Does the Addition of Involved Field Radiotherapy to High-Dose Chemotherapy and Stem Cell Transplantation Improve Outcomes for Patients With Relapsed/Refractory Hodgkin Lymphoma?

Kahn, Shannon; Flowers, Christopher R.; Xu, Zhiheng; Esiashvili, Natia

doi:10.1016/j.ijrobp.2010.05.010

Cited by 38 publications

(24 citation statements)

References 34 publications

(33 reference statements)

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“…34 Radiation to field encompassing the spinal cord also poses a risk of radiation myelitis, especially when the conditioning regimen contains busulfan that readily crosses the blood-brain barrier. 35 Based on these data, the expert panel considers that the decision to include RT in the salvage strategy should be made individually taking into account prior irradiation, disease localization, and response to salvage chemotherapy. RT, which can be part of the strategy because HL remains a radiosensitive disease, should always be integrated in a combined modality treatment with chemotherapy, even for localized relapses.…”

Section: Radiotherapymentioning

confidence: 99%

Classical Hodgkin's lymphoma: the Lymphoma Study Association guidelines for relapsed and refractory adult patients eligible for transplant

et al. 2013

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Key pre-salvage treatment risk factors that were almost consistently found to independently prognosticate outcome in Classical Hodgkin's lymphoma: the Lymphoma Study Association guidelines for relapsed and refractory adult patients eligible for transplant open-access paper. doi:10.3324/haematol.2012.072090 Manuscript received on January 15, 2013. Manuscript accepted on May 6, 2013 .beThe Hodgkin's Lymphoma Committee of the Lymphoma Study Association (LYSA) gathered in 2012 to prepare guidelines on the management of transplant-eligible patients with relapsing or refractory Hodgkin's lymphoma. The working group is made up of a multidisciplinary panel of experts with a significant background in Hodgkin's lymphoma. Each member of the panel of experts provided an interpretation of the evidence and a systematic approach to obtain consensus was used. Grades of recommendation were not required since levels of evidence are mainly based on phase II trials or standard practice. Data arising from randomized trials are emphasized. The final version was endorsed by the scientific council of the LYSA. The expert panel recommends a risk-adapted strategy (conventional treatment, or single/double transplantation and/or radiotherapy) based on three risk factors at progression (primary refractory disease, remission duration < 1 year, stage III/IV), and an early evaluation of salvage chemosensitivity, including 18 fluorodeoxy glucose-positron emission tomography interpreted according to the Deauville scoring system. Most relapsed or refractory Hodgkin's lymphoma patients chemosensitive to salvage should receive high-dose therapy and autologous stem-cell transplantation as standard. Efforts should be made to increase the proportion of chemosensitive patients by alternating non-cross-resistant chemotherapy lines or exploring the role of novel drugs. ABSTRACT © F e r r a t a S t o r t i F o u n d a t i o nN o c o m m e r c i a l u s e relapsing and refractory HL are primary refractoriness, short time to HL relapse, and advanced clinical stage at relapse. 2,12,13 The expert panel recommends using these robust prognostic factors to stratify patients into three risk groups (Table 1). There have been inconsistent reports of other predictive risk factors, sometimes with independent value, such as anemia, poor performance status (PS), presence of B symptoms, extranodal relapse, relapse in previous radiation field, age, or bulky disease, but the latter were not retained by the expert panel to serve in the risk group definition. 2,14,15 Primary refractoriness is defined either by progression at any time during chemotherapy or radiotherapy (RT) and up to three months after the end of treatment, and/or by persistence of a PET positive residual mass, using the quantitative 5-point scale Deauville score (DS) for PET interpretation. Using these criteria, a positive FDG-PET (i.e. DS 4 or 5) after 3-4 cycles of ABVD for supra-diaphragmatic HL, and after four cycles of BEACOP Pesc or ABVD for advanced HL, is considered as primary refractory disease...

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Section: Radiotherapymentioning

confidence: 99%

Classical Hodgkin's lymphoma: the Lymphoma Study Association guidelines for relapsed and refractory adult patients eligible for transplant

et al. 2013

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“…77,[80][81][82] Data from Emory University from Kahn et al described a cohort in which none had received prior RT. 79 DFS was improved in those subjects who received IFRT with bulk disease. Common sites of failure remain within the radiation field and prior sites of disease bulk.…”

Section: Radiation Post-hdctmentioning

confidence: 86%

“…78 No randomized trials exist and due to the rarity of patients, the age ranges are broad. 77,[79][80][81][82] Most of these studies involve heterogenous populations in terms of indication for RT, dose, timing, and choice of field. 78 In addition, these data typically do not exclude radiation-naïve subjects.…”

Section: Radiation Post-hdctmentioning

confidence: 99%

Relapsed Hodgkin lymphoma in adolescents: focus on current high-dose chemotherapy and autologous stem cell transplant

Guilcher¹,

Stewart²

2014

COAYA

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Hodgkin lymphoma is one of the most common cancers of adolescence and young adulthood. Most patients are cured of their disease, with very high cure rates in early stage disease and improving rates of cure even in those who present with advanced stage disease. Upfront therapy often involves chemotherapy and radiation therapy; with improving cure rates, acute and late effects of therapy are informing newer treatment protocols to avoid toxicities. Those children and adolescents with refractory or relapsed disease have lower rates of cure and generally warrant more intensive therapy. High-dose chemotherapy and autologous stem cell transplantation is often administered in such cases. This intensive intervention can be curative, but carries additional risks in the short and long term. This review includes a discussion of both transplant and non-transplant therapy for relapsed disease, commonly employed conditioning regimens, acute and late toxicities of therapy, as well as quality of life data. In addition, newer approaches to therapy for Hodgkin lymphoma are reviewed, with a focus on how such novel therapies might relate to high-dose chemotherapeutic approaches.

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“…There have been no randomized trials evaluating the use of post-HCT radiation therapy. Support for this approach is limited to retrospective series that generally demonstrate improved local control and disease-free survival, particularly in the subset of patients with bulky disease, but without effect on overall survival (Mundt et al 1995 ;Yahalom et al 1991 ;Poen et al 1996 ;Kahn et al 2011 ;Lancet et al 1998 ). Most recently, University of Rochester researchers reported improved 3-year EFS and OS with IFRT (median dose 30.6 Gy, range 6-44 Gy) administered within 6 months (median 2 months) following autologous HCT (Biswas et al 2012 ).…”

Section: Radiation Therapy Following Autologous Hctmentioning

confidence: 99%

“…For example, in a casecontrol study of 92 adult patients with relapsed/ refractory HL treated with HDCT and autologous HCT, there was a trend toward better disease control with relapse in 22 % of those receiving IFRT within 2 months of HCT and 37 % of those who did not receive IFRT (Kahn et al 2011 ). However, toxicities were signifi cantly higher in the IFRT group with 28 % of patients experiencing grade 4 or greater toxicity, including pulmonary fi brosis/ pneumonitis or myelitis.…”

Section: Radiation Therapy Following Autologous Hctmentioning

confidence: 99%

Lymphomas

O’Brien¹,

Absalon²,

Gross³

et al. 2013

Pediatric Oncology

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Lymphomas are the third most common malignancy in children and adolescents, after acute leukemias and brain tumors; they account for approximately 15 % of all pediatric cancers (Howlader et al. 2012 ). Among children <15 years of age, non-Hodgkin lymphomas (NHL) predominate, accounting for approximately 6 % of childhood cancers, while Hodgkin lymphoma (HL) is more rare (3.6 %). In older adolescents, Hodgkin lymphoma incidence increases signifi cantly, such that it represents 17 % of new cancer diagnoses compared to 8.3 % for NHL (Howlader et al. 2012 ). Fortunately, lymphomas are among the most curable of childhood cancers, with 5-year survival rates improving substantially from 1975 (44 % for NHL, 82 % for HL) to 2006 (80 % for NHL, 95 % for HL) (Smith et al. 2010 ). In NHL, improved understanding of the biology of different subtypes (lymphoblastic lymphoma, Burkitt lymphoma, diffuse large B-cell lymphoma, and anaplastic large cell lymphoma) has led to refi ned treatment strategies. In HL, advances in risk-and response-adapted chemotherapy and radiation therapy have contributed to high cure rates for newly diagnosed patients. As a result, there is

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Does the Addition of Involved Field Radiotherapy to High-Dose Chemotherapy and Stem Cell Transplantation Improve Outcomes for Patients With Relapsed/Refractory Hodgkin Lymphoma?

Cited by 38 publications

References 34 publications

Classical Hodgkin's lymphoma: the Lymphoma Study Association guidelines for relapsed and refractory adult patients eligible for transplant

Classical Hodgkin's lymphoma: the Lymphoma Study Association guidelines for relapsed and refractory adult patients eligible for transplant

Relapsed Hodgkin lymphoma in adolescents: focus on current high-dose chemotherapy and autologous stem cell transplant

Lymphomas

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