skip to main content
OSTI.GOV title logo U.S. Department of Energy
Office of Scientific and Technical Information

Title: Accelerated Total Lymphoid Irradiation-containing Salvage Regimen for Patients With Refractory and Relapsed Hodgkin Lymphoma: 20 Years of Experience

Abstract

Purpose: We report the long-term results of integrated accelerated involved field radiation therapy (IFRT) followed by total lymphoid irradiation (TLI) as part of the high-dose salvage regimen followed by autologous bone marrow transplantation or autologous stem cell transplantation in patients with relapsed or refractory Hodgkin lymphoma (HL). Methods and Materials: From November 1985 to July 2008, 186 previously unirradiated patients with relapsed or refractory HL underwent salvage therapy on 4 consecutive institutional review board–approved protocols. All patients had biopsy-proven primary refractory or relapsed HL. After standard-dose salvage chemotherapy (SC), accelerated IFRT (18-20 Gy) was given to relapsed or refractory sites, followed by TLI (15-18 Gy) and high-dose chemotherapy. Overall survival (OS) and event-free survival (EFS) were analyzed by Cox analysis and disease-specific survival (DSS) by competing-risk regression. Results: With a median follow-up period of 57 months among survivors, 5- and 10-year OS rates were 68% and 56%, respectively; 5- and 10-year EFS rates were 62% and 56%, respectively; and 5- and 10-year cumulative incidences of HL-related deaths were 21% and 29%, respectively. On multivariate analysis, complete response to SC was independently associated with improved OS and EFS. Primary refractory disease and extranodal disease were independently associated with poor DSS. Eight patients had grademore » 3 or higher cardiac toxicity, with 3 deaths. Second malignancies developed in 10 patients, 5 of whom died. Conclusions: Accelerated IFRT followed by TLI and high-dose chemotherapy is an effective, feasible, and safe salvage strategy for patients with relapsed or refractory HL with excellent long-term OS, EFS, and DSS. Complete response to SC is the most important prognostic factor.« less

Authors:
;  [1];  [2];  [1];  [2];  [1]; ; ;  [3];  [1]
  1. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (United States)
  2. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (United States)
  3. Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York (United States)
Publication Date:
OSTI Identifier:
22649897
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 97; Journal Issue: 5; Other Information: Copyright (c) 2017 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BONE MARROW; CHEMOTHERAPY; GY RANGE 10-100; LYMPHOMAS; MULTIVARIATE ANALYSIS; PATIENTS; RADIATION HAZARDS; RADIOTHERAPY; STEM CELLS

Citation Formats

Rimner, Andreas, Lovie, Shona, Hsu, Meier, Chelius, Monica, Zhang, Zhigang, Chau, Karen, Moskowitz, Alison J., Matasar, Matthew, Moskowitz, Craig H., and Yahalom, Joachim, E-mail: yahalomj@mskcc.org. Accelerated Total Lymphoid Irradiation-containing Salvage Regimen for Patients With Refractory and Relapsed Hodgkin Lymphoma: 20 Years of Experience. United States: N. p., 2017. Web. doi:10.1016/J.IJROBP.2017.01.222.
Rimner, Andreas, Lovie, Shona, Hsu, Meier, Chelius, Monica, Zhang, Zhigang, Chau, Karen, Moskowitz, Alison J., Matasar, Matthew, Moskowitz, Craig H., & Yahalom, Joachim, E-mail: yahalomj@mskcc.org. Accelerated Total Lymphoid Irradiation-containing Salvage Regimen for Patients With Refractory and Relapsed Hodgkin Lymphoma: 20 Years of Experience. United States. doi:10.1016/J.IJROBP.2017.01.222.
Rimner, Andreas, Lovie, Shona, Hsu, Meier, Chelius, Monica, Zhang, Zhigang, Chau, Karen, Moskowitz, Alison J., Matasar, Matthew, Moskowitz, Craig H., and Yahalom, Joachim, E-mail: yahalomj@mskcc.org. Sat . "Accelerated Total Lymphoid Irradiation-containing Salvage Regimen for Patients With Refractory and Relapsed Hodgkin Lymphoma: 20 Years of Experience". United States. doi:10.1016/J.IJROBP.2017.01.222.
@article{osti_22649897,
title = {Accelerated Total Lymphoid Irradiation-containing Salvage Regimen for Patients With Refractory and Relapsed Hodgkin Lymphoma: 20 Years of Experience},
author = {Rimner, Andreas and Lovie, Shona and Hsu, Meier and Chelius, Monica and Zhang, Zhigang and Chau, Karen and Moskowitz, Alison J. and Matasar, Matthew and Moskowitz, Craig H. and Yahalom, Joachim, E-mail: yahalomj@mskcc.org},
abstractNote = {Purpose: We report the long-term results of integrated accelerated involved field radiation therapy (IFRT) followed by total lymphoid irradiation (TLI) as part of the high-dose salvage regimen followed by autologous bone marrow transplantation or autologous stem cell transplantation in patients with relapsed or refractory Hodgkin lymphoma (HL). Methods and Materials: From November 1985 to July 2008, 186 previously unirradiated patients with relapsed or refractory HL underwent salvage therapy on 4 consecutive institutional review board–approved protocols. All patients had biopsy-proven primary refractory or relapsed HL. After standard-dose salvage chemotherapy (SC), accelerated IFRT (18-20 Gy) was given to relapsed or refractory sites, followed by TLI (15-18 Gy) and high-dose chemotherapy. Overall survival (OS) and event-free survival (EFS) were analyzed by Cox analysis and disease-specific survival (DSS) by competing-risk regression. Results: With a median follow-up period of 57 months among survivors, 5- and 10-year OS rates were 68% and 56%, respectively; 5- and 10-year EFS rates were 62% and 56%, respectively; and 5- and 10-year cumulative incidences of HL-related deaths were 21% and 29%, respectively. On multivariate analysis, complete response to SC was independently associated with improved OS and EFS. Primary refractory disease and extranodal disease were independently associated with poor DSS. Eight patients had grade 3 or higher cardiac toxicity, with 3 deaths. Second malignancies developed in 10 patients, 5 of whom died. Conclusions: Accelerated IFRT followed by TLI and high-dose chemotherapy is an effective, feasible, and safe salvage strategy for patients with relapsed or refractory HL with excellent long-term OS, EFS, and DSS. Complete response to SC is the most important prognostic factor.},
doi = {10.1016/J.IJROBP.2017.01.222},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 5,
volume = 97,
place = {United States},
year = {Sat Apr 01 00:00:00 EDT 2017},
month = {Sat Apr 01 00:00:00 EDT 2017}
}