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• W2024772911 abstract "Purpose/Objective(s)Patients with relapsed non-Hodgkin lymphoma (NHL) treated with hematopoietic cell transplantation (HCT) are often consolidated by involved-field radiation therapy (IFRT) targeting areas of disease resistant to conditioning. However, data are limited as to whether adding IFRT following total body irradiation (TBI)-containing HCT can prevent relapse. We analyzed the rates and patterns of recurrence and survival in patients undergoing IFRT in addition to TBI-containing HCT as compared to patients not receiving IFRT.Materials/MethodsWe reviewed all consecutive NHL patients who received TBI-containing myeloablative and non-myeloablative conditioning followed by either autologous or allogeneic HCT between January 1, 1990 and July 31, 2009. TBI dose for myeloablative HCT was typically 1320 cGy in eight twice-daily fractions, and that for non-myeloablative HCT was 200 cGy in a single fraction. In patients undergoing multiple transplants (typically an allogeneic HCT following a failed autologous one), time to recurrence was calculated only with respect to the first transplant.ResultsOut of 398 eligible NHL patients, 248 received autologous and 150 allogeneic grafts. 35 and 12 patients received IFRT after autologous and allogeneic HCT, respectively. 51% of allogeneic transplants and all autologous transplants were myeloablative. IFRT was given for persistent disease ≥ 2 cm by CT or to sites otherwise suspicious for NHL involvement at the 28 day follow-up. The cumulative incidences of relapse at 1- and 5- years were 39% and 50% following autologous HCT without IFRT (n = 213) compared to 37% and 43% with IFRT (n = 35, p = 0.80; p = 0.46). For allogeneic HCT, 1- and 5- year relapse rates were 28% and 31% without IFRT (n = 138) compared to 17% and 25% with IFRT (n = 12, p = 0.37; p = 0.58). Of 113 (auto) and 40 (allo) patients not treated with IFRT who relapsed, in 37% (auto) and 56% (allo) their first recurrence included a site of prior nodal disease. Of eight (auto) and four (allo) patients treated with IFRT who relapsed, 38% (auto) and zero (allo) patients had a first relapse in an irradiated site. There was a non-significant trend toward improved overall survival in the small subgroup of myeloablative, allo patients receiving (n = 6) vs. not receiving (n = 68) IFRT, 100% vs. 56% at 1 year (p = 0.06) and 83% vs. 46% at 5 years (p = 0.12).ConclusionsWhile consolidative IFRT can be an effective tool for local control in patients with high-risk NHL in other settings, we demonstrate no significant benefit in relapse rate, progression-free survival, or overall survival in patients receiving IFRT following TBI-containing HCT. Purpose/Objective(s)Patients with relapsed non-Hodgkin lymphoma (NHL) treated with hematopoietic cell transplantation (HCT) are often consolidated by involved-field radiation therapy (IFRT) targeting areas of disease resistant to conditioning. However, data are limited as to whether adding IFRT following total body irradiation (TBI)-containing HCT can prevent relapse. We analyzed the rates and patterns of recurrence and survival in patients undergoing IFRT in addition to TBI-containing HCT as compared to patients not receiving IFRT. Patients with relapsed non-Hodgkin lymphoma (NHL) treated with hematopoietic cell transplantation (HCT) are often consolidated by involved-field radiation therapy (IFRT) targeting areas of disease resistant to conditioning. However, data are limited as to whether adding IFRT following total body irradiation (TBI)-containing HCT can prevent relapse. We analyzed the rates and patterns of recurrence and survival in patients undergoing IFRT in addition to TBI-containing HCT as compared to patients not receiving IFRT. Materials/MethodsWe reviewed all consecutive NHL patients who received TBI-containing myeloablative and non-myeloablative conditioning followed by either autologous or allogeneic HCT between January 1, 1990 and July 31, 2009. TBI dose for myeloablative HCT was typically 1320 cGy in eight twice-daily fractions, and that for non-myeloablative HCT was 200 cGy in a single fraction. In patients undergoing multiple transplants (typically an allogeneic HCT following a failed autologous one), time to recurrence was calculated only with respect to the first transplant. We reviewed all consecutive NHL patients who received TBI-containing myeloablative and non-myeloablative conditioning followed by either autologous or allogeneic HCT between January 1, 1990 and July 31, 2009. TBI dose for myeloablative HCT was typically 1320 cGy in eight twice-daily fractions, and that for non-myeloablative HCT was 200 cGy in a single fraction. In patients undergoing multiple transplants (typically an allogeneic HCT following a failed autologous one), time to recurrence was calculated only with respect to the first transplant. ResultsOut of 398 eligible NHL patients, 248 received autologous and 150 allogeneic grafts. 35 and 12 patients received IFRT after autologous and allogeneic HCT, respectively. 51% of allogeneic transplants and all autologous transplants were myeloablative. IFRT was given for persistent disease ≥ 2 cm by CT or to sites otherwise suspicious for NHL involvement at the 28 day follow-up. The cumulative incidences of relapse at 1- and 5- years were 39% and 50% following autologous HCT without IFRT (n = 213) compared to 37% and 43% with IFRT (n = 35, p = 0.80; p = 0.46). For allogeneic HCT, 1- and 5- year relapse rates were 28% and 31% without IFRT (n = 138) compared to 17% and 25% with IFRT (n = 12, p = 0.37; p = 0.58). Of 113 (auto) and 40 (allo) patients not treated with IFRT who relapsed, in 37% (auto) and 56% (allo) their first recurrence included a site of prior nodal disease. Of eight (auto) and four (allo) patients treated with IFRT who relapsed, 38% (auto) and zero (allo) patients had a first relapse in an irradiated site. There was a non-significant trend toward improved overall survival in the small subgroup of myeloablative, allo patients receiving (n = 6) vs. not receiving (n = 68) IFRT, 100% vs. 56% at 1 year (p = 0.06) and 83% vs. 46% at 5 years (p = 0.12). Out of 398 eligible NHL patients, 248 received autologous and 150 allogeneic grafts. 35 and 12 patients received IFRT after autologous and allogeneic HCT, respectively. 51% of allogeneic transplants and all autologous transplants were myeloablative. IFRT was given for persistent disease ≥ 2 cm by CT or to sites otherwise suspicious for NHL involvement at the 28 day follow-up. The cumulative incidences of relapse at 1- and 5- years were 39% and 50% following autologous HCT without IFRT (n = 213) compared to 37% and 43% with IFRT (n = 35, p = 0.80; p = 0.46). For allogeneic HCT, 1- and 5- year relapse rates were 28% and 31% without IFRT (n = 138) compared to 17% and 25% with IFRT (n = 12, p = 0.37; p = 0.58). Of 113 (auto) and 40 (allo) patients not treated with IFRT who relapsed, in 37% (auto) and 56% (allo) their first recurrence included a site of prior nodal disease. Of eight (auto) and four (allo) patients treated with IFRT who relapsed, 38% (auto) and zero (allo) patients had a first relapse in an irradiated site. There was a non-significant trend toward improved overall survival in the small subgroup of myeloablative, allo patients receiving (n = 6) vs. not receiving (n = 68) IFRT, 100% vs. 56% at 1 year (p = 0.06) and 83% vs. 46% at 5 years (p = 0.12). ConclusionsWhile consolidative IFRT can be an effective tool for local control in patients with high-risk NHL in other settings, we demonstrate no significant benefit in relapse rate, progression-free survival, or overall survival in patients receiving IFRT following TBI-containing HCT. While consolidative IFRT can be an effective tool for local control in patients with high-risk NHL in other settings, we demonstrate no significant benefit in relapse rate, progression-free survival, or overall survival in patients receiving IFRT following TBI-containing HCT." @default.
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• W2024772911 title "Involved-Field Radiation Therapy Following TBI-containing Myeloablative and Nonmyeloablative Conditioning Regimens in Hematopoietic Cell Transplant for Non-Hodgkin Lymphoma: No Impact on Relapse Rate" @default.
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