Involved Field Radiation Therapy Following Autologous Stem Cell Rescue for Hodgkin and Non-Hodgkin Lymphoma - Is It Efficacious?.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3676-3676
Author(s):  
Tithi Biswas ◽  
Sughosh Dhakal ◽  
Sheema Chawla ◽  
Nikhil Uppal ◽  
Sarada Uppuliri ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Stem Cell ◽  
Hodgkin Lymphoma ◽  
P Value ◽  
Stem Cell Rescue ◽  
Non Hodgkin Lymphoma ◽  
Field Radiation ◽  
Involved Field ◽  
Disease Free

Abstract Introduction: Patients with recurrent or refractory Hodgkin (HL) and non-Hodgkin lymphoma (NHL) treated with high dose chemotherapy and autologous stem-cell rescue (ASCR) commonly relapse (post-ASCR) (70–90%) in sites of previous disease. Although adjuvant involved field radiation therapy (IFRT) to sites of previous recurrence might be expected to enhance local control, translation of this into improved disease-free (DFS) or overall survival (OS) is controversial. We sought to evaluate IFRT following ASCR in terms of patterns of recurrence, OS and DFS. Methods and Materials: All 281 patients with recurrent or refractory HL and NHL who underwent ASCR between 5/92 and 7/03 were analyzed. Disease stratification at the time of transplant included HL, 24%, aggressive NHL (ANHL) 62%, and indolent NHL (INHL) 14%. Most, 46% underwent ASCR after 1st relapse, 18% after 2nd relapse, 4% after 3rd relapse and 26% had refractory disease at ASCR. IFRT was administered to 129 patients (46%). Physician and patient choice determined which patients received IFRT. Dose ranged from 20–36 Gy depending on response to salvage therapy before ASCR and the presence of visible imaging abnormalities following ASCR. For end point analysis 39 patients (14%) including 11 HL, 23 ANHL, and 5 INHL had insufficient data and were excluded. Results: Mean follow-up was 3 years (.3 – 12). The median age at ASCR was 45 years (8 – 73). Male to female ratio was 1.3:1. Thirty five percent of patients had prior RT. On univariate analysis, OS and DFS following IFRT for ANHL was superior (or approached this statistically) at 5 years. For HL, improved OS approached significance, whereas DFS did not despite an apparent benefit by disease-free percentages. IFRT appears to be disadvantageous in INHL, but patient numbers were very small. OS and DFS at 5 years are in the table. Survival Table 5-year OS (%) 5-year DFS (%) HL With IFRT 62 79 Without IFRT 37 68 p-value .07 .41 Aggressive NHL With IFRT 57 65 Without IFRT 37 49 p-value .02 .07 Indolent HNL With IFRT 50 67 Without IFRT 85 88 p-value .06 .30 On multivariate analysis, for ANHL, IFRT was protective (p = .002, Hazard Ratio = 0.39) and bulky disease was adverse (p = .04, HR = 2.04). For HL, an advantage of IFRT did not reach statistical significance (p = .63, HR = .8). For INHL, IFRT was associated with an inferior outcome (p = .23, HR = 4.9). Conclusion: Recognizing that bias exists in patient selection for IFRT post-ASCR (in both directions), a survival benefit appears to exist for patients with ANHL, and potentially for those with HL. The absence of a difference in DFS may relate to relapses in other sites or competing events with censored data. Longer follow-up or larger patient numbers are necessary to confirm a long- term improvement. INHL did not benefit from IFRT as might be expected since this group is more likely to have occult disseminated, chemotherapy insensitive disease. Determination of specific patterns of disease recurrence is in progress.

Pediatric Hodgkin Lymphoma Patients Treated with ABVD Chemotherapy with or without Low-Dose Radiation Therapy.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4672-4672
Author(s):  
Amani Al-Kofide ◽  
Asim F. Belgaumi ◽  
Yasser Khafaga ◽  
Nicey Joseph ◽  
Rubina J. Malik ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Hodgkin Lymphoma ◽  
Pediatric Patients ◽  
Combined Modality Therapy ◽  
Bulky Disease ◽  
Field Radiation ◽  
Extended Field ◽  
Involved Field ◽  
Higher Doses

Abstract The ABVD protocol is probably the most effective chemotherapy (CTX) regimen for the treatment of Hodgkin Lymphoma (HL), however the dose and volume, and indeed the need for radiation therapy (XRT) in combination remains uncertain. Pediatric patients (0–14 years) at our institution have been treated with ABVD either with or without XRT, based on the treating physician’s decision. Patients receiving XRT were usually given one or two cycles less of CTX than those without. Since 1998 we have used 1500cGy as the dose of XRT, however the field was determined by the radiation oncologist. Between 1990 and 2003, 152 patients were treated according to the ABVD protocol. Of these, 64 were treated with CTX alone, while 88 also received radiation as consolidation therapy (Combined modality therapy; CMT). Of those who received XRT 63 were administered a dose of 1500cGy. The remaining 25 received various higher doses (1655cGy: 1, 2400cGy: 9, 2500cGy: 10, 3500cGy: 3, 3680cGy: 1, 3980cGy:1). Patients who were treated with CMT were older (mean age 9.2 v. 7.4 years; p<0.05), had less B-symptoms (10.2% v. 26.6%; p<0.05), but not more bulky disease (43.2% v. 34.4%; p=0.2). CTX group had more patients with stage III and IV disease, while CMT group had more stage II disease (p<0.05). With a median follow-up of 4 years, the actuarial overall survival (OS) and event free survival (EFS) at 5 years for all the patients is 97.3% and 88.0%, respectively. The OS and EFS for the patients treated with CTX and CMT were 95.3% v. 98.8% (p=0.4) and 85.1% v. 90.2% (p=0.3), respectively. We next looked at the patients who received only 1500cGy of radiation therapy. Of the 63 patients, 29 received extended field radiation (EFXRT) and 34 involved field radiation (IFXRT). Patients who received radiation were administered a median of two cycles of ABVD less than those who did not (median 4 v. 6 cycles; mean 4.3 v. 5.1, p<0.05). OS at 5 years for the patients treated by CTX v. CMT/EFXRT v. CMT/IFXRT is 95.3%, 96.6% and 100%, respectively (p=0.3). The EFS for the same groups is 85.1%, 86.2% and 90.1% (p=0.4). Conclusion: Pediatric patients with HL can be treated successfully with minimal or no XRT. These results need to be confirmed in a prospective clinical trial.

Cardiac Outcomes in a Prospective Cohort of Adult Non-Hodgkin Lymphoma Survivors

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 2656-2656
Author(s):  
Carrie A. Thompson ◽  
Hongxiu Luo ◽  
Matthew J Maurer ◽  
Cristine Allmer ◽  
Thomas M. Habermann ◽  
...  
Keyword(s):  
Heart Disease ◽  
Hodgkin Lymphoma ◽  
Valvular Heart Disease ◽  
Mayo Clinic ◽  
Cumulative Incidence ◽  
Medical Records ◽  
P Value ◽  
Non Hodgkin Lymphoma ◽  
Increased Risk

Abstract Abstract 2656 Background Treatment of non-Hodgkin lymphoma (NHL) can lead to development of cardiovascular disease (CVD). We sought to describe the cumulative incidence of CVD in adult NHL survivors diagnosed in the recent treatment era (since 2002) and identify clinical and treatment predictors for its development. Methods All patients were from the Mayo component of the Molecular Epidemiology Resource (MER) of the University of Iowa/Mayo Clinic Lymphoma Specialized Program of Research Excellence (SPORE). The MER offers enrollment to all consecutive patients with newly diagnosed NHL who are US residents and age >18 years. Clinical data from the time of diagnosis and treatment data are abstracted from medical records using a standard protocol. Patients are prospectively contacted via telephone or in person per protocol every 6 months for the first 3 years from diagnosis and yearly afterwards to assess disease status and development of comorbid conditions. CVD events, including heart failure (HF), myocardial infarction (MI), arrhythmia, pericarditis, and valvular heart disease, occurring after diagnosis were identified during follow-up and validated against medical records. HF was validated with the Cardiovascular Health Study Criteria and/or the Framingham Criteria. MI was validated using case definition standards of coronary heart disease, while arrhythmia, pericarditis, and valvular heart disease were validated using clinical definitions. The prevalence of CVD and associations between CVD and clinical characteristics (sex, age) and treatment (radiation, anthracyclines) were performed using Cox models with a competing risk approach. Results 1164 patients with NHL were enrolled into the MER at Mayo Clinic between 9/1/2002–2/28/2008. 646 were male (56%) and median age at diagnosis was 62 years (range 20–93). Median follow-up of all cases was 59 months (range 1–105). 131 patients reported CVD prior to the diagnosis of NHL and were excluded from analyses. An additional 76 patients did not have follow-up and were excluded. Of the 957 remaining patients, 75 (7.8%) self-reported a new diagnosis of CVD. Of these, 71 cases had available medical records. 57 of the 71 reviewed cases (80%) were validated (18 HF, 9 MI, 21 arrhythmia, 2 pericarditis, and 10 valvular heart disease). Cumulative incidence of CVD at 1, 3, 5, and 7 years was 1.3%, 3.7%, 5.2%, and 7.4%, respectively. Median time from NHL diagnosis to CVD was 26.5 months (range 1–84). Older age was associated with increased risk of overall CVD (p-value<0.001). Gender (p=0.59), radiation therapy (p=0.61), and anthracycline treatment (p=0.25) were not associated with the incidence of overall CVD. Among types of CVD, anthracycline use was associated with development of HF (HR=5.30; p-value=0.008) and arrhythmia (HR=2.68; p-value=0.04). Radiation was associated with development of arrhythmia (HR=2.73; p-value=0.03), while older age was associated with development of HF (HR=1.36 per 5 year increment; p-value=0.003) and arrhythmia (HR=1.25 per 5 year increment; p-value=0.02). Conclusions The risk of CVD in patients with NHL is approximately 1% per year after the initial diagnosis of lymphoma. The most commonly occurring CVDs in this cohort of NHL survivors were arrhythmia and HF. Treatment with anthracyclines and radiation are associated with increased risk of developing some types of CVD. 80% of self-reported CVD events in NHL survivors were validated using epidemiologic criteria. Future studies will include building models incorporating comorbid health conditions and lifestyle factors to determine risk of CVD as well as the impact of CVD on quality of life. Disclosures: No relevant conflicts of interest to declare.

Durable Local Disease Control and Survival in Patients with Limited-Stage Diffuse Large B-Cell Lymphoma Receiving Involved-Node Radiation Therapy Plus Short-Course R-CHOP or CHOP Chemotherapy: Involved-Node Versus Involved-Field Radiation Therapy

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3665-3665
Author(s):  
Harumi Kato ◽  
Takeshi Kodaira ◽  
Kazuhito Yamamoto ◽  
Yukihiko Oshima ◽  
Yasuhiro Oki ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radiation Therapy ◽  
Survival Rates ◽  
Secondary Malignancy ◽  
Limited Stage ◽  
Short Course ◽  
Field Radiation ◽  
Involved Field ◽  
Overall Survival Rates

Abstract Abstract 3665 Background: Chemoradiotherapy is considered as one of standard treatment for limited-stage diffuse large B-cell lymphoma (DLBCL). Involved-node radiation therapy (IN-RT) is a newly defined concept for patients with early Hodgkin lymphoma. However, there are as yet few reports of applying the strategy to DLBCL and the optimal radiation treatment fields for patients with limited-stage DLBCL have not been well defined. We conducted a retrospective study to evaluate efficacy and long-term toxicities in limited-stage DLBCL patients receiving IN-RT or involved-field radiation therapy (IF-RT) plus short-course chemotherapy. Patients and Methods: Subjects were consecutive patients newly diagnosed as limited-stage DLBCL and receiving local radiation therapy after short-course CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) or R-CHOP (rituximab-CHOP) chemotherapy in our institute from 1993 to 2010. Each patient underwent CT simulation for treatment planning and decided to receive either IN-RT or IF-RT regarding diagnostic imaging after chemotherapy including FDG-PET or PET-CT. The concept of IFRT included the whole initially involved lymph node regions according to the Ann Arbor staging diagram. IN-RT was defined as radiation therapy fields that encompass the initially involved lymph nodes exclusively and to encompass their initial volume with adequate margin less than 3 cm. Results: A total of 108 patients were identified, of which 70 patients received IF-RT. The median age was 62 years (range: 19 to 81). Twelve patients (11%) had bulky disease (≥ 5cm). Baseline patients' characteristics were given in Table 1. There was no statistically difference in risk factors as defined by the stage-modified International Prognostic Index score (IPI) between the two groups (P= 0.25). Most patients (94%) received three courses of chemotherapy (range: 2 to 4). Median dose of radiation was 40Gy (range: 23.4 to 51.2). With a median follow-up of 5.5 years (range: 0.35–17), the 5-year overall survival rates were 94% (95%CI: 87 to 97) in all 108 patients, and 94% (95%CI: 79 to 99) and 94% (94%CI: 84 to 98), in the groups of IN-RT and IF-RT, respectively (P=0.76). Estimated 5-year overall survival rates in patients undergoing IF-RT plus CHOP or R-CHOP were 92% and 94%, respectively (P=0.65). Estimated 5-year overall survival rates in patients treated with IN-RT plus CHOP or R-CHOP were 88% and 100%, respectively (P=0.10). Four patients in the IF-RT group experienced relapses [median: 1.8 years after the start of therapy (range: 0.9 to 7.6)], on the other hand, no patient had relapse in the IN-RT group. Three out of the four patients had three adverse risk factors as defined by the stage-modified IPI. Two patients had the relapsed diseases outside radiation fields. Cumulative incidence of relapse at 5 year was 0% and 4.6% (95%CI: 1.2 to 12) in the patients receiving IN-RT and IF-RT, respectively (P= 0.13). During long-term follow-up, a total of nine patients (8%) developed solid cancer, including skin (n=2), lung (n=2), breast (n=1), gastric (n=2) and bladder (n=2). Seven of which occurred outside radiation fields. No patients developed secondary MDS/AML. Cumulative incidence of secondary malignancy at 5 year was 2.7% (95%CI: 0.20 to 12) and 9.5 % (95%CI: 3.3 to 19) in the groups of IN-RT and IF-RT, respectively, and the cumulative incidence at 10 year was estimated to be 22% (95%CI: 4.0 to 49) and 23% (95%CI: 4.4 to 51) in the groups of IN-RT and IF-RT, respectively. There was no statistically difference in the occurrence of secondary malignancy between the two treatment arms. (P=0.70). Conclusions: IN-RT with short-course CHOP or R-CHOP chemotherapy could be expected as good as IF-RT in terms of local disease control and could produce excellent survival rates. However, incidence of secondary malignancy in patients receiving IN-RT was not decreased compared to that of IF-RT and the incidence was estimated to have been gradually increased until after 10 years. Physicians might consider the development of follow-up programs for patients with DLBCL undergoing chemoradiotherapy. Overall survival according to types of irradiation. The 5-year overall survival rates in patients receiving involved-node (IN-RT) and involved-field radiation therapy (IF-RT) were 94% (95%CI: 79 to 99) and 94% (94%CI: 84 to 98), respectively (p=0.76). Disclosures: Kinoshita: Chugai Pharmaceutical Co., LTD.: Honoraria, Research Funding; Zenyaku Kogyo: Honoraria.

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