autologous blood and marrow transplantation - Blog Science ...

Schenkein et al. 189
Toxicity
Toxic effects occurred in 10 patients receiving IFRT after HDS chemotherapy
and PBSCT. Grade 3 toxicity occurred in three cases, all of which were
hematologic. These patients experienced a significant break in the course of their
radiation treatments (14-15 days) due to myelosuppression and required
transfusions and hematologic growth factors. There were no grade 4 or 5 toxicities.
Esophagitis was the most common form of toxicity recorded; however, all cases
were minor, grade 1 symptoms.
DISCUSSION
The International Non-Hodgkin's Lymphoma Prognostic Factors Project 18
identified four risk groups based on prognostic factors. The age-adjusted index
used advanced tumor stage, LDH level, and performance status to model the four
risk groups. The present study identified and treated newly diagnosed NHL patients
with two or three risk factors.
Several studies that incorporate high-dose therapy as part of initial therapy or in
first CR/PR have been reported with both positive and negative results. No trial has
directly compared early vs. late autotransplant, although the Parma trial clearly
demonstrates the utility of this modality in first chemosensitive relapse.
We have confirmed the extremely positive results reported by Gianni with a
high OS and RFS at extended follow-up for a cohort of high-risk untreated NHL
patients. We have also examined the role of involved-field x-ray therapy in this
patient population. Our preliminary results indicate that the addition of IFRT is
well tolerated in this group of patients with high-risk, newly diagnosed NHL.
While the small patient numbers limit the statistical power of this analysis, there
was nonetheless a strong trend toward improved RFS with the use of involved-field
radiation therapy. Additional studies, including the ongoing ECOG trial of CHOP
vs. HDS and initial PBPC transplantation, are needed to address the controversy of
early vs. late transplantation.
REFERENCES
l.Shipp MA, Klatt MM, Yeap B, et al.: Patterns of relapse in large cell lymphoma patients
with bulk disease: Implications for the use of adjuvant radiation therapy. J Clin Oncol
7:613-618,1989.
2.Schenkein D, Roitman D, Miller K, et al.: A phase II multicenter trial of high-dose sequen­
tial chemotherapy and peripheral blood stem cell transplantation as initial therapy for
patients with high-risk non-Hodgkin's lymphoma. Biol Blood Marrow Transplant
3:210-216,1997.