autologous blood and marrow transplantation - Blog Science ...

188 Chapter 4: Lymphoma
diameter. Radiation was to be initiated 30-100 days after stem cell infusion.
Involved-field radiation therapy was used in 15 of the 27 patients (56%).
Radiotherapy was initiated following a median of 61 days (range 31-136) in the
15 patients receiving radiation as consolidative treatment after high-dose sequential
chemotherapy and autologous PBSCT. Involved-field radiation therapy was
delivered to two patients achieving CR, 10 patients achieving PR, and three
patients with persistent disease. Radiotherapy was delivered to a median of three
sites (range one to six) as defined by the Ann Arbor Staging Manual. Patients
received a median of 2400 cGy per site (range 1980-5400). Twelve patients did not
receive IFRT because of early posttransplant progressive disease («=2), no areas of
bulky disease (n=5), early complications (n=2), and unknown reasons («=3).
Toxicity resulting from radiotherapy was determined from medical chart review
and graded according to the ECOG system.
RESULTS
Overall and disease-free survival
The median follow-up for the entire cohort was 34 months (range 24—63) from
the initiation of HDS chemotherapy. The OS and relapse-free survival (RFS) for the
entire cohort were 73 and 58%, respectively. The overall survival was not significantly
altered by the use of IFRT. Relapse occurred in 11 of 27 patients (40%) at a
median of 108 days after PBSC infusion. Two of the patients with late relapses are
currently disease-free after undergoing either a second transplant or further
multiagent chemotherapy. The RFS was 72% for the IFRT group vs. 40% for the
group that did not receive IFRT (Z^O.08) at a median follow-up of 14 months.
Excluding four patients with small noncleaved non-Burkitt's and lymphoblastic
lymphoma, the OS and RFS were 82 and 78%, respectively.
Patterns of failure
Local failure, after IFRT, occurred in four of 15 patients (27%). Failure in the
radiation portal occurred in all three patients considered to have radiographic
persistent disease after HDS chemotherapy. One patient considered to have a CR
to treatment relapsed in the radiotherapy field. This patient had a high-grade
lymphoblastic lymphoma and relapsed both inside and outside of the radiation
field. The mean radiation dose in the group of patients with infield failure was 2434
cGy (range 2400-4580), and radiotherapy was initiated within an average of 67
days (range 42-93) from PBSC reinfusion. The mean radiation dose for the patients
without evidence of failure was 2929cGy (range 2000-5400), and radiation therapy
was initiated within an average of 58 days (range 31-105) from PBSC reinfusion.