Evaluating long-term outcomes after radiation and stem cell transplantation for recurrent or unresponsive Hodgkin lymphoma

This study evaluated the long-term outcomes of patients with recurrent or non-responsive classical Hodgkin’s lymphoma (cHL) after undergoing radiation, chemotherapy, and autologous stem cell transplantation (autoSCT). This study concluded that total lymphoid irradiation (TLI) therapy before a bone marrow transplant can improve long-term survival outcomes for these patients.

Recurrent or unresponsive cHL remains challenging to treat. High-dose chemotherapy followed by a bone marrow transplant has been shown to improve survival outcomes for these patients. Radiation therapy may also be given after the transplant to help keep the cancer from coming back.

There are 2 main types of radiation therapy (RT). Involved-field RT targets specific areas of the body. This is a local radiation treatment. Total lymphoid irradiation (TLI) is a more widespread treatment. The long-term outcomes of TLI after autoSCT for patients with recurrent or unresponsive cHL remain under investigation.

This study involved 89 patients with recurrent or unresponsive cHL. All patients received high-dose chemotherapy followed by radiation therapy. Then, patients underwent autoSCT. Patients were followed-up for an average of 4 years. Patients had PET/CT scans before and after treatment.

After chemotherapy, 50.6% of patients had a disappearance of all signs of cancer (complete response). Overall, patients survived for an average of 47.9 months after transplant. At 5 years, 72.8% of patients were still alive. At 10 years, this rate was 68.0%. 73.3% of patients were still alive 5 years later without tumor growth or spread. At 10 years, this rate was 68.5%.

Significantly more patients who had a complete response were still alive 5 years later compared to patients who did not (90.0% vs. 63.5%). At 10 years, this rate was 90.9% vs. 57.6%. Achieving a complete response after chemotherapy was associated with a 92% lower risk of mortality, and an 82% lower risk of tumor growth or spread.

Overall, 22.5% of patients experienced treatment failure at an average of 6.1 months after transplant. At an average of 5.6 years after transplant, 8 patients developed secondary cancer.

This study concluded that TLI therapy before a bone marrow transplant can improve long-term survival outcomes for patients with recurrent or unresponsive cHL.

This study was retrospective, meaning it looked back in time to analyze data. Also, this study involved a small number of patients. More studies are needed to confirm these results.