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Low-dose radiation (4 Gy) with/without concurrent chemotherapy is highly effective for relapsed, refractory mantle cell lymphoma

Matthew S. Ning, Chelsea C. Pinnix, Bhavana V. Chapman, Jillian R. Gunther, Sarah A. Milgrom, Joseph D. Khoury, Preetesh Jain, Wendy Y. Chen, Onyeka N. Oriabure, Maria R. Badillo, L. Michael Wang and Bouthaina S. Dabaja

Article Figures & Data

Figures

  • Figure 1.

    Outcomes following LDRT (4 Gy). (A) FFLR at 2 and 4 months was 88.8% and 84.5%, respectively. (B) OS at 1 year following initial LDRT was 90% among the 19 patients. (C) PFS at 1 year following the last course of LDRT was 55%. Nine patients were progression-free at the time of analysis (with a median follow-up of 9.7 months), and 3 patients were completely off systemic therapy since last LDRT course.

Tables

  • Table 1.

    Clinical and treatment characteristics of all 98 sites of relapsed, refractory MCL treated with consolidative LDRT and associations with CR

    VariableNo. of sites (%)CR, univariateCR, multivariable
    HR (95% CI)P*HR (95% CI)P*
    Site
     Soft tissue63 (64)1.80 (1.12-2.90).0151.79 (1.11-2.89).018
     Non–soft tissue
      Nodal22 (22)
      GI7 (7)
      Orbit3 (3)
      Mucosal2 (2)
      Bone1 (1)
    No. of fractions
     2, ×2 Gy72 (73)1.17 (0.68-2.02).566
     1, ×4 Gy26 (27)
    RT modality
     Photons65 (66)0.68 (0.43-1.09).109
     Nonphotons
      Electrons32 (33)
      Orthovoltage1 (1)
    Diagnosis to LDRT
     ≥36 mo36 (37)0.73 (0.46-1.18).201
     <36 mo62 (63)
    Lesion size
     ≥3 cm47 (48)0.76 (0.48–1.21).2450.69 (0.43-1.10).120
     <3 cm51 (52)
    Histology
     Blastoid27 (28)0.78 (0.45-1.35).374
     Nonblastoid71 (72)
    Chemorefractory
     Yes, to ongoing74 (76)1.41 (0.86-2.32).1751.40 (0.84-2.32).194
     No, to ongoing24 (24)
    Ibrutinib-refractory
     Yes80 (82)1.10 (0.65-1.88).716
     No18 (18)
    Prior chemo
     >5 courses33 (34)0.97 (0.61-1.55).906
     ≤5 courses65 (66)
    Prior SCT
     Yes42 (43)0.92 (0.58-1.44).706
     No56 (57)
    Concurrent chemo
     Yes74 (76)1.26 (0.75-2.11).379
     No24 (24)
    Post-LDRT chemo
     Yes79 (81)0.99 (0.58-1.68).963
     No19 (19)
    • chemo, chemotherapy; CI, confidence interval; GI, gastrointestinal; HR, hazard ratio; SCT, stem cell transplantation.

    • * Cox proportional hazards for univariate and multivariable analyses of associations with outcomes.