The risk of late effects following pediatric and adult radiotherapy regimens in Hodgkin lymphoma

Lundgaard, Anni Young; Hjalgrim, Lisa Lyngsie; Rechner, Laura Ann; Lundemann, Michael; Brodin, N. Patrik; Joergensen, M.; Specht, Lena; Maraldo, M.V.

doi:10.1007/s00066-020-01721-w

Cited by 4 publications

(6 citation statements)

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“…In this multimodally treated cohort, late effects cannot be attributed to a single therapy element but are a consequence of combined effects. With complete organ-at-risk (OAR) ex- posure in TBI though, the estimation of radiation-induced late effects is higher than in focal radiotherapy [6]. GD (24%) and hypothyroidism (21.2%) are the most frequent late effects [7], with a median time to onset of hypothyroidism of 50 months [8].…”

Section: Discussionmentioning

confidence: 99%

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Total body irradiation as part of conditioning regimens in childhood leukemia—long-term outcome, toxicity, and secondary malignancies

et al. 2021

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Background Total body irradiation (TBI) is an established part of conditioning regimens prior to stem cell transplantation in childhood leukemia but is associated with long-term toxicity. We retrospectively analyzed survival, long-term toxicity, and secondary malignancies in a pooled cohort of pediatric patients (pts.) treated with the same TBI regimen. Methods Analyzed were 109 pts. treated between September 1996 and November 2015. Conditioning treatment according to EBMT guidelines and the ALL SCTped 2012 FORUM trial consisted of chemotherapy (CT) and TBI with 2 Gy b.i.d. on 3 consecutive days to a total dose of 12 Gy. Median follow-up was 97.9 months (2–228 months). Results Overall survival (OS) in our cohort at 2, 5, and 10 years was 86.1, 75.5, and 63.0%, respectively. Median survival was not reached. Long-term toxicity developed in 47 pts. After chronically abnormal liver and kidney parameters in 31 and 7 pts., respectively, growth retardation was the most frequent finding as seen in 13 pts. Secondary malignancies were rare (n = 3). Conclusion TBI-containing conditioning regimens in pediatric stem cell transplantation (SCT) are highly effective. Efforts to replace TBI- with CT-containing regimens have only been successful in subgroups of pts. Although we could show long-term toxicity in 43% of pts., overall survival was 63% at 10 years. Still, long-term effects such as growth retardation can permanently impact the pts.’ quality of life and functioning. Along with new substances, efforts should be undertaken to optimize TBI techniques and accompany the treatment by systematic follow-up programs beyond 5 years to improve detection of rare events.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Total body irradiation as part of conditioning regimens in childhood leukemia—long-term outcome, toxicity, and secondary malignancies

et al. 2021

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“…48 Although radiotherapy clearly is an effective local treatment for classic HL, it must be weighed against the risk of late adverse effects, especially in children and young adults who are expected to live long enough to experience such effects. 49 In our case, the radiation fields would have included large lung volumes, central blood vessels and the heart, with a risk of lung fibrosis and cardiovascular disease in the long term. 49 Furthermore, a complete metabolic response before BEAM, which is associated with a better prognosis, was achieved.…”

Section: Discussionmentioning

confidence: 99%

“…49 In our case, the radiation fields would have included large lung volumes, central blood vessels and the heart, with a risk of lung fibrosis and cardiovascular disease in the long term. 49 Furthermore, a complete metabolic response before BEAM, which is associated with a better prognosis, was achieved. Taken together, we deemed the risk of severe side effects to outweigh the potential benefit of radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of paediatric refractory Hodgkin lymphoma with immunotherapy – A case report and literature review

Mogensen,

Cananau,

Ranta

et al. 2024

Acta Paediatrica

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AimTo describe a rare case of primary refractory Hodgkin lymphoma nodular sclerosis syncytial variant in a child and review immunotherapy in relapsed/refractory Hodgkin lymphoma.MethodsWe described the treatment course of a child with primary refractory classic Hodgkin lymphoma and discussed different options for salvage therapy, with an emphasis on immunotherapy. We searched PubMed for all published clinical trials investigating immunotherapy in classic Hodgkin lymphoma written in English until 31 June, 2023. The reference list of each identified paper was searched for additional publications.ResultsOur patient was salvaged with anti‐programmed cell death 1 (PD‐1) antibody therapy followed by high‐dose chemotherapy with autologous stem cell rescue. Radiotherapy was avoided. We identified five one‐armed phase II trials investigating anti‐PD‐1 therapy in first relapse/refractory disease in a total of 254 patients aged 9–71 years, of which one included 31 children. The complete remission rate before high‐dose chemotherapy was 59%–95% overall and 67%–89% among those with refractory disease.ConclusionAlthough it remains to be proven in randomised trials, anti‐PD‐1 therapy may provide higher complete response rates than traditional chemotherapy. Anti‐PD‐1 therapy has the potential to increase the chance of cure while decreasing the risk of late effects from chemotherapy and radiotherapy.

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“…Techniques such as IMRT or tomotherapy make it possible to irradiate pathological tissue in a more conformal manner while sparing healthy surrounding tissue [27,28]. It is well known that in addition to the radiation dose used, the volume irradiated has a major impact on organs at risk (OARs) and this is minimized by new radiation methods [29]. Maximum doses are often determined for OARs to minimize sequelae (for example, < 55 Gy at the base of the skull, optic chiasm, optic nerve) [26].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of treatment-associated eye toxicity after irradiation in childhood and adolescence—results from the Registry of the Evaluation of Side Effects after Radiotherapy in Childhood and Adolescence (RiSK)

et al. 2021

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Purpose The aim of the study is to evaluate treatment-related acute and late eye toxicity associated with radiation therapy in childhood and adolescence as correlated with RT (radiotherapy) doses. Methods From 2001 to 2016, a total of 1725 children and adolescents undergoing radiation therapy were prospectively documented in the Registry of the Evaluation of Side Effects after Radiotherapy in Childhood and Adolescence (RiSK). The RTOG/EORTC criteria were used to classify ocular acute and late effects. Uni- and multivariate analyses were carried out to evaluate the impact of patient age, pre-existing impairments, and radiation dose on ocular toxicity. Results Of all documented patients, 593 received dose to the eye and formed the basis of this analysis. In 435 patients, information on acute reaction was available and graded 1, 2, 3, and 4 in 49, 17, 0, and 2 patients, respectively. Information on late toxicity was available in 268 patients and graded 1, 2, 3, and 4 in 15, 11, 11, and 5 patients, respectively. The acute toxicity rate was significantly higher in children who received a maximum dose > 50 Gy to the eye (p < 0.001) and who had a pre-existing eye impairment (p < 0.001 in multivariate analysis). The development of late toxicity was significantly higher for patients experiencing acute toxicity and having received a radiation dose > 50 Gy. Conclusion Acute and late toxicity both correlate with high radiation dose to the eye (> 50 Gy) and acute toxicity additionally with pre-existing eye impairments.

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The risk of late effects following pediatric and adult radiotherapy regimens in Hodgkin lymphoma

Cited by 4 publications

References 45 publications

Total body irradiation as part of conditioning regimens in childhood leukemia—long-term outcome, toxicity, and secondary malignancies

Total body irradiation as part of conditioning regimens in childhood leukemia—long-term outcome, toxicity, and secondary malignancies

Successful treatment of paediatric refractory Hodgkin lymphoma with immunotherapy – A case report and literature review

Evaluation of treatment-associated eye toxicity after irradiation in childhood and adolescence—results from the Registry of the Evaluation of Side Effects after Radiotherapy in Childhood and Adolescence (RiSK)

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