The role of consolidative radiotherapy following autologous hematopoietic cell transplantation for the treatment of relapsed or refractory Hodgkin lymphoma
Menée à partir de données portant sur 80 patients atteints d'un lymphome hodgkinien réfractaire aux traitements ou récidivant traité entre 2005 et 2014 (durée médiane de suivi : 25 mois), cette étude évalue, du point de vue de la survie sans progression et de la survie globale à 2 ans, l'intérêt d'ajouter une radiothérapie de consolidation à un traitement comportant une chimiothérapie à haute dose et une greffe autologue de cellules souches hématopoïétiques
Purpose : To evaluate the role of the addition of consolidative radiotherapy following high-dose chemotherapy and autologous hematopoietic cell transplantation (AHCT) for relapsed or refractory Hodgkin lymphoma (HL). Methods and Materials : Medical records were reviewed from a total of 80 consecutive patients who underwent high-dose chemotherapy with AHCT treated under a single protocol at XXXX between 11/2005 – 1/2014. Of these, 32 patients received radiotherapy following AHCT as planned consolidation. Results : At a median follow-up of 25 months, the 2-year overall survival (OS) and progression-free survival (PFS) for the entire cohort was 96% and 52%, respectively. Consolidative radiotherapy was found to significantly improve the 2-year PFS (67% vs 42%, p<0.01) without a significant change in OS (100% vs 93%, p=0.15). On subgroup analysis, consolidative radiotherapy was shown to improve PFS in patients with bulky disease (62% vs 39%, p=0.02), B-symptoms (48% vs 28%, p=0.05), primary refractory disease (47% vs 32%, p=0.02) and those with a partial response on pre-transplant imaging (47% vs 32%, p=0.02). The improvement seen on 2-year PFS with consolidative radiotherapy remained significant on multivariate analysis (HR 4.64, 95% CI 1.98 – 10.88). Minimal toxicity was observed among the patients receiving radiotherapy. Conclusion : The addition of consolidative radiotherapy following high-dose chemotherapy and AHCT demonstrated a significant improvement in 2-year PFS and no impact on OS. Radiotherapy was well tolerated with minimal toxicity. Our study supports a role of consolidative radiotherapy in patients with HL treated with AHCT.
http://www.redjournal.org/article/S0360-3016(17)30904-5/fulltext