RADIATION MYELOPATHY FOLLOWING TRANSPLANTATION AND RADIOTHERAPY FOR NON-HODGKINS-LYMPHOMA

Background: Combined modality therapy with chemotherapy and radiothera py has become increasingly popular in the management of solid malignan cies. However, unexpected toxicities may arise from their interactions . Methods and Materials: We report the case of a young woman with a la rge mediastinal non-Hodgkin's lymphoma who underwent high-dose chemoth erapy with autologous bone marrow transplantation and involved field r adiotherapy, and who developed radiation myelopathy after a latent per iod of only 3 months. The spinal cord dose did not exceed 40.3 Gy in 2 2 fractions over 4.5 weeks, which is well within accepted tolerance li mits. She had no other identifiable risk factors for radiation myelopa thy, suggesting an adverse drug-radiation interaction as the most like ly cause of her injury. Results and Conclusions: This represents the f irst report of radiation myelopathy at accepted safe radiation doses f ollowing high-dose chemotherapy with autologous bone marrow transplant ation, and we recommend caution in the choice of radiotherapeutic dose in this setting. (C) 1998 Elsevier Science Inc.