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Step A: Patient Selection and Eligibility
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Step B: Thyroid protection
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Day -1
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| Saturated solution of potassium iodide (SSKI )- 4 drops orally 3 times/day or Lugol's solution 20 drops orally 3 times/day or KI tablets 130 mg orally once/day; Administered from the day before until 14 days following therapy |
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Step C: Diagnostic and Dosimetry Scan
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Day 0:
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| Acetaminophen 650 mg and diphenhydramine 50 mg, 30 minutes prior to infusion |
| Unlabeled tositumomab 450 mg intravenously in 50 ml saline over 1 hour |
| Small dosimetric amount of 131I-tositumomab (5 mCi or 185 MBq of 131I and 35 mg Tositumomab) in 30 ml saline over 20 minutes |
| Whole body dosimetry and bio-distribution immediately following injection within one hour, pre-void |
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Day 2, 3 or 4:
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| Whole body dosimetry and bio-distribution, post void |
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Day 6 or 7:
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| Whole body dosimetry and bio-distribution, post void (to maintain consistency, the same camera, collimator, and set up are utilized on all the dosimetric scans) |
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Step D: Dose Calculation
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| Assess the bio-distribution and if acceptable, determine the dose |
| Calculate the dose to deliver 75cGy total body dose (65 cGy, if platelets are 100-150,000) |
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Step E: Therapeutic Dose Administration
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Day 7 up to 14: (exact timing depends on dose arrival and logistics):
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| Acetaminophen 650 mg and diphenhydramine 50 mg, 30 minutes prior to infusion |
| 450 mg infusion of unlabeled Tositumomab in 50 mL of saline over 1 hour |
| 20 minute infusion of Bexxar in a volume of 30 mL given through a millipore micron filter |
| Flush the catheter post infusion to administer complete dose |
| Assay the administration tubing set |
