Quality Analysis of a Multidisciplinary Program Project in Radioimmunotherapy.
Authors: Recasens Valle , Rubio-Martinez Araceli , Agustin Maria J. , Lopez Carlos , Galego Teresa , Ciria Maria J. , Rubio-Escuin Rebeca , Baringo Teresa , Giraldo Pilar 
Published: October 2019

Aims: Ibritumomab tiuxetan 90Y (90Y-IT) is an effective therapy for Follicular non Hodgkin Lymphoma (F-NHL), and besides is safe and well tolerated in outpatient regimen. Nevertheless it is necessary to coordinate a multidisciplinary team with a planned strategy in order to establish a structured protocol.

Patients and Methods: between September 2005– July 2007, 26 Lymphoma patients were treated with 90Y-IT according own protocol, in a University Hospital reference centre for other surrounded hospitals. 20 adults NHL-F, 3 MC-NHL, 2 NHL-LCDB and 1 HD with inclusion criteria were admitted in the protocol. Participants: Hematology, Nuclear Medicine, Clinical Pharmacy, Outpatient team. Scheduled program: every new patient is registered in the electronic agenda, when the Hematologist established the indication of 90Y-IT therapy. The patient is informed about the therapy and signed the informed consent; a dossier with the information and recommendations about the therapy is hand over. -At this moment a coordinating meeting is generated with the participants in the program in order to discuss the clinical history, according date to therapy with 90Y-IT, and reserve the time of infusion in outpatient regimen (−7 and 0 days). The patients are registered in the agendas (Outpatient place, Medicina Nuclear) and perform the application of anti CD20 and 90Y-IT. Later is fixed the calendar of clinical and analytical follow-up during the 12 weeks after therapy and the program of response evaluation. When the process is completed an inquiry is sending to every patient in order to know the opinion and demand suggestions. Variables for analysis: % of completed informed consent, time since indication to complete the therapy, full agendas, identification of application defects, control marked of 90Y-IT, % of inquiry fill in.

Results: 16 males and 10 females treated with 90Y-IT according the program. Mean age: 57.6 y (37–77); ECOG 0–1, 73.3%. Mean time since diagnosis 4.2 y(1–14); NHL-F grade1 85%, grade2 10%, grade3 5%. Mean previous therapies 3(1–7) . In 20, 0,4 mCi/kg and 6, 0,3 mCi/kg were administered. Response: according previous therapies 1–2 (90.9%) vs >2 (75%); according age <60 (85%) vs >60(60%). At 22 months on follow-up 5 patients relapsed and 1 patient dead for colon carcinoma. The overall survival is 85%. During the 12 weeks of protocol not hospitalization was required. The fill in of informed consent, coordinated meeting, fill in agendas was completed in 100% of cases, the mean time between indication and administration therapy has been 14 days. The marked control has been > 95%. All patients have received written instructions and planned therapy. The follow-up controls have completed in 90% of patients. The program has been comfortable and satisfactory, for patients and involved professionals.

Comments: The multidisciplinary program to therapy with 90Y-IT in every day clinical use is a useful tool to analyze and improve the quality of working procedures in an outpatient regimen.