A phase II trial of adjuvant low-dose total body irradiation in non-hodgkin's lymphoma patients following standard CHOP

Safwat, Akmal; Bayoumi, Yasser; Akkoush, Hany; Mahmoud, Hossam K.

doi:10.1080/02841860410035440

Cited by 3 publications

(2 citation statements)

References 14 publications

(12 reference statements)

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“…The philosophy of using immune-modulators and maintenance therapy in relapsed LG-NHL is gaining popularity in the last decades. Currently, the immune-modulatory effect of LTBI is well known as mentioned previously [6] and proved by NCI, Cairo publications in NHL and metastatic renal cell carcinoma cases [30]- [32].…”

Section: Discussionmentioning

confidence: 93%

Low Dose Total Body Irradiation for Relapsed Low Grade Non-Hodgkin’s Lymphoma: Experience of National Cancer Institute, Cairo

Bayoumi¹,

Radwan²

2015

JCT

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Background and Purpose: The relapsed low grade non-Hodgkin's lymphoma (LG-NHL) is currently incurable disease and the optimal treatment regimen has not determined yet. Low dose total body irradiation (LTBI) provides an alternative mechanism of action against cancer cells rather than direct cell kill. The mode of action of LTBI is immune-modulatory effect, induction of apoptosis and hypersensitivity to low radiation doses. The aim of our study is to evaluate the effect of LTBI on relapsed LG-NHL and reporting our experience at National Cancer Institute, Cairo (NCI, Cairo). Material and Methods: Fifty eight patients with relapsed LG-NHL and received LTBI studied retrospectively. LTBI dose was 1.6 Gy/8 fractions divided on 2 courses; each course 4 fractions treated over 4 days with 2 weeks rest between the 2 courses. Results: The median age is 54 years; 65% of the patients are men. Forty (69%) patients had performance status of 2 or more. Twenty seven patients were stage II/III and 31 patients (53%) had stage IV disease. Twenty six (45%) patients had bulky disease more than 10 cm and 22 (38%) patients had B symptoms at the time of relapse. The extranodal disease was present in 17 patients (29%) and 78% of the patients received >3 regimens of chemotherapy before referral to LTBI. Twenty three patients received IFRT (mean dose 32 ± 4 Gy) to initially bulky sites after LTBI. Fourteen patients (24%) achieved complete remission (CR) while 45%, 21% and 10% had partial remission (PR), stable disease (SD) and progressive disease (PD) respectively. The median PFS duration was 14 months and the median OS duration was 39 months. Stage VI, >3 regimen of chemotherapy and bad response to LTBI (SD) affected progression duration adversely (0.03, 0.05 and 0.01 respectively). The response to LTBI is the only factor af-* Corresponding author. Y. Bayoumi, A. Radwan 26 fected the OS duration significantly. The 3-year PFS was 19% ± 9%, and 3-year OS was 45% ± 8%. Stage IV was the only factor affected the 3-year PFS significantly with p value 0.03. The hematological toxicity was the main side effect of LTBI. Eleven patients developed G3/4 anemia while 8 patients only developed G3/4 thrombocytopenia and 13 patients developed G3/4 leucopenia. Conclusion: The use of LTBI in patients with relapsed low grade NHL is a feasible, effective and tolerable treatment that is worthy of testing in a future with chemotherapy and Rituximab maintenance.

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Section: Discussionmentioning

confidence: 93%

Low Dose Total Body Irradiation for Relapsed Low Grade Non-Hodgkin’s Lymphoma: Experience of National Cancer Institute, Cairo

Bayoumi¹,

Radwan²

2015

JCT

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“…To date, a few groups have performed clinical phases I and II trials with WB-LDR for cancer patients and shown the effective enhancement of the therapeutic efficacy for nonHodgkin's lymphoma without increase in toxic effects (5, 13, 18 -20), and even clinical phase III trail has been proposed (20). These studies suggest that appropriate use of LDR can offer beneficial effects to cancer patients under certain conditions.…”

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confidence: 96%

Reply to “Letter to the Editor: ‘Low-dose whole body irradiation: a potential therapeutic modality’”

Zhang

Cai

2010

American Journal of Physiology-Endocrinology and Metabolism

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In their letter (17), Chander M. Pathak and Krishan K. Khanduja commended the findings of our paper (27). We are grateful to them for highlighting the clinical relevance and important implications of our research. However, two issues require clarification.First, we did not simultaneously investigate the temporal long-term impact of whole body low-dose radiation (WB-LDR) on both pancreatic and renal tissue in diabetic animals (27). One reason is that we focused on the preventive effect of WB-LDR on diabetic kidney. With this goal in mind, all animals in the study were treated with multiple low doses of streptozotocin (STZ), which destroyed pancreatic ␤-cells before WB-LDR was given. However, studies by others suggest that WB-LDR at 0.5 Gy gamma rays, administered either before alloxan-induced diabetes or in NOD mice with spontaneously developed diabetes, leads to upregulation of pancreatic antioxidants (22,23). There was also a study indicating that chronic exposure of type 2 diabetic db/db mice to LDR significantly upregulated pancreatic antioxidants along with reduction of glucose levels (24). These findings suggest that WB-LDR can induce pancreatic antioxidant upregulation, resulting in certain preventive effects on diabetic complications, but this hypothesis has yet to be specifically tested. We recently demonstrated that STZ-induced diabetes significantly reduces systemic (plasma) and testicular antioxidants (catalase and superoxide dismutase) and then showed that repeated WB-LDR (25 or 50 mGy X-rays) in posthyperglycemic diabetic rats significantly prevented reduction of diabetes-induced systemic and testicular antioxidants and also prevented diabetes-induced testicular cell death and oxidative damage (28).The second issue is that we did not explore the optimal conditions for WB-LDR to effectively protect the kidney from diabetes. The authors pointed out that the application of moderate doses (between 3 and 6 Gy) for therapeutic purposes to diabetic patients appear to be unacceptable to the scientific community, since with application of higher radiation doses acute toxic effects and potentially late long-term effects are expected. Unlike high and middle doses of ionizing radiation, LDR induces few detrimental effects and significantly stimulates cellular metabolism and enhances cell defense function, which is known as hormesis and adaptive response (2, 3, 12, 25). The hormetic and adaptive response includes the stimulation of DNA, RNA, and protein synthesis as well as DNA repair activity, the increase in cellular antioxidant capacity, the prolongation of life span, and the activation of immune functions. Whether LDR can be considered as an alternative approach to preventing diabetes and diabetic complications has been questioned (25). In the study under discussion here, however, we demonstrated that accumulated dose 0.175 Gy at week 2 and 0.35 Gy at week 4 can significantly protect the kidney from diabetes-induced inflammation, dysfunction, and oxidative damage. At higher radiation doses (0.70 Gy at week 8 ...

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Current Awareness in Hematological Oncology

2004

Hematological Oncology

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In order to keep subscribers up‐to‐date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of hematological oncology. Each bibliography is divided into 14 sections: 1 Books, Reviews & Symposia; 2 General; Leukemias: 3 Lymphoblastic; 4 Myeloid & Myelodysplastic Syndromes; 5 Chronic; 6 Others; Lymphomas: 7 Hodgkin's; 8 Non‐Hodgkin's; 9 Plasmacytomas/Multiple Myelomas; 10 Others; 11 Bone Marrow Transplantation; 12 Cytokines; 13 Diagnosis; 14 Cytogenetics. Within each section, articles are listed in alphabetical order with respect to author. If, in the preceding period, no publications are located relevant to any one of these headings, that section will be omitted.

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A phase II trial of adjuvant low-dose total body irradiation in non-hodgkin's lymphoma patients following standard CHOP

Cited by 3 publications

References 14 publications

Low Dose Total Body Irradiation for Relapsed Low Grade Non-Hodgkin’s Lymphoma: Experience of National Cancer Institute, Cairo

Low Dose Total Body Irradiation for Relapsed Low Grade Non-Hodgkin’s Lymphoma: Experience of National Cancer Institute, Cairo

Reply to “Letter to the Editor: ‘Low-dose whole body irradiation: a potential therapeutic modality’”

Current Awareness in Hematological Oncology

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