Total lymphoid irradiation as part of a salvage regimen for patients with unresponsive Hodgkin Lymphoma

The authors looked at the long-term results of total lymphoid irradiation for patients with relapsed or unresponsive Hodgkin lymphoma. The authors concluded that total lymphoid irradiation combined with high-dose chemotherapy is a safe and effective treatment for patients with relapsed or unresponsive Hodgkin lymphoma.

Hodgkin lymphoma (HL) is generally considered a curable disease. However, some patients will relapse or not respond to treatment. HL that does not respond to first-line therapy is known as refractory. Patients with relapsed or refractory HL must undergo more aggressive second-line treatment known as salvage therapy. Salvage therapy options include high-dose chemotherapy, radiation therapy, and stem cell transplantation.

Involved field radiation therapy (IFRT) has generally been used along with high-dose chemotherapy. However, relapses still often occur in previously involved sites, as well as in the lymph nodes nearest to the site. Total lymphoid irradiation (TLI) delivers radiation directly to the lymph nodes. It is not clear whether TLI combined with high-dose chemotherapy prior to stem cell transplantation is safe and effective in the long-term. 

This study looks at the outcomes of patients who receive salvage therapy that includes TLI.

The medical records of 186 patients with refractory or relapsed HL were reviewed. All patients received TLI as part of their salvage treatment. Patients first received salvage chemotherapy, followed by IFRT and TLI. Patients then underwent high-dose chemotherapy and stem cell transplantation. The average follow-up time was 57 months.

The average survival time was 13 years. The 5-year overall survival rate (time from beginning of treatment to death from any cause) was 68%. The 10-year overall survival rate was 56%.

The average event-free survival (time from start of treatment to relapse or other complication) was 12 years. The 5-year event-free survival rate was 62%. The 10-year event-free survival rate was 56%.

Patients treated after 1995 had improved overall survival because of the introduction of a new type of stem cell transplantation technique. 

Eight patients developed severe cardiac (heart) toxicities. Ten patients developed second cancers following treatment.

The authors concluded that salvage therapy including TLI is safe and effective, with excellent long-term outcomes for patients with relapsed or refractory Hodgkin lymphoma.