can treat and important safety information you should know about ZEVALIN >>

Key takeaways:

Lymphoma: the basics

Lymphoma is a general name for a range of cancers that develop in the lymphatic systemLymphatic system
The tissues and organs that produce, store, and carry white blood cells that fight infections and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes, and lymphatic vessels (a network of thin tubes that carry lymph and white blood cells). Lymphatic vessels branch, like blood vessels, into all the tissues of the body.
. The lymphatic system is a crucial part of the body’s immune system. Cells called lymphocytesLymphocytes
A type of immune cell that is made in the bone marrow and is found in the blood and in lymph tissue. The two main types of lymphocytes are B lymphocytes and T lymphocytes. B lymphocytes make antibodies, and T lymphocytes help kill tumor cells and help control immune responses. A lymphocyte is a type of white blood cell.
are major components of the immune system.1 Lymphocytes are white blood cellsWhite Blood Cells
A type of blood cell that is made in the bone marrow and found in the blood and lymph tissue. White blood cells are part of the body’s immune system. They help the body fight infection and other diseases. Types of white blood cells are granulocytes (neutrophils, eosinophils, and basophils), monocytes, and lymphocytes (T cells and B cells). Checking the number of white blood cells in the blood is usually part of a complete blood cell (CBC) test. It may be used to look for conditions such as infection, inflammation, allergies, and leukemia. Also called leukocyte and WBC.
that are made in the bone marrow. They are found in lymph nodesLymph Nodes
A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Lymph nodes filter lymph (lymphatic fluid), and they store lymphocytes (white blood cells). They are located along lymphatic vessels. Also called lymph gland.
and in the bloodstream circulating the body. 1,2

Types of Lymphoma

There are 3 types of lymphocytesLymphocyte
A type of immune cell that is made in the bone marrow and is found in the blood and in lymph tissue. The two main types of lymphocytes are B lymphocytes and T lymphocytes. B lymphocytes make antibodies, and T lymphocytes help kill tumor cells and help control immune responses. A lymphocyte is a type of white blood cell.
: B-cellsB-cells
A type of immune cell that is made in the bone marrow and is found in the blood and in lymph tissue. The two main types of lymphocytes are B lymphocytes and T lymphocytes. B lymphocytes make antibodies. A lymphocyte is a type of white blood cell.
, T-cellsT-cells
A type of immune cell that is made in the bone marrow and is found in the blood and in lymph tissue. The two main types of lymphocytes are B lymphocytes and T lymphocytes. B lymphocytes make antibodies. A lymphocyte is a type of white blood cell.
, and Natural Killer (NK) cellsNatural Killer (NK) cells
A type of immune cell that has granules (small particles) with enzymes that can kill tumor cells or cells infected with a virus. An NK cell is a type of white blood cell. Also called natural killer cell and NK-LGL.
. Each different type of lymphocyteLymphocyte
A type of immune cell that is made in the bone marrow and is found in the blood and in lymph tissue. The two main types of lymphocytes are B lymphocytes and T lymphocytes. B lymphocytes make antibodies, and T lymphocytes help kill tumor cells and help control immune responses. A lymphocyte is a type of white blood cell.
leads to a different type of lymphoma.1,2

Lymphoma types, by origin

Lymphoma types, by origin

Now that you understand what lymphoma means, let’s move on to the types of lymphoma

There are two major types of lymphoma: Hodgkin’s lymphoma and non-Hodgkin’s lymphoma (NHL)Non-Hodgkin’s Lymphoma
Any of a large group of cancers of lymphocytes (white blood cells). Non-Hodgkin lymphomas can occur at any age and are often marked by lymph nodes that are larger than normal, fever, and weight loss. Lymphomas that occur after bone marrow or stem cell transplantation are usually B-cell non-Hodgkin lymphomas. Prognosis and treatment depend on the stage and type of disease. Also called NHL.
. The main difference between Hodgkin’s lymphoma and non-Hodgkin’s lymphoma is the specific type of lymphocyte each involves:

  • Hodgkin’s lymphoma involves a specific type of abnormal cell called a Reed-Sternberg cell. If your doctor sees Reed-Sternberg cells when examining your lymphoma under a microscope, it will be classified as Hodgkin’s lymphoma.
  • Non-Hodgkin’s lymphoma is lymphoma that does not involve Reed-Sternberg cells.3

The difference between Hodgkin’s and non-Hodgkin’s lymphoma is important because the treatments for each are different. Follicular lymphoma is a type of non-Hodgkin’s lymphoma.

Non-Hodgkin’s lymphoma is the more common of the 2 lymphomas:

  • 90% of all cases of lymphoma are classified as non-Hodgkin’s lymphoma.4
  • An estimated 71,850 people will be diagnosed with non-Hodgkin’s lymphoma in the U.S. in 2015.5
  • As of 2014, an estimated 584,133 people are living with the disease or are in remission.6
  • In 2015, 19,790 people are expected to die from non-Hodgkin’s lymphoma.7

Types of Non-Hodgkin's Lymphoma

It’s important to know that non-Hodgkin’s lymphoma is not a single disease

There are 3 main types of non-Hodgkin’s lymphoma organized based on the type of lymphocytes they affect: B-cells, T-cells, or NK-cells.2

B-lymphocyte

B-lymphocytes: B-cell lymphomas affect B-lymphocytes. As a B-cell lymphoma, follicular lymphoma affects B-lymphocytes.

T-lymphocyte

T-lymphocytes: T-cell lymphomas affect T-lymphocytes.

NK lymphocyte

NK lymphocytes: NK-cell lymphomas affect NK (or natural killer) lymphocytes.

Types of lymphocytes

ZEVALIN is FDA-approved to treat follicular non-Hodgkin's lymphoma, a type of B-cell lymphoma that affects B-lymphocytes.

A majority of non-Hodgkin’s lymphomas arise from B-cells

B-cell lymphomas are the most common type of non-Hodgkin’s lymphoma, while NK lymphomas are the rarest:2 Diffuse large B-cell lymphoma (DLBCL) is the most common form of non-Hodgkin’s lymphoma, while follicular lymphoma is the second most common. Follicular lymphoma accounts for 22% of all new diagnoses (about 15,807 new cases in 2015).2,7

Non-Hodgkin’s lymphoma can also be classified based on how quickly the cancer is spreading:2,5

  • High-grade

    High-grade non-Hodgkin’s lymphomas spread quickly and aggressively.

  • Low-grade

    Low-grade non-Hodgkin’s lymphomas are slow growing, also known as indolent.

Remember that ZEVALIN is FDA-approved for the treatment of follicular non-Hodgkin's lymphoma, a type of low-grade lymphoma.

Follicular lymphoma is the most common type of slow-growing or indolent NHL.2,4

Next section: What is Follicular Lymphoma? >>

Indications and Usage

ZEVALIN® (ibritumomab tiuxetan) injection for intravenous use is a prescription medication that has three parts: two infusions of rituximab and one injection of Yttrium-90 (Y-90) ZEVALIN. Rituximab is used to reduce the number of B-cells in your blood and Y-90 ZEVALIN is given to treat your non-Hodgkin's lymphoma (NHL).

The ZEVALIN therapeutic regimen is used to treat patients with:

  • Low-grade or follicular B-cell NHL that has relapsed during or after treatment with other anticancer drugs.
  • Newly diagnosed follicular NHL following a response to initial anticancer therapy.

Patient Important Safety Information

What Is the Most Important Safety Information I Should Know About ZEVALIN Treatment?

The following section provides an overview of the most important safety information you should know about ZEVALIN, including side effects. Not all of the safety information about ZEVALIN treatment is included here. For complete safety information, please see the accompanying full prescribing information for ZEVALIN. Additional information may also be found on the ZEVALIN Website (www.ZEVALIN.com) or by speaking with your health care provider. Because ZEVALIN treatment includes the use of rituximab, please see the rituximab medication guide (www.rituxan.com).

WARNING: ZEVALIN TREATMENT CAN CAUSE SERIOUS SIDE EFFECTS:

  • Serious Infusion Reactions: Rituximab, alone or as part of the ZEVALIN treatment, may cause serious infusion reactions. Deaths have occurred within 24 hours of rituximab infusion, an important component of the ZEVALIN treatment. Tell your doctor or infusion nurse or get medical treatment right away if you develop fever or chills, a rash, itching, dizziness, swelling of your hands, feet or face, throat irritation or trouble breathing during or after receiving the ZEVALIN treatment.
  • Extended and Severe Decreases in Your Blood Counts (Cytopenias): Your doctor will monitor your blood counts after receiving the ZEVALIN treatment. Decreased blood counts can occur late and continue for more than 12 weeks after receiving ZEVALIN. Tell your doctor if you have a fever, feel too tired to do daily activities, feel weak, develop bruises or pinpoint red or purple spots on your skin, have unusual bleeding or notice blood in your urine or stool.
  • Severe Skin or Mucous Membrane Reactions: If you experience any reactions related to your skin or mucous membranes (e.g. mouth, nose), your infusion of rituximab and Y-90 ZEVALIN should be discontinued.

Dosing Warning: The dose of Y-90 ZEVALIN should not exceed 32.0 mCi (1184 MBq).

Additional Safety Information:

  • Risk of Developing Myelodysplastic Syndrome, Leukemia and Other Malignancies (Cancers): The radiation dose resulting from therapeutic exposure to Y-90 ZEVALIN may result in secondary malignancies.

    Myelodysplastic syndrome (MDS; a type of pre-cancerous bone marrow abnormality) and/or Acute Myelogenous Leukemia (AML, a type of cancer of the blood) were reported in 5.2% (11/211) of patients treated with Y-90 ZEVALIN for relapsed or refractory non-Hodgkin's lymphoma (NHL) in clinical studies, and 1.5% (8/535) of all patients included in the expanded-access trial, with median follow-up of 6.5 and 4.4 years, respectively. Among the 19 reported cases, the median time to diagnosis of MDS or AML was 1.9 years following the ZEVALIN therapy; however, the total incidence continues to increase.

    Among 204 newly diagnosed patients who received Y-90 ZEVALIN, following complete or partial response to initial anticancer therapy, 7 patients (3.4%) were diagnosed with MDS/AML after receiving ZEVALIN treatment, compared to one patient (0.5%, 1/205) in the control arm, with a median follow-up of 7.3 years. Deaths due to secondary new malignancies occurred in 8 (3.9%) patients treated with ZEVALIN compared to 3 (1.5%) patients in the control arm of the study. Deaths due to MDS or AML occurred in 5 (2.5%) patients treated with ZEVALIN compared to no patients in the control arm.

  • Infusion Site Leakage: ZEVALIN may leak from your vein or infusion site. Your doctor will monitor you during treatment and will stop the infusion and switch to another vein, if this occurs during treatment.
  • Immunization: Do not get a vaccine that contains live virus for at least 12 months following ZEVALIN treatment.
  • Precautions During and After Administration: Your doctor will discuss precautions with you to minimize radiation exposure.
  • Potential for Birth Defects: ZEVALIN therapy may cause harm to an unborn baby, please tell your doctor if you are pregnant or plan to become pregnant.
  • Reproductive Organs: There is a risk that ZEVALIN therapy will affect the male and female reproductive organs. Use birth control during treatment and for a minimum of 12 months following ZEVALIN therapy.
  • Nursing Mothers: Discontinue nursing during and after ZEVALIN treatment.
  • Adverse Reactions (Side Effects): The most common adverse reactions (≥10%) in clinical trials with ZEVALIN were: decreases in blood counts, tiredness, inflammation of the nose and upper throat, nausea (upset stomach), abdominal (stomach) pain, weakness, cough, diarrhea, and fever. The most serious adverse reactions of ZEVALIN are prolonged and severe reduction in the number of blood counts and secondary cancers.

    When administered following initial anticancer therapy, grade 3/4 adverse reactions of ZEVALIN include prolonged and severe decrease in blood counts (decrease in platelets [51%], decrease in neutrophils (a type of white blood cell) [41%], decrease in total white blood cells [36%], decrease in lymphocytes [18%], and decrease in red blood cells or hemoglobin [5%]), and secondary cancers (12.7%). Reductions in blood cells were more severe and more prolonged among 11 (5%) patients who received ZEVALIN after first-line fludarabine or a fludarabine-containing anticancer regimen as compared to patients receiving non-fludarabine-containing regimens. Grade 3/4 infections occurred in 8% of ZEVALIN-treated patients and in 2% of controls and included neutropenic sepsis (fever and infection due to decrease in the number of neutrophils [1%]), bronchitis, catheter sepsis (bacterial infection in the blood related to catheter), diverticulitis (inflammation in the intestines), shingles or blistering skin rash caused from herpes virus reactivation, flu, lower air passage infection, sinusitis (swelling of the sinuses), and upper air passage infection.

    Grade 3/4 adverse reactions of ZEVALIN in recurring NHL patients include prolonged and severe reduction of blood cells (decrease in platelets [63%], decrease in neutrophils [60%], decrease in red blood cells or hemoglobin [17%], and ecchymosis (small blue or purple patch on the skin or mucous membrane [<1%])) and secondary cancers (5.2%). Serious infections occurred in 3% of patients (urinary tract infection, febrile neutropenia, sepsis, pneumonia, cellulitis (type of skin infection), colitis (swelling of the large intestine), diarrhea, osteomyelitis (bone infection), and upper-air passage infection). Life-threatening infections were reported in 2% of patients (sepsis, empyema (collection of pus in a cavity in the body), pneumonia, febrile neutropenia, fever, and biliary stent-associated cholangitis (bile duct infection)).

Please click here to see the full Prescribing Information, including the BOXED WARNINGS, for ZEVALIN. Because ZEVALIN treatment includes the use of rituximab, please see the rituximab medication guide (www.rituxan.com).

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

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References:

1. Non-Hodgkin Lymphoma Overview. American Cancer Society Web site. http://www.cancer.org/acs/groups/cid/documents/webcontent/003067-pdf.pdf. Updated January 28, 2015. Accessed March 13, 2015.

2. Understanding Non-Hodgkin Lymphoma. Lymphoma Research Foundation Web site. http://www.lymphoma.org/atf/cf/%7Baaf3b4e5-2c43-404c-afe5-fd903c87b254%7D/LRF%20UNDERSTANDING%20NHL%20GUIDE2.PDF. Updated 2012. Accessed March 13, 2015.

3. Hodgkin Disease. American Cancer Society Web site. http://www.cancer.org/acs/groups/cid/documents/webcontent/003105-pdf.pdf. Updated January 13, 2015. Accessed March 13, 2015.

4. The Lymphoma Guide. Leukemia & Lymphoma Society Web site. https://www.lls.org/content/nationalcontent/resourcecenter/freeeducationmaterials/lymphoma/pdf/lymphomaguide.pdf. Published 2013. Accessed March 13, 2015.

5. Adult Non-Hodgkin Lymphoma Treatment (PDQ®). National Cancer Institute Web site. http://www.cancer.gov/cancertopics/pdq/treatment/adult-non-hodgkins/HealthProfessional/page1/AllPages/print. Updated February 13, 2015. Accessed March 13, 2015.

6. Facts 2014–2015. Leukemia & Lymphoma Society Web site. http://www.lls.org/content/nationalcontent/resourcecenter/freeeducationmaterials/generalcancer/pdf/facts.pdf. Published 2015. Accessed March 13, 2015.

7. Cancer Facts & Figures 2015. American Cancer Society Web site. http://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc-044552.pdf. Published 2015. Accessed March 13, 2015.