Leukemia following low-dose total body irradiation and chemotherapy for non-Hodgkin's lymphoma.

1996 ◽  
Vol 14 (2) ◽  
pp. 565-571 ◽  
Author(s):  
L B Travis ◽  
J Weeks ◽  
R E Curtis ◽  
J T Chaffey ◽  
M Stovall ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Total Body Irradiation ◽  
Hodgkin’S Lymphoma ◽  
Low Dose ◽  
Alkylating Agents ◽  
Salvage Treatment ◽  
Hodgkin's Lymphoma ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma ◽  
Total Body

PURPOSE Low-dose total body irradiation (TBI) is used to treat non-Hodgkin's lymphoma (NHL) and several other malignancies. Large volumes of bone marrow and other tissue receive considerable exposure, but few studies have quantified late carcinogenic sequelae. PATIENTS AND METHODS A cohort of 61 2-year survivors of NHL treated initially with low-dose TBI was monitored for second cancer occurrence. Data on primary and subsequent therapy were collected, and cumulative dose of radiation to active bone marrow (ABM) (median, 5.2 Gy) was reconstructed. RESULTS Thirteen second primary cancers occurred. Four patients developed acute nonlymphocytic leukemia (ANLL), which represents a relative risk (RR) of 117 (95% confidence interval [CI], 31.5 to 300) compared with population rates. A fifth patient was diagnosed with myelodysplastic syndrome (MDS). All five patients with secondary hematologic malignancies subsequently received salvage treatment, with either alkylating agents alone (n = 1) or combined modality therapy (CMT) (n = 4). Overall, eight solid tumors were observed (RR = 2.0; 95% CI, 0.9 to 4.0). The 15-year cumulative risks of all second cancers and secondary ANLL were 37% and 17%, respectively. CONCLUSIONS Despite the small number of subjects, a considerable risk of leukemia was observed among patients treated with low-dose TBI in combination with CMT including alkylating agents. Based on these results, approximately eight to nine excess ANLLs might be expected to occur among 100 NHL patients treated with low-dose TBI and salvage treatment and followed-up for 15 years.

Secondary Acute non Lymphoid Leukemia in Patients Treated for non Hodgkin's Lymphoma: No Risk of Therapy-Related Anll after Provecip Schedule

1987 ◽  
Vol 73 (4) ◽  
pp. 363-367 ◽  
Author(s):  
Giuseppe Cimino ◽  
Anna Paola Anselmo ◽  
Claudio Cartoni ◽  
Cesare Guglielmi ◽  
Francesco Lo Coco ◽  
...  
Keyword(s):  
Total Body Irradiation ◽  
Hodgkin’S Lymphoma ◽  
Hodgkin's Lymphoma ◽  
Induction Treatment ◽  
Lymphoid Leukemia ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma ◽  
Extended Field ◽  
Actuarial Risk ◽  
Total Body

The present study was undertaken to evaluate the frequency, characteristics and actuarial risk of secondary acute non lymphoid leukemia (s-ANLL) in 141 patients treated for non Hodgkin's lymphoma with different modalities. One hundred and twenty-four patients received chemotherapy according to PROVECIP protocol (9). Of these, 15 also received as induction treatment a local nodal irradiation and 33 an extended field radiotherapy. Seventeen out of 141 were treated by total body irradiation. Of these, 15 relapsed and received salvage chemotherapy. Sixteen of the 124 patients treated with PROVECIP also underwent different chemotherapeutic programs as salvage treatment. Of the entire population studied, 2 patients developed an s-ANLL, 45 and 63 months after diagnosis of NHL. The type of treatment significantly affected the occurrence of s-ANLL, since both leukemias occurred in patients treated with total body irradiation, given alone or followed by chemotherapy. The actuarial risk at 8 years was 5.24% in the whole group, whereas it greatly increased in the group of patients treated with total body irradiation (24%). Conversely, no risk was found in the group treated with PROVECIP, alone, with additional chemotherapy, or with associated local or extended field radiotherapy.

Treatment of patients with relapsed and resistant non-Hodgkin's lymphoma using total body irradiation, etoposide, and cyclophosphamide and autologous bone marrow transplantation.

1992 ◽  
Vol 10 (6) ◽  
pp. 936-941 ◽  
Author(s):  
S Gulati ◽  
J Yahalom ◽  
L Acaba ◽  
L Reich ◽  
R Motzer ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Total Body Irradiation ◽  
Hodgkin’S Lymphoma ◽  
Conditioning Regimen ◽  
Autologous Bone Marrow ◽  
Hodgkin's Lymphoma ◽  
Cytotoxic Therapy ◽  
Non Hodgkin's Lymphoma ◽  
Autologous Bone ◽  
Total Body

PURPOSE Patients with non-Hodgkin's lymphoma (NHL) who do not achieve a complete response (CR) after induction chemotherapy or who relapse after achieving a CR are rarely cured of their disease by the usual salvage therapy. Success of high-dose cytotoxic therapy with an autologous bone marrow transplant (AuBMT) is limited. We describe the results of a prospective single-institution study using a new conditioning regimen for patients with relapsed or resistant NHL who underwent AuBMT. PATIENTS AND METHODS Forty-four patients were reinduced with cytotoxic therapy and then evaluated for response. All patients received the conditioning regimen of hyperfractionated total body irradiation (TBI), etoposide (VP-16), and cyclophosphamide (CTX) followed by autologous bone marrow reinfusion. RESULTS The disease-free survival (DFS) rate was 57% with a median follow-up of 42+ months. The only variable significantly associated with DFS was the patient's remission status at AuBMT. Patients who underwent AuBMT in CR had a DFS of 80%, whereas patients who underwent AuBMT in partial response (PR) or with progressive disease (PD) had a DFS of 60% and 11%, respectively (P = .002). The major toxicity was hemorrhage at the site of bulky disease, especially in patients with residual mediastinal and/or pulmonary disease. CONCLUSION Planned reinduction cytotoxic therapy followed by TBI, VP-16, and CTX with AuBMT is an effective treatment for patients with relapsed and resistant NHL.

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