Leukemia/Lymphoma/Hematologic

SS 35 - Hematologic 3 -?Translating Better Technology to Improved Outcome in Primary and Relapsed Disease

256 - Patterns of Failure and Survival Outcomes After Total Lymphoid Irradiation and High-Dose Chemotherapy With Autologous Stem-Cell Transplantation for Relapsed or Refractory classical Hodgkin's Lymphoma

Wednesday, October 24
8:35 AM - 8:45 AM
Location: Room 007 A/B

Patterns of Failure and Survival Outcomes After Total Lymphoid Irradiation and High-Dose Chemotherapy With Autologous Stem-Cell Transplantation for Relapsed or Refractory classical Hodgkin’s Lymphoma
N. Paudel1, D. Schulze2, I. B. Helenowski3, L. Gordon4, J. Winter2, E. D. Donnelly5, and B. B. Mittal6; 1Northwestern Feinberg School of Medicine, Chicago, IL, 2Northwestern Memorial Hospital, Chicago, IL, 3Department of Preventive Medicine, Division of Biostatistics, Northwestern University, Chicago, IL, 4Northwestern Memorial Hospital, CHICAGO, IL, 5Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, 6Northwestern University, Chicago, IL

Purpose/Objective(s): We report the patterns of failure based on post salvage PET/CT scan and long-term outcomes of patients with relapsed or refractory classical Hodgkin’s lymphoma (cHL) treated with total lymphoid irradiation (TLI) and high-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (aHSCT).

Materials/Methods: Patients who previously received no more than 20 Gy of radiation and had biopsy-proven primary refractory or relapsed cHL were eligible. All patients received TLI, administered twice daily at 150 cGy, 5d each week, for a total of 10d prior to high-dose chemotherapy and aHSCT. The patterns of failure were delineated after fusing treatment planning CT to the post treatment imaging study that reported the first failure. Survival rates were computed via the Kaplan-Meier method; from the day of aHSCT. Multivariate analysis using proportional hazards regression was done to determine prognostic factors for overall survival (OS), disease specific survival (DSS), progression free survival (PFS) and event free survival (EFS).

Results: Between 1993 and 2016, 89 patients with relapsed/refractory cHL were treated with TLI, chemotherapy followed by aHSCT. Median follow up from the date of the transplant was 4 years (range 22 days to 22.5 years). There were total of 20 failures after aHSCT. Post treatment imaging studies were available for 16 of those patients that showed 43 different sites of failures. Eight failures were completely outside the radiation fields, 30 sites of failure were infield (13 were completely within IFRT field of >30Gy) and 5 sites were both inside and outside of the RT fields. Thirteen failures (30.2%) within the IFRT fields were the site of initial relapse after the induction therapy. Eleven failures were extra-nodal that included spleen, lungs, liver and bone. The median time from transplant to failure was 6.1 m (2.1-18.8 m). The median OS was 47.9 months (range, .7- 265.9m). The 5, 10 and 15 yr. OS rates were 72.8%, 67.96% and 58.25% respectively; DSS rates were 84.54%, 78.66% and 78.66% respectively; and PFS rates were 73.3%, 68.49% and 58.71% respectively. There were 28 combined events and the 5, 10 and 15 yr. EFS was 72.26%, 67.48% and 57.84% respectively. Complete response to salvage chemotherapy based on PET/CT was associated with statistically significant improved OS, PFS and DSS on multivariate analysis.

Conclusion: Survival rates are excellent following salvage TLI-chemotherapy-transplant, which indicates the efficacy of this regimen in controlling the disease in patients with relapsed or refractory cHL. The majority of the patients who failed after TLI and aHSCT did so within 6 months from transplant; mostly within the irradiated volume reflecting the aggressive, treatment resistant disease biology. TLI should continue to be part of the salvage treatment regimen and PET/CT should be utilized for treatment response evaluation. New strategies and novel systemic therapies should be explored to combat radio-resistant biology of tumor.

Author Disclosure: N. Paudel: None. D. Schulze: None. I.B. Helenowski: None. E.D. Donnelly: None. B.B. Mittal: None.

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256 - Patterns of Failure and Survival Outcomes After Total Lymphoid Irradiation and High-Dose Chemotherapy With Autologous Stem-Cell Transplantation for Relapsed or Refractory classical Hodgkin's Lymphoma



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