Treatment of leukemia with radiolabeled monoclonal antibodies.
Review
Overview
abstract
In contrast to radioimmunotherapy of solid disease, wherein the primary obstacle to success is access of radiolabeled antibody to antigen-positive cells, in the treatment of leukemia delivering a lethal absorbed dose to the isolated cell appears to be the primary obstacle. The isolated cell is defined as one that is exposed only to self-irradiation (from internalized or surface-bound radiolabeled antibody) and to irradiation from free antibody in the blood. It is isolated in the sense that the particulate (beta, electron, alpha) emissions from its nearest neighboring antigen-positive cell do not contribute to its absorbed dose. Disease in the bone marrow and other tissues, since it is confined to a smaller volume, is more easily eradicated because the absorbed dose to a given cell nucleus is enhanced by emissions from adjacent cells (a smaller fraction of the emission energy is 'wasted'). The optimization simulations presented above for the M195 antibody suggest that the optimum dose of antibody that should be administered is that required to yield a concentration within the distribution volume of the antibody that is approximately equal to the concentration of antigen sites as determined by the tumor burden. Although not specifically considered in the modeling example presented above, antibody internalization and catabolism may be expected to play an important role in radioimmunotherapy treatment planning of leukemia. Depending upon the kinetics of internalization and catabolism, the absorbed dose to the red marrow and to antigen-positive cells may be reduced considerably, since catabolism, assuming that it is followed by rapid extrusion of the radioactive label, would decrease the cells' exposure time considerably. The recently demonstrated effectiveness of radioimmunotherapy in certain cases of B-cell lymphoma and in reducing tumor burden in acute myelogenous leukemia suggests that radioimmunotherapy is beginning to fulfill the promise held when it was initially conceived. The long delay in achieving reproducible success has, in large part, been the result of the conceptual simplicity of using agents that specifically 'target' tumor cells and they may thus selectively deliver cytotoxic agents. Emboldened by this apparent simplicity, early trials of radioimmunotherapy failed to consider the many variables involved in its implementation. As has been recently demonstrated using mathematical models of antibody delivery to solid tumor, chief among these may have been the failure to select the appropriate tumor type. By significantly reducing the problems associated with antibody delivery, hematopoietic malignancies offer the optimum conditions for successful radioimmunotherapy. As evinced by the wide range of antibody and radioactivity doses administered in the B-cell lymphoma trials, the case-specific nature of radioimmunotherapy requires an understanding of the relationship between the various input parameters and patient response. The complexity and interrelationship of these parameters precludes an experimental trial-and-error approach to their optimization. A stepwise approach to radioimmunotherapy treatment planning is proposed in which a model of antibody kinetics is developed and validated.(ABSTRACT TRUNCATED AT 400 WORDS)
