Impact of Radiation Therapy After High Dose Chemotherapy and Autologous Hematopoietic Stem Cell Transplantation in Patients With Relapsed/Refractory Lymphomas: A Single Center Experience |
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| Institution: | 1. Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA;2. Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA;3. Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA;1. Section of Hematology, Department of Medicine, Yale School of Medicine, and Yale Cancer Center, New Haven, CT;2. OPEN Health, Bethesda, MD;3. The Myelodysplastic Syndromes (MDS) Foundation, Inc;4. Aplastic Anemia and MDS International Foundation, Bethesda, MD;5. Taiho Oncology, Princeton, NJ;1. Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX;2. Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX;1. Department of Hematology and Hematopoietic Stem Cell Transplant, Toni Stephenson Lymphoma Center, City of Hope Comprehensive Cancer Center, Duarte, CA;2. US Oncology Research–Texas Oncology, Tyler, TX;3. Arizona Oncology, Tucson, AZ;4. Rocky Mountain Cancer Centers & US Oncology, Aurora, CO;5. Division of Clinical Research, Fort Wayne Medical Oncology & Hematology & US Oncology, Fort Wayne, IN;6. US Medical Affairs, Genentech, Inc., South San Francisco, CA;7. Patient-Centered Outcomes Research, Genentech, Inc., South San Francisco, CA;8. Department of Medical Oncology, Willamette Valley Cancer Institute and Research Center & US Oncology, Eugene, OR |
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| Abstract: | IntroductionAfter high dose chemotherapy (HDC) and autologous stem cell transplantation (auto-SCT), in patients with relapsed/refractory diffuse large B cell lymphoma (DLBCL) and Hodgkin lymphoma (HL), involved field radiation therapy (RT) for consolidation and residual/progressive disease (PD) eradication is a common practice.Materials and methodsRetrospective single-institution cohort analysis to evaluate the impact of early RT after HDC auto-SCT.ResultsBetween 1996 and October 2019, 153 patients (43 DLBCL, 110 HL) underwent RT after HDC auto-SCT. Males 95 (62%), females 58 (38%), median age 24 years. Indications for RT was consolidation 65%: residual disease eradication 16%: and PD eradication 19%. For DLBCL, the median overall survival (OS) for the above indications was not reached (NR):NR:2 months and the KM 5-year OS was 72.6%:64.3%:12.5% respectively (P ≤ .000). Pair-wise analysis showed that consolidation versus residual disease eradication had no difference (P = .88) but both were superior to PD disease eradication (P ≤ 000 and P = .005 respectively). For HL, indication for RT was, 54%:23%:24% respectively. The median OS was NR:NR:28.8 months and KM 5-year OS was 82.3%:78%:30% respectively (P ≤ .000). Pair-wise analysis showed that consolidation versus residual disease eradication had no difference (P = .98) but both were superior to the PD eradication group (P ≤ 000). RT was well tolerated with no significant long-term toxicity.ConclusionPost HDC auto-SCT RT was well tolerated. DLBCL and HL patients with residual disease treated with the RT had similar long-term survival as those who received RT for consolidation. RT failed to improve the poor survival in patients with post-HDC auto-SCT PD. |
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