Total body irradiation and prednimustine in chronic lymphocytic leukemia and low grade non-Hodgkin's lymphomas. A 9-year experience at a single institution

Abstract

Background. The efficacy and toxicity of total body irradiation (TBI) in patients with chronic lymphocytic leukemia (CLL) and low grade non‐Hodgkin's lymphomas (NHL) were evaluated. Methods. Between January 1984 and September 1992, 81 consecutive patients, 40 affected with CLL and 41 with low grade NHL, with symptomatic Stage III and IV disease, were treated with TBI followed by prednimustine. TBI was given with a 6 MV linear accelerator, applying two opposite alternating fields, including total body, with two fractions of 15 cGy given per week (3‐day interval). A total dose of 150 cGy was given over 5 weeks. Six to nine courses of prednimustine (100 mg/m2 orally for 5 consecutive days every 4 weeks) was administered 2 months after TBI treatment as consolidation therapy. Results. Of 40 patients with CLL, 18 (Group I; median age 58.5 years) were younger than 65 years and 22 (Group II; median age 73 years) were older. The overall response rates were 78% in Group I and 91% in Group II, with a median response time of 16.5 and 16 months, respectively. Hematologic toxicity was 72% in Group I and 73% in Group II. It was reversible in all but one heavily pretreated patient who died of progressive anemia and thrombocytopenia after TBI alone. In the 40 patients with CLL, the response rate was 85%; there were 5 complete responses (CRs) (12.5%) and 29 partial responses (PRs) (72.5%). Of the 41 patients with NHL, 29 (Group I; median age 55 years) were younger than 65 years and 12 (Group II; median age 71.5) were older. The overall response rate in both groups was 83%, with median response times of 18.5+ and 14.5+ months for Groups I and II, respectively. Hematologic toxicity was 59% in Group I, whereas it was 50% in Group II. It was reversible in all patients. Overall, in the 41 patients with symptomatic Stage III and IV low grade NHL, the response rate was 82.8%; there were 10 CRs (24.3%) and 24 PRs (58.5%). The prednimustine regimen was generally well tolerated. Conclusions. In our experience, TBI given in a dose of 150 cGy in 10 fractions twice a week, followed by prednimustine, is an effective treatment for patients with CLL and patients with low grade NHL. This treatment also is effective in patients older than 65 years. The toxicity is acceptable, particularly when TBI and prednimustine are given as initial treatment. Pretreated patients should be monitored strictly.

Hematopoietic cell transplantation in older patients with hematologic malignancies: replacing high-dose cytotoxic therapy with graft-versus-tumor effects

“…The molecular remissions occurred while patients received immunosuppression for treatment of GVHD, indicating that powerful GVT responses were generated and continued even with control of other GVHD manifestations. Although low-dose TBI given with or without alkylating agents may induce remissions in some patients with untreated CLL and NHL, 52,53 it has not been reported that low-dose TBI can induce CRs and molecular remissions in patients with chemotherapyresistant CLL, and in particular after failure of previous fludarabinecontaining regimens. Similarly, although low-dose TBI may have transient suppressive effects on CML, even high-dose myeloablative regimens (at least 1200 cGy TBI plus intensive chemotherapy) are by themselves often incapable of providing sustained disease control, as indicated by the frequent relapses observed after using T-cell-depleted allografts.…”

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

“…The overall response rate was around 85%. The complete remission rate occurred in 12.5% and 24.30% in the CLL and LG-NHL patients respectively [29].…”

Good things come in small packages: low-dose radiation as palliation for indolent non-Hodgkin lymphomas

“…In both NHL [10][11][12][13][14][15][16][17] and CLL [18][19][20], complete response (CR) rates of *25-80% have been observed depending on histology and whether the therapy was used as initial treatment. These studies have typically used 1.5 to 2.5 Gy in 10 to 20 fractions though in many cases, additional radiation to localized sites of disease following the TBI was utilized.…”