Lake Katherine E, Jackson Meredith, Hull Samantha, All Sean, Patel Akshat M, Li Xingzhe, Desai Neil B, Yilmaz Elif, Wolfe Heather, Zahid Mohammad Faizan, Li Hsiao-Ching, Awan Farrukh, Kozak Margaret M, Ramakrishnan Geethakumari Praveen, Kumar Kiran A
Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States.
Department of Hematology and Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States.
Front Oncol. 2025 Jul 31;15:1617087. doi: 10.3389/fonc.2025.1617087. eCollection 2025.
For indolent B-cell non-Hodgkin lymphomas (iNHLs), ultra-low-dose radiation therapy (ULDRT) with 4 Gy has demonstrated durable local control (70%), although distal relapses may occur. Concurrent systemic chemotherapy with radiation therapy (RT) extends progression-free survival (PFS) but is often avoided due to toxicity. We hypothesize that the combination of adaptive ULDRT, with repeat treatment as needed, and single-agent rituximab results in excellent local and systemic control with minimal toxicity.
We conducted an institutional review board (IRB)-approved retrospective review of patients with iNHLs (n=26) who were treated with both ULDRT and rituximab (four weekly doses of 375 mg/m2), either concurrently or within a short interval (median 16 days), at our institution from 2017 to 2024. Treatment response and disease control (local and distant) were measured by PET/CT. Overall survival (OS) and PFS were analyzed using the Kaplan-Meier method. Common Terminology Criteria for Adverse Events (CTCAE) v4 was used to record acute and long-term toxicities.
Overall response rate (ORR) at the first follow-up was 28/31 (90%), of which 19 sites (61%) achieved complete response (CR) and nine (26%) achieved partial response (PR). One (3%) patient had stable disease (SD). In our cohort, the 2-year in-field, out-of-field, and overall PFS rates were 91%, 78%, and 78%, respectively, and OS was 92%. No patient had disease transformation.
The combination of rituximab and ULDRT demonstrates sustained local and distant disease control with minimal side effects in iNHLs.
对于惰性B细胞非霍奇金淋巴瘤（iNHLs），4 Gy的超低剂量放射治疗（ULDRT）已显示出持久的局部控制效果（70%），尽管可能会发生远处复发。放疗（RT）联合全身化疗可延长无进展生存期（PFS），但由于毒性作用，这种联合治疗常常被避免。我们推测，根据需要重复治疗的适应性ULDRT与单药利妥昔单抗联合使用，可在毒性最小的情况下实现出色的局部和全身控制。
我们对2017年至2024年期间在本机构接受ULDRT和利妥昔单抗（4个每周剂量，375 mg/m²）治疗的iNHL患者（n = 26）进行了一项经机构审查委员会（IRB）批准的回顾性研究。这些患者接受的是同步治疗或在短时间间隔内（中位间隔16天）接受治疗。通过PET/CT测量治疗反应和疾病控制情况（局部和远处）。采用Kaplan-Meier方法分析总生存期（OS）和无进展生存期（PFS）。使用不良事件通用术语标准（CTCAE）v4记录急性和长期毒性反应。
首次随访时的总缓解率（ORR）为28/31（90%），其中19个部位（61%）达到完全缓解（CR），9个部位（26%）达到部分缓解（PR）。1例（3%）患者疾病稳定（SD）。在我们的队列中，2年的野内、野外和总体无进展生存率分别为91%、78%和78%，总生存率为92%。没有患者发生疾病转化。
利妥昔单抗和ULDRT联合使用在iNHL中显示出持续的局部和远处疾病控制效果，且副作用最小。
