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Macmillan and Cancerbackup merged in 2008. Together we provide free, high quality information for people affected by cancer through our publications, website and phone service. Find out more|.
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This information is about 90Y-Ibritumomab tiuxetan, which is also known as Zevalin®. It is used to treat people with a type of non‑Hodgkin lymphoma| called follicular lymphoma|. Zevalin may also be used to treat other types of cancer| as part of a research trial|.
Zevalin belongs to a group of cancer drugs known as monoclonal antibodies|.
Monoclonal antibodies recognise and lock on to specific proteins on the surface of cancer cells. This helps the body's immune system recognise the cancer cells and destroy them. Monoclonal antibodies are sometimes called targeted therapies because they're designed to target cancer cells.
Zevalin is a special type of monoclonal antibody known as a radiolabelled monoclonal antibody. This means it has a radioactive substance, which is called Yttrium-90 (90Y), attached to it. This produces radiation that's strong enough to destroy cancer cells. It can also affect normal cells.
Zevalin locks on to a protein called CD20, which is present on the surface of one of the main types of white blood cells called B-lymphocytes, or B-cells. CD20 is present both on normal B-cells and on abnormal (malignant) B-cells found in many types of non-Hodgkin lymphoma.
When Zevalin locks on to the B-cells, it releases radiation that damages or kills them. Both normal and abnormal B-cells are killed, but the body can replace the normal white blood cells that are damaged.
Zevalin may be used as a treatment for people who have follicular lymphoma that has come back after treatment with rituximab| or that hasn't responded to rituximab. It may also be given to people who are in remission from follicular lymphoma (no sign of lymphoma) after their first treatment. This is called consolidation therapy.
Zevalin is licensed and can be prescribed in the UK. But the National Institute for Health and Clinical Excellence (NICE|) hasn't yet assessed it. NICE currently gives advice on which new drugs or treatments should be available for use in the NHS in England and Wales. The Scottish Medicines Consortium (SMC|), which gives advice to the NHS in Scotland, has not recommended the use of Zevalin.
As a result, Zevalin may not be widely available on the NHS. We have information about what you can do if a treatment isn't available|.
Zevalin can only be given in hospitals with the appropriate specialist facilities, so you may need to travel to another hospital to receive it.
Zevalin is given as a one-off treatment and not as repeated courses of treatment. It consists of two parts, given approximately one week apart:
Rituximab is given on the first day of treatment to reduce the number of normal B-cells. This is to reduce the effects of Zevalin on healthy, non-cancerous cells.
About one week later you'll have a second infusion of rituximab. Within four hours of this infusion, you'll go to the nuclear medicine or radiotherapy department to have the Zevalin. This is given by drip into a vein (intravenous infusion) and takes about 10 minutes.
Each person's reaction to treatment is different. Some people have very few side effects while others may experience more. The side effects described here will not affect everyone who has this treatment.
We have outlined the most common side effects and rarer ones, so that you can be aware of them if they occur. However, we haven't included those that are very rare and therefore unlikely to affect you. If you notice any effects that aren't listed here, discuss them with your doctor or nurse.
While receiving Zevalin or rituximab, some people have a reaction to the treatment. You'll be given drugs before the infusion to reduce the likelihood of this. If you have a reaction it can usually be treated by slowing or stopping the drip until you feel better. Sometimes additional medicines may also be given.
You'll be monitored closely during the infusion but tell your nurse or doctor immediately if you feel unwell or have any of the following symptoms:
Rarely an infusion-reaction can occur a few hours after treatment. If you develop these symptoms or feel unwell after you get home, contact the hospital straight away for advice.
Zevalin reduces the number of white cells in your blood, making you more prone to infection|. This may continue for a few weeks after treatment.
Your doctors will check your blood levels regularly during treatment and as part of your follow-up.
Zevalin can reduce the production of platelets, which help the blood clot. Tell your doctor if you have any unexplained bruising or bleeding.
You may become anaemic while having treatment. This may make you look pale, feel tired and cold, or breathless. Your blood levels will be checked regularly, but tell your doctor if you have any of these symptoms. You may be given a transfusion of red cells (blood transfusion|) if you have anaemia.
Your doctor can prescribe anti-sickness (anti-emetic)| drugs to prevent, or greatly reduce, this. If the sickness isn't controlled, or if it continues, tell your doctor; they can prescribe other medication that may be more effective.
This can usually be controlled with medicine, but let your doctor know if it's severe or continues. It's important to drink plenty of fluids if you have diarrhoea|.
Some people notice an increase in headaches or have episodes of dizziness for a few weeks after treatment with Zevalin. Tell your doctor or nurse if you are affected. If you feel dizzy it's important not to drive.
This can usually be managed by eating a high-fibre diet and drinking plenty of fluids. You may also need laxatives. Let your doctor know if you become constipated|.
This is usually mild but may be itchy. It's important to tell your nurse or doctor if you develop a rash. They can advise you on what can help.
It's important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they're not mentioned above.
Precautions are needed after treatment with Zevalin because radiation can remain in the body and bodily fluids for a short time afterwards. This includes the blood, stools, urine, saliva, vaginal fluid and semen. For seven days after therapy, you should avoid transfer of body fluids to other people. It's important to wash your hands thoroughly after going to the toilet and clear up any spills. You should also use a condom during sexual intercourse. All of this will help minimise exposure to radiation for those close to you. Pregnancy should be avoided for one year after treatment.
Some medicines should only be used under the supervision of your doctor while you have Zevalin. This includes blood thinners (anticoagulants) and drugs such as aspirin and ibuprofen.
You should avoid having live vaccines during treatment and for at least 12 months afterwards. Live vaccines include BCG, yellow fever, measles, mumps, rubella, liquid typhoid, poliomyelitis liquid and MMR.
This information has been compiled using information from a number of reliable sources, including:
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.