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Localized radiation increases morbidity and mortality after TBI-containing autologous stem cell transplantation in patients with lymphoma

Bone Marrow Transplantation volume 32, pages 863–867 (2003)Cite this article

Summary:

The purpose of this study is to assess the relationship between involved field radiation therapy (IFRT) and treatment-related morbidity and mortality in patients receiving high-dose chemotherapy (HDC), total body irradiation (TBI) and autologous peripheral stem cell transplant (PSCT) for Hodgkin's and non-Hodgkin's lymphoma. Between January 1994 and May 2002, 156 patients underwent HDC, TBI and autologous PSCT. Localized external beam radiation therapy was given to 21 patients for consolidation, or to achieve control of symptomatic or active disease prior to or after transplant. Among patients who had IFRT prior to autologous PSCT, five treatment-related deaths were observed, compared to seven deaths in 135 patients who had autologous PSCT without IFRT (P<0.01). Most deaths were attributable to sepsis and multiorgan failure. A higher incidence of pneumonitis was also noted in patients exposed to mediastinal irradiation. No adverse impact on long-term survival could be demonstrated. Involved field radiation prior to TBI is associated with higher treatment-related mortality in lymphoma patients undergoing autologous peripheral stem cell transplant, necessitating careful monitoring.

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References

  1. Canellos GP, Anderson JR, Propert KJ et al. Chemotherapy of advanced Hodgkin's disease with MOPP, ABVD, or MOPP alternating with ABVD. N Engl J Med 1992; 327: 1478–1484.

    Article  CAS  Google Scholar 

  2. Specht L, Gray RG, Clarke MJ, Peto R . Influence of more extensive radiotherapy and adjuvant chemotherapy on long-term outcome of early-stage Hodgkin's disease: a meta-analysis of 23 randomized trials involving 3,888 patients. International Hodgkin's Disease Collaborative Group. J Clin Oncol 1998; 16: 830.

    Article  CAS  Google Scholar 

  3. Longo DL, Duffey PL, Young RC et al. Conventional-dose salvage combination chemotherapy in patients relapsing with HL after combination chemotherapy: the low probability for cure. J Clin Oncol 1992; 10: 210–218.

    Article  CAS  Google Scholar 

  4. Lazarus HM, Loberiza Jr FR, Zhang MJ et al. Autrotransplants for Hodgkin's disease in first relapse or second remission: a report from the autologous blood and marrow transplant registry. Bone Marrow Transplant 2001; 27: 387–396.

    Article  CAS  Google Scholar 

  5. Lazarus HM, Rowlings PA, Zhang MJ et al. Autotransplants for Hodgkin's disease in patients never achieving remission: a report from the autologous blood and marrow transplant registry. J Clin Oncol 1999; 17: 534–545.

    Article  CAS  Google Scholar 

  6. Fisher RI, Gaynor ER, Dahlberg S et al. Comparison of a standard regimen (CHOP) with three intensive chemotherapy regimens for advanced non-Hodgkin's lymphoma. N Engl J Med 1993; 328: 1002–1006.

    Article  CAS  Google Scholar 

  7. Philip T, Guglielmi C, Hagenbeek A et al. Autologous bone marrow transplantation as compared with salvage chemotherapy in relapses of chemo-sensitive NHL. N Engl J Med 1995; 333: 1540–154.

    Article  CAS  Google Scholar 

  8. Stiff PJ, Forman SJ, McCall AR et al. Autologous bone marrow transplantation for patients with relapsed or refractory diffuse aggressive Non-Hodgkin's lymphoma: value of augmented preparative regimens – a Southwest Oncology Group Trial. J Clin Oncol 1998; 16: 48–55.

    Article  CAS  Google Scholar 

  9. Longo DL, Glasttein E, Duffey PL et al. Treatment of localized aggressive lymphomas with combination chemotherapy followed by IFRT. J Clin Oncol 1989; 7: 1295–1302.

    Article  CAS  Google Scholar 

  10. Parlovsky S, Maschio M, Santarelli MT et al. Randomized trial of chemotherapy versus chemotherapy plus radiotherapy for stage I–II Hodgkin's disease. J Natl Cancer Inst 1988; 80: 1466–1473.

    Article  Google Scholar 

  11. Miller TP, Dahlberg SM, Cassady JR et al. Chemotherapy alone compared to chemotherapy and radiotherapy for localized intermediate and high grade NHL. N Engl J Med 1998; 339: 21–26.

    Article  CAS  Google Scholar 

  12. Poen JC, Hoppe RT, Horning SJ . High-dose therapy and autologous bone marrow transplantation for relapsed/refractory Hodgkin's disease: the impact of involved field radiotherapy on patterns of failure and survival. Int J Radiat Oncol Biol Phys 1995; 33: 261.

    Article  Google Scholar 

  13. Mundt AJ, Sibley G, Williams S et al. Patterns of failure following high-dose chemotherapy and autologous bone marrow transplantation for refractory and relapsing patients with Hodgkin's disease. J Clin Oncol 1993; 11: 1062.

    Article  Google Scholar 

  14. Yahalom J, Gulati SC, Toia M et al. Accelerated hyperfractionated total-lymphoid irradiation, high-dose chemotherapy, and autologous bone marrow transplantation for refractory and relapsing patients with Hodgkin's disease. J Clin Oncol 1993; 11: 1062–1070.

    Article  CAS  Google Scholar 

  15. Jules-Ellysee K, Stover DE, Yaholom J et al. Pulmonary complications in lymphoma patients treated with high-dose therapy and autologous bone marrow transplantation. Am Rev Respir Dis 1992; 146: 485–491.

    Article  Google Scholar 

  16. Movsas B, Raffin TA, Epstein AH et al. Pulmonary radiation injury. Chest 1997; 111: 1061–1077.

    Article  CAS  Google Scholar 

  17. Crump M, Smith AM, Brandwein J et al. High-dose etoposide and melphalan, and autologous bone marrow transplantation for patients with advanced Hodgkin's disease: importance of disease status at transplant. J Clin Oncol 1993; 11: 704–711.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Hematology and Oncology, University of California, Los Angeles, USA

    C Emmanouilides, C Wolf, S Scott & M Territo

  2. Department of Internal Medicine, University of California, Los Angeles, USA

    D J Asuncion

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  1. C Emmanouilides
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  2. D J Asuncion
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  3. C Wolf
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  4. S Scott
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  5. M Territo
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Correspondence to C Emmanouilides.

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Emmanouilides, C., Asuncion, D., Wolf, C. et al. Localized radiation increases morbidity and mortality after TBI-containing autologous stem cell transplantation in patients with lymphoma. Bone Marrow Transplant 32, 863–867 (2003). https://doi.org/10.1038/sj.bmt.1704238

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