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Radiation myelitis following allogeneic stem cell transplantation and consolidation radiotherapy for non-Hodgkin's lymphoma

Bone Marrow Transplantation volume 26, pages 1355–1359 (2000)Cite this article

Abstract

Myelitis is a rare but well documented complication of therapeutic radiation exposure to the spinal cord and is characterized by delayed development of paresthesias, sensory changes and, in severe cases, progressive paresis and paralysis. Although accepted radiation tolerance limits for the spinal cord have successfully limited the incidence of this problem (45–50 Gy, in daily 1.8–2 Gy fractions), aggressive systemic therapy may render patients more susceptible to radiation-related neurotoxicity. We describe the case of a 38-year-old man with refractory non-Hodgkin's lymphoma who underwent matched sibling peripheral blood stem cell transplant following a conditioning regimen of cyclophosphamide (60 mg/kg × 2) and total body irradiation (120 cGy × 11). This was followed by delivery of 30.6 Gy involved-field radiation at 1.8 Gy/day to the mediastinum and left supraclavicular fossa for bulky residual tumor. Although maximum cumulative radiation dose to the spinal cord was less than 45 Gy, the patient subsequently developed progressive lower extremity weakness and MRI abnormalities of the spinal cord limited to the radiation field. This represents the second report in the literature of this unexpected complication, prompting a need to re-examine current guidelines for radiotherapy in the context of high-dose systemic treatment. Bone Marrow Transplantation (2000) 26, 1355–1359.

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Authors and Affiliations

  1. Department of Radiation Oncology, VA Puget Sound Health Care System, Seattle, USA

    DL Schwartz

  2. Department of Radiation Oncology, University of Washington, Seattle, WA, USA

    DL Schwartz

  3. Hematology Section, VA Medical Center, USA

    GP Schechter

  4. Radiology Service, VA Medical Center, USA

    S Seltzer

  5. George Washington University, Washington, DC, USA

    GP Schechter & S Seltzer

  6. Marrow Transplant Unit, VA Puget Sound Health Care System, Seattle, USA

    TR Chauncey

  7. Division of Oncology, University of Washington, Seattle, WA, USA

    TR Chauncey

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  1. DL Schwartz
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  3. S Seltzer
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  4. TR Chauncey
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Schwartz, D., Schechter, G., Seltzer, S. et al. Radiation myelitis following allogeneic stem cell transplantation and consolidation radiotherapy for non-Hodgkin's lymphoma. Bone Marrow Transplant 26, 1355–1359 (2000). https://doi.org/10.1038/sj.bmt.1702705

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