Salvage central lymphatic irradiation in follicular lymphomas following failure of chemotherapy: A feasibility study

Purpose: Management of follicular lymphoma after chemotherapy failure has b een controversial and has ranged from watchful waiting to high-dose chemoth erapy. High-dose chemotherapy,vith bone marrow reconstitution may produce c linical and molecular complete responses at the risk of serious morbidity a nd mortality. It has been previously reported that central lymphatic irradi ation (CLI) can achieve long-term relapse-free survival in patients with St age I, II, or III follicular lymphoma. Therefore, we investigated the feasi bility of treating patients in whom front-line chemotherapy failed with sal vage CLI instead of instituting more intensive chemotherapy, Methods and Materials: Salvage CLI with curative intent for patients,vith f ollicular lymphoma was started at The University of Texas M, D, Anderson Ca ncer Center in 1992, Eleven patients whose disease showed poor response to or relapsed after chemotherapy were managed with this approach. The median age of the patients was 61 years. Criteria for exclusion included bone marr ow involvement or other evidence of Ann Arbor Stage IV disease at any time during the course of the disease. Overall survival and relapse-free surviva l were calculated from the first day of CLI, Results: Ten patients were alive at a median follow-up of 25 months (range 9-73 months). The treatment was well tolerated in general. Two patients cou ld not complete CLI: one 75-year-old patient owing to prolonged platelet co unt depression and deterioration in general medical condition, and a 66-yea r-old patient because of exacerbation of preexisting pancytopenia and worse ning of heart disease. Everyone who completed CLI remains in remission at t he time of this report, except for one patient who had a relapse in the rig ht lacrimal gland at 32 months. This patient was treated with local radiati on therapy and is free of disease. Eventual recovery of the blood counts wa s observed for the patients who completed CLI, Conclusion: These results demonstrate for the first time that,vith CLI, it is possible to achieve complete remission of acceptable quality in follicul ar lymphoma patients who experience a chemotherapy failure. The main toxici ty is limited to transient depression in hematological profiles. The treatm ent is fairly well tolerated and seems to carry little risk compared with h igh-dose chemotherapy and bone marrow rescue. Salvage CLI may not necessari ly compromise future treatment with chemotherapy, including autologous bone marrow or stem cell transplantation, because the patients' blood counts re cover. (C) 1999 Elsevier Science Inc.