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The role of radiotherapy as salvage and/or consolidation treatment in relapsed/refractory and high‐risk diffuse large B‐cell lymphoma
Author(s) -
Grignano Eric,
Laurent Jérémy,
Deau Bénédicte,
Burroni Barbara,
Bouscary Didier,
Kirova Youlia M.
Publication year - 2018
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.13080
Subject(s) - medicine , salvage therapy , radiation therapy , lymphoma , refractory (planetary science) , chemotherapy , diffuse large b cell lymphoma , retrospective cohort study , oncology , surgery , gastroenterology , physics , astrobiology
Objective Many salvage therapies have been proposed for relapsed/refractory (R/R) diffuse large B‐cell lymphomas or for consolidation in the case of suboptimal response. Radiotherapy ( RT ) is one modality of salvage therapy, but its place is currently not well defined. Method This study reports a retrospective review of patients receiving unplanned radiotherapy for R/R diffuse large B‐cell lymphoma ( DLBCL ) or primary mediastinal B‐cell lymphoma ( PMBCL ), or as consolidation therapy after second‐line chemotherapy, treated in our hospital. Results Fifty‐one patients with a median age of 53.5 years [19‐89] were selected. The histologic type was DLBCL in 35 cases (68%), PMBCL in 8 cases (16%), and secondary transformed NHL in 8 cases (16%). Median aa IPI was 1 [0‐4], and 17 patients (33%) had a high tumor burden (bulky disease). Sixteen patients (31%) were irradiated for a response considered to be insufficient, 18 patients (36%) were refractory, and 17 patients (33%) had relapsed. Patients were irradiated with a median dose of 40 Gy [15‐44], 29 (57%) by a conformal 3D technique and 22 (43%) by tomotherapy. With a median follow‐up of 36 months [1.0‐127.8] after irradiation, 5‐year progression‐free survival ( PFS ) and overall survival ( OS ) were 62% and 72%, respectively. In multivariate analysis, adverse factors associated with PFS and OS in our cohort were age >70 years ( HR = 5.06, P = .02) and post‐ RT relapse ( HR = 12.24, P = .002), whereas favorable factors were number of lines of chemotherapy <3 ( HR = 0.02, P = .03) and bulky disease ( HR = 0.02, P = .009). Conclusion Due to its low toxicity and ease of use, radiotherapy should therefore remain an available option in patients with R/R DLBCL or as consolidation therapy in patients with high‐risk disease, mostly in patients with chemo‐sensitive disease or bulky disease.