Peritransplant Radiation Therapy in Patients With Refractory or Relapsed Hodgkin Lymphoma Undergoing Autologous Stem Cell Transplant: Long-Term Results of a Retrospective Study of the Fondazione Italiana Linfomi
- Author(s)
- Levis, M; Campbell, BA; Matrone, F; Grapulin, L; Di Russo, A; Buglione, M; Iamundo De Cumis, I; Simontacchi, G; Ciammella, P; Magli, A; Pascale, G; Meregalli, S; MacManus, M; Fanetti, G; De Felice, F; Furfaro, G; Ciccone, G; Ricardi, U;
- Details
- Publication Year 2023-08-01,Volume 116,Issue #5,Page 1008-1018
- Journal Title
- International Journal of Radiation Oncology, Biology, Physics
- Publication Type
- Research article
- Abstract
- PURPOSE: In this multicenter collaboration, we report real-world data in the largest published series of long-term outcomes for patients with relapsed/refractory (r/r) Hodgkin lymphoma (HL) treated with peritransplant radiation therapy (pt-RT) and high-dose chemotherapy with autologous stem cell transplant (ASCT). METHODS AND MATERIALS: We conducted a retrospective analysis including data from 12 institutions. Eligibility required histologic diagnosis of HL, receipt of ASCT plus pt-RT between 2004 and 2014 for r/r HL, and age >/=18 years at the time of ASCT. All patients received salvage chemotherapy for maximum debulking before ASCT. Metabolic responses were scored according to the Lugano Classification. The primary endpoint was overall survival (OS). Univariate and multivariate Cox proportional hazards were calculated to estimate the effect of covariates on patients' outcome. RESULTS: One hundred thirty-one patients were eligible: 68 were male (52%), and median age at ASCT was 32 years (range, 18-70). At the time of diagnosis with r/r HL, 92 patients (70%) had limited (stage I-II) disease, and 10 patients (8%) had bulky disease. Pt-RT was given pre-ASCT in 32 patients (24%) and post-ASCT in 99 (76%); median prescribed dose was 30.6 Gy (range, 20-44 Gy). With median follow-up of 60 months, 3- and 5-year OS were 84% and 77%, while 3- and 5-year progression-free survival were 75% and 72%, respectively. On univariate and multivariate analysis, advanced stage at relapse (hazard ratio [HR], 2.18; P = .04), irradiation of >3 sites (HR, 3.69; P = .01), and incomplete metabolic response after salvage chemotherapy (HR, 2.24; P = .01) had a negative effect on OS. The sequencing of pt-RT (pre- vs post-ASCT) did not affect outcomes. CONCLUSIONS: Overall, the addition of pt-RT to ASCT for patients with r/r HL is associated with very good outcomes. Limited relapsed disease with </=3 sites involved and achievement of complete metabolic response after salvage chemotherapy were predictive of more favorable prognosis.
- Publisher
- Elsevier
- Keywords
- Humans; Male; Adolescent; Young Adult; Adult; Middle Aged; Aged; Female; *Hodgkin Disease/radiotherapy/drug therapy; Retrospective Studies; Antineoplastic Combined Chemotherapy Protocols/therapeutic use; Neoplasm Recurrence, Local/drug therapy; Stem Cell Transplantation; Transplantation, Autologous; Salvage Therapy/methods; *Hematopoietic Stem Cell Transplantation/methods; Recurrence
- Department(s)
- Radiation Oncology
- PubMed ID
- 36822373
- Publisher's Version
- https://doi.org/10.1016/j.ijrobp.2023.02.019
- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2023-10-03 06:39:59
Last Modified: 2024-07-09 05:49:10