Peri-transplant radiotherapy in refractory or relapsed Hodgkin lymphoma patients undergoing autologous stem cell transplant: long term results of a retrospective study of the Fondazione Italiana Linfomi (FIL)
Menée à l'aide de données multicentriques 2004-2014 portant sur 131 patients atteints d'un lymphome hodgkinien récidivant ou réfractaire et ayant reçu une chimiothérapie de sauvetage (durée médiane de suivi : 60 mois ; 52 % d'hommes ; âge médian : 32 ans), cette étude analyse l'efficacité, du point de vue de la survie globale, de l'ajout d'une radiothérapie avant ou après une greffe autologue de cellule souches hématopoïétiques
Purpose: In this multicenter collaboration, we report real-world data in the largest published series of long-term outcomes for patients with relapsed/refractory (r/r) Hodgkin lymphoma (HL) treated with peri-transplant radiotherapy (pt-RT) and high-dose chemotherapy with autologous stem cell transplant (ASCT). Materials/Methods: We conducted a retrospective analysis, including data from 12 institutions. Eligibility required histological diagnosis of HL, receipt of ASCT plus pt-RT between 2004-2014 for r/r HL, and age
≥
18 years at time of ASCT. All patients received salvage chemotherapy for maximum debulking prior to ASCT. Metabolic responses were scored according to the Lugano Classification. The primary endpoint was overall survival (OS). Univariate and Multivariate (MVA) Cox proportional hazards were calculated to estimate the effect of covariates on patients’ outcome. Results: 131 patients were eligible: 68 (52%) were male, median age at ASCT was 32 (range, 18-70) years. At time of diagnosis with r/r HL, 92 (70%) patients had limited (stage I-II) disease, and 10 (8%) patients had bulky disease. Pt-RT was given pre-ASCT in 32 patients (24%) and post-ASCT in 99 (76%); median prescribed dose was 30.6 Gy (range, 20-44 Gy). With median follow-up of 60 months, 3- and 5-year OS were 84% and 77%, while 3- and 5-year PFS were 75% and 72%, respectively. On MVA, advanced stage at relapse (HR 2.18, p=0.04), irradiation of >3 sites (HR 3.69, p=0.01), and incomplete metabolic response after salvage chemotherapy (HR 2.24, p=0.01) had a negative impact on OS. The sequencing of pt-RT (pre- vs post-ASCT) did not affect outcome. Conclusion: Overall, the addition of pt-RT to ASCT for patients with r/r HL is associated with very good outcomes. Limited relapsed disease with
≤
3 sites involved, and achievement of complete metabolic response after salvage chemotherapy, were predictive of more favorable prognosis.
International Journal of Radiation Oncology, Biology, Physics 2023