A multi-institutional analysis of peritransplantation radiotherapy in patients with relapsed/refractory Hodgkin lymphoma undergoing autologous stem cell transplantation - PubMed (original) (raw)

Multicenter Study

. 2017 Apr 15;123(8):1363-1371.

doi: 10.1002/cncr.30482. Epub 2016 Dec 16.

Shekeab Jauhari 2, John P Plastaras 3, Yago Nieto 4, Bouthaina S Dabaja 1, Chelsea C Pinnix 1, Grace L Smith 1, Pamela K Allen 1, J Nicholas Lukens 3, Amit Maity 3, Yasuhiro Oki 5, Michelle A Fanale 5, Sunita D Nasta 2

Affiliations

Multicenter Study

A multi-institutional analysis of peritransplantation radiotherapy in patients with relapsed/refractory Hodgkin lymphoma undergoing autologous stem cell transplantation

Sarah A Milgrom et al. Cancer. 2017.

Abstract

Background: No consensus exists regarding the use of radiotherapy (RT) in conjunction with high-dose chemotherapy and autologous stem cell transplantation (HDC/ASCT) for patients with relapsed/refractory classical Hodgkin lymphoma (HL). The objectives of the current study were to characterize practice patterns and assess the efficacy and toxicity of RT at 2 major transplantation centers.

Methods: Eligible patients underwent HDC/ASCT from 2006 through 2015 using the combination of either carmustine (BCNU), etoposide, cytarabine, and melphalan (BEAM) or cyclophosphamide, BCNU, and etoposide (CBV).

Results: For the cohort of 189 patients, the 4-year overall survival rate was 80%, the progression-free survival rate was 67%, and the local control (LC) rate was 68%. RT was used within 4 months of ASCT for 22 patients (12%) and was given more often for disease that was early stage, primary refractory, or [18 F]fluorodeoxyglucose (FDG)-avid at the time of HDC/ASCT. Disease recurrence occurring after HDC/ASCT was associated with primary refractory disease and FDG-avidity at the time of HDC/ASCT. RT was not found to be associated with LC, progression-free survival, or overall survival on univariate analysis. In a model incorporating primary refractory HL and FDG-avid disease at the time of HDC/ASCT, RT was found to be associated with a decreased risk of local disease recurrence (hazard ratio, 0.3; P = .02). In patients with primary refractory HL and/or FDG-avid disease at the time of HDC/ASCT, the 4-year LC rate was 81% with RT versus 49% without RT (P = .03). There was one case of Common Terminology Criteria for Adverse Events grade ≥ 3 RT-related toxicity (acute grade 3 pancytopenia).

Conclusions: In patients undergoing ASCT for relapsed/refractory HL, peritransplantation RT was used more often for disease that was early stage, primary refractory, or FDG-avid after salvage conventional-dose chemotherapy. RT was associated with improved LC of high-risk localized disease and was well tolerated with modern techniques. Cancer 2017;123:1363-1371. © 2016 American Cancer Society.

Keywords: Hodgkin lymphoma; lymphoma; radiotherapy (RT); stem cell transplantation (SCT).

© 2016 American Cancer Society.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES

The authors made no disclosures.

Figures

Figure 1

Figure 1

Flow diagram summarizing the study cohort. ASCT indicates autologous stem cell transplantation; BEAM, carmustine (BCNU), etoposide, cytarabine, and melphalan; CBV, cyclophosphamide, carmustine (BCNU), and etoposide; HDC, high-dose chemotherapy; HL, Hodgkin lymphoma; RT, radiotherapy.

Figure 2

Figure 2

(A) Local control, (B) progression-free survival, and (C) overall survival for the total cohort (189 patients). SCT indicates stem cell transplantation.

Figure 3

Figure 3

(A) Local control, (B) progression-free survival, and (C) overall survival in the subset of patients with primary refractory Hodgkin lymphoma and/or active (FDG-avid) disease at the time of high-dose chemotherapy/autologous stem cell transplantation (72 patients). Dotted line indicates receipt of peritransplantation radiotherapy (RT); solid line, did not receive peritransplantation RT. SCT indicates stem cell transplantation.

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