Involved Field Radiation After Autologous Stem Cell Transplant for Diffuse Large B-Cell Lymphoma in the Rituximab Era

Journal Article · Sat May 01 00:00:00 EDT 2010 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2009.04.036· OSTI ID:21372243

Biswas, Tithi; Dhakal, Sughosh ^[1]; Rui, Chen; Hyrien, Ollivier ^[2]; Bernstein, Steven; Friedberg, Jonathan W; Fisher, Richard I; Liesveld, Jane; Phillips, Gordon ^[3]

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1. Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York (United States)
2. Department of Biostatistics, University of Rochester Medical Center, Rochester, New York (United States)
3. Department of Medicine, Division of Medical Oncology, University of Rochester Medical Center, Rochester, New York (United States)

Purpose: For patients with recurrent or refractory large B-cell non-Hodgkin's lymphoma, high-dose chemotherapy and autologous stem cell transplant (ASCT) is the treatment of choice. We evaluated the role of involved field radiation therapy (IFRT) post-ASCT for patients initially induced with cyclophosphamide, adriamycin, vincristine, and prednisone (CHOP) or, more recently, rituximab-CHOP (R-CHOP). Materials and Methods: Between May 1992 and April 2005, 176 patients underwent ASCT for recurrent or refractory large B-cell non-Hodgkin's lymphoma; 164 patients were evaluable for endpoint analysis. Fifty percent of the CHOP group (n = 131), and 39% of the R-CHOP group (n = 33), received IFRT. Follow-up from the time of transplant was a median/mean of 1.7/3 years (range, 0.03-13 years). Results: The 5-year overall survival (OS) and disease-specific survival (DSS) improved with IFRT in both the R-CHOP (p = 0.006 and 0.02, respectively) and CHOP (p = 0.02 and p = 0.04, respectively) groups. IFRT was associated with a 10% (p = 0.17) reduction in local failure, alone or with a distant site. On univariate analysis, IFRT was associated with superior OS (hazard ratio [HR] = 0.50 [95% CI 0.32, 0.78]; p = 0.002) and DSS (HR = 0.53 [95% CI 0.33, 0.86]; p = 0.009). Presence of B symptoms was adverse (p = 0.03). On multivariate analysis, only IFRT was associated with significant improvement in OS (HR = 0.35 [0.18, 0.68]; p = 0.002) and DSS (HR = 0.39 [95% CI 0.18, 0.84]; p = 0.01). Conclusions: Recognizing that positive and negative patient selection bias exists for the use of IFRT post-ASCT, patients initially treated with CHOP or R-CHOP and who undergo ASCT for recurrent or refractory disease may benefit from subsequent IFRT presumably due to enhanced local control that can translate into a survival advantage.

• OSTI ID: 21372243
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Vol. 77, Issue 1; Other Information: DOI: 10.1016/j.ijrobp.2009.04.036; PII: S0360-3016(09)00604-X; Copyright (c) 2010 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; ISSN 0360-3016
• Country of Publication: United States
• Language: English

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62 RADIOLOGY AND NUCLEAR MEDICINE
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PREDNISONE
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STEM CELLS
TRANSPLANTS
ADRENAL HORMONES
ALKYLATING AGENTS
ANIMAL CELLS
ANTIBIOTICS
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IMMUNE SYSTEM DISEASES
IMMUNOSUPPRESSIVE DRUGS
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NUCLEAR MEDICINE
ORGANIC COMPOUNDS
PREGNANES
RADIOLOGY
SOMATIC CELLS
STEROID HORMONES
STEROIDS
THERAPY