Impact of peri-transplant consolidative radiotherapy in patients with relapsed or refractory classical Hodgkin lymphoma.
Following salvage chemotherapy (SC) and autologous stem-cell transplantation (ASCT), 30-60% of patients with relapsed/refractory Hodgkin lymphoma (r/rHL) experience disease relapse. Appropriate patient selection for consolidation radiotherapy (cRT) may improve outcomes. Positron-emission tomography (PET) is a powerful prognostic tool, with potential utility in PET-directed therapy. Predictive roles of post-SC metabolic and structural response assessments, and prognostic impact of peri-transplant cRT, were retrospectively evaluated in r/rHL patients from two tertiary hospitals, median follow-up >5 years. Five-year progression-free survival (PFS) was 65% (95%CI 55-74%). Metabolic response post-SC significantly predicted PFS. For patients with complete metabolic response (CMR) post-SC, structural residuum ≥2 cm suggested inferior PFS. Potential PFS advantages from cRT were observed in all subgroups with limited-stage r/rHL, regardless of response post-SC. Peri-transplant cRT may abrogate the negative predictive value of non-CMR or residual masses ≥2 cm in CMR post-SC. In advanced-stage r/rHL, post-SC non-CMR predicted for poor outcomes, warranting prioritization of alternative salvage strategies.
Authors
Campbell Campbell, Minson Minson, Brown Brown, Chin Chin, Wirth Wirth, Hofman Hofman, MacManus MacManus, Seymour Seymour, Ritchie Ritchie, Dickinson Dickinson
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