Friedberg J W, Neuberg D, Monson E, Jallow H, Nadler L M, Freedman A S
Department of Adult Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Biol Blood Marrow Transplant. 2001;7(8):446-53. doi: 10.1016/s1083-8791(01)80012-4.
External beam radiation therapy (XRT) is frequently used to treat refractory disease sites or consolidate remission in patients with relapsed non-Hodgkin's lymphoma (NHL) prior to autologous bone marrow transplantation (ABMT). We report the long-term outcome and toxicities associated with this therapy. We uniformly treated 552 patients with NHL with total body irradiation, high-dose chemotherapy, and anti-B-cell monoclonal antibody-purged ABMT. Of these patients, 152 received XRT to the mediastinum, abdomen, or pelvis (n = 102) or other sites (n = 50) prior to ABMT. In this nonrandomized series, there was no difference in progression-free survival between patients treated with XRT and those not treated with XRT. For patients with indolent histology, there was no difference in overall survival between patients treated with XRT and those not treated with XRT. For patients with aggressive histology, the median overall survival time was 64 months in the XRT patients and 79 months in the patients not treated with XRT (P= .09). The risk of acute transplantation-related deaths was not influenced by prior XRT (P = .68). Of patients who received XRT, 12.5% developed secondary myelodysplasia compared with 5.8% of patients not receiving XRT (P = .01). Patients receiving XRT to the mediastinum or axilla had a significantly higher risk of late respiratory death (P = .002). In conclusion, XRT allows refractory patients to become eligible for transplantation and experience a disease-free survival interval equivalent to that of patients who do not receive XRT. However, a higher incidence of non-relapse-associated deaths was observed in patients who received XRT. Future work should explore alternative conditioning strategies and altered timing of XRT, in an attempt to limit these late toxicities.
体外放射治疗（XRT）常用于治疗难治性疾病部位或在自体骨髓移植（ABMT）前巩固复发的非霍奇金淋巴瘤（NHL）患者的缓解状态。我们报告了这种治疗的长期结果和毒性。我们对552例NHL患者进行了全身照射、高剂量化疗和抗B细胞单克隆抗体清除的ABMT治疗。在这些患者中，152例在ABMT前接受了纵隔、腹部或骨盆（n = 102）或其他部位（n = 50）的XRT治疗。在这个非随机系列研究中，接受XRT治疗的患者和未接受XRT治疗的患者在无进展生存期方面没有差异。对于惰性组织学类型的患者，接受XRT治疗的患者和未接受XRT治疗的患者在总生存期方面没有差异。对于侵袭性组织学类型的患者，接受XRT治疗的患者中位总生存期为64个月，未接受XRT治疗的患者为79个月（P = 0.09）。急性移植相关死亡风险不受先前XRT治疗的影响（P = 0.68）。接受XRT治疗的患者中，12.5%发生了继发性骨髓发育异常，而未接受XRT治疗的患者为5.8%（P = 0.01）。接受纵隔或腋窝XRT治疗的患者发生晚期呼吸死亡的风险显著更高（P = 0.002）。总之，XRT使难治性患者有资格接受移植，并经历与未接受XRT治疗的患者相当的无病生存期。然而，在接受XRT治疗的患者中观察到非复发相关死亡的发生率更高。未来的工作应探索替代预处理策略和改变XRT的时间安排，以试图限制这些晚期毒性。
