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Yttrium (90Y) besilesomab barzuxetan (also known as TLX66 or 90Y-besilesomab) is an investigational targeted radioimmunotherapy being developed by Telix Pharmaceuticals for bone marrow conditioning prior to hematopoietic stem cell transplantation (HSCT). It consists of besilesomab, a murine IgG1 monoclonal antibody that targets CD66 (specifically binding to CEACAM1, CEACAM5, CEACAM6, and CEACAM8), conjugated via the bifunctional chelator barzuxetan (a DTPA derivative) to the beta-emitting radioisotope yttrium-90. By targeting CD66-expressing granulocytes and myeloid-lineage cells, the drug selectively delivers cytotoxic beta radiation to the red bone marrow, enabling bone marrow ablation with reduced systemic toxicity compared to conventional chemotherapy-based conditioning. It is currently in Phase II clinical development for pediatric leukemia, multiple myeloma, and systemic AL amyloidosis.
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