Radiation therapy salvage of Hodgkin's disease following chemotherapy failure

Leigh, Bryan R.; Fox, Kenneth A.; Mack, C.; Baier, Monika; Miller, Thomas P.; Cassady, J. Robert

doi:10.1016/0360-3016(93)90460-d

Cited by 43 publications

(18 citation statements)

References 31 publications

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“…It may be appropriate in selected patients with limited stage disease, relapse at sites of original disease only and who are considered poor candidates for intensive chemotherapy. The 5-year DFS in several series with salvage RT is around 40% (Leigh et al, 1993;Campbell et al, 2005). In another study the GHLSG (Josting et al, 2005b) found a 5-year FFS of 28% and OS 51%.…”

Section: Radiotherapymentioning

confidence: 96%

Management of relapsed and refractory classical Hodgkin lymphoma in children and adolescents

2010

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SummaryThere are a number of options for salvage treatment in children and adolescents with relapsed and refractory classical Hodgkin Lymphoma. These include salvage with standard dose chemotherapy, high dose chemotherapy with autologous stem cell transplant, allogeneic stem cell transplant or other novel approach. Radiotherapy has an important role in the salvage of some patients as part of a combined modality approach. This review outlines these salvage approaches and discusses whether the evidence from paediatric studies justifies a risk-adapted approach to salvage for individual patients or whether all patients should receive consolidation with high dose chemotherapy and autologous stem cell transplantation, which is often described as standard salvage management in adults. The important prognostic factors and how these may be used to allocate patients to standard versus high dose chemotherapy regimens are discussed. The role of allogeneic transplantation, novel agents and late effects will also be discussed.Keywords: paediatric, Hodgkin lymphoma, relapsed, refractory, salvage.The cure rates of first-line treatment for classical Hodgkin lymphoma (HL) in children are very high with the use of modern effective chemotherapy, often used in combination with involved field radiotherapy (IFRT). The most effective regimens achieve cure rates in excess of 90% for early stage and 80% for advanced stage disease, with equivalent outcomes for adolescents and children (Schellong et al, 1986(Schellong et al, , 1999Vecchi et al, 1993Vecchi et al, , 1997Hunger et al, 1994;Schellong, 1996;Donaldson & Link, 1997;Hutchinson et al, 1998;Dörffel et al, 2003;El-Badawy et al, 2008). Single modality radiotherapy (RT) is rarely used now as primary treatment due to unacceptable failure rates even in low stage patients (Shankar et al, 1997). Paediatric paradigms for primary treatment have evolved to reduce late effects whilst maintaining excellent cure rates (Hodgson et al, 2007), achieved by developing chemotherapeutic regimens that minimize late toxicity and, when given, RT is low dose (20-25 Gy) and involved field. Primary chemotherapy is allocated using a risk-adapted approach utilizing prognostic factors associated with primary treatment failure (Smith et al, 2003), and response to chemotherapy is under study to guide either the final number of chemotherapy cycles (Schwartz et al, 2009), or to limit or remove RT in patients who achieve complete remission with chemotherapy alone (Dörffel et al, 2003). Salvage therapy -general considerationsApproximately 10% of patients with early stage, and up to 25% with advanced stage disease, relapse after first line therapy (Donaldson et al, 2007;Schwartz et al, 2009). Cure may still be achieved in patients with recurrent disease and all should receive second-line standard dose salvage chemotherapy (SDCT). Salvage single modality RT is rarely used. There are no randomized trials in children defining the 'best' salvage chemotherapy regimen or comparing SDCT with high dose chemotherapy (HDCT) and...

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Section: Radiotherapymentioning

confidence: 96%

Management of relapsed and refractory classical Hodgkin lymphoma in children and adolescents

2010

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“…[11][12][13] Selected patients with local recurrence after chemotherapy can be successfully treated with radiation therapy. [14][15][16][17] Patients who recur after combination chemotherapy generally have a poor longterm prognosis; few achieve durable disease control. [18][19][20] High-dose chemotherapy (HDT) followed by autologous bone marrow (BM) or peripheral blood progenitor cell (PBPC) transplantation is commonly used for treatment of HL after failure of initial systemic chemotherapy treatment.…”

Section: Tation; Prognostic Factorsmentioning

confidence: 99%

Prognostic factors for disease progression after high-dose chemotherapy and autologous hematopoietic stem cell transplantation for recurrent or refractory Hodgkin's lymphoma

Popat

Hosing

Saliba

et al. 2004

Bone Marrow Transplant

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Summary:Our purpose was to study the risk factors associated with disease progression after high-dose chemotherapy followed by autologous stem cell transplantation in patients with recurrent or refractory Hodgkin's lymphoma (HL). We analyzed the long-term outcome of 184 patients with recurrent or refractory HL who underwent autologous hematopoietic stem cell transplantation. At the time of transplantation, 82 patients were in first relapse or second remission, 46 patients were refractory to the primary induction chemotherapy, and 56 patients were beyond first relapse or second remission. In 64 patients, the disease had proved refractory to the chemotherapy regimen administered immediately prior to transplantation. The median follow-up of patients who were alive and free of disease at the time of this report was 8.9 years (range, 0.1-19.0 years). At 10 years, the overall and disease-free survival rates were 34% (95% CI 27-42) and 29% (95% CI 22-36) respectively. The major cause of treatment failure was disease relapse. Chemotherapy resistance prior to transplantation, advanced stage, and higher number of chemotherapy regimens administered prior to transplantation were adverse prognostic factors for disease progression. We conclude that autologous transplantation is an effective salvage treatment for recurrent HL.

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“…Several lines of evidence support the use of IFRT with AuSCT for lymphomas: 2,22-24 (1) relapse following AuSCT most commonly occurs at sites of prior disease involvement in HD, aggressive NHL and follicular NHL, 3,6,14,15,[25][26][27][28][29] (2) relapse of lymphoma appears to be less common in sites receiving IFRT following AuSCT for HD and NHL, 3,6,8,15,30 (3) radiotherapy alone can salvage 25-50% of selected patients with HD after failure of initial chemotherapy, [31][32][33][34][35][36][37][38][39][40][41][42] (4) in series with short follow-up, IFRT has been reported to salvage some transplant failures for both HD and NHL 17,27,43 and (5) several retrospective series have demonstrated improved failure-free survival with the addition of IFRT to AuSCT for HD and NHL. [3][4][5][6][7][8]11 In two studies, the improvement in progressionfree survival associated with the use of IFRT was significant on multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

Optimal scheduling to reduce morbidity of involved field radiotherapy with transplantation for lymphomas: A Prospective Australasian Leukaemia and Lymphoma Group Study

Wirth

Prince

Wolf

et al. 2004

Bone Marrow Transplant

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Radiation therapy salvage of Hodgkin's disease following chemotherapy failure

Cited by 43 publications

References 31 publications

Management of relapsed and refractory classical Hodgkin lymphoma in children and adolescents

Management of relapsed and refractory classical Hodgkin lymphoma in children and adolescents

Prognostic factors for disease progression after high-dose chemotherapy and autologous hematopoietic stem cell transplantation for recurrent or refractory Hodgkin's lymphoma

Optimal scheduling to reduce morbidity of involved field radiotherapy with transplantation for lymphomas: A Prospective Australasian Leukaemia and Lymphoma Group Study

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