Salvage Chemotherapy Versus Radiation Therapy in Diffuse Large B-Cell Lymphoma

By Patrick Daly - Last Updated: February 24, 2022

According to a study published in the International Journal of Radiation Oncology, Biology, Physics, approximately 50% of patients with relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL) will relapse after undergoing autologous stem cell transplant (ASCT). The researchers, led by Colton Ladbury, MD, assessed the unclear role of salvage radiation therapy (RT) in this population and observed that “patients who received RT as first salvage therapy post-ASCT, particularly with localized disease, had favorable oncologic outcomes.”

The retrospective review included a total of 165 patients with DLBCL who underwent ASCT and subsequently relapsed. Clinical and pathologic characteristics, as well as detailed post-ASCT treatment data, were used for assessing the response rate and safety of various salvage therapy approaches.

Among the identified patients, 91 received salvage chemotherapy as their first-line therapy after relapse, while 14 received salvage radiation. The median salvage RT dose was 36 Gy (range = 24-50). The objective response rates for salvage chemotherapy and RT were 53.0% and 78.5%, respectively (p = 0.07), while the complete response rates were 31.3% and 57.1%, respectively (p = 0.06). According to the authors, the median overall survival in patients who received salvage RT was significantly greater among those who received chemotherapy (p = 0.008), though median progression-free survival was not significantly different between the two groups.

Ultimately, the authors gave the advantage to RT over chemotherapy as a first-line salvage therapy in patients who underwent ASCT. In closing, they added that “future studies are needed to understand which patients with R/R DLBCL who relapse after ASCT may benefit from early salvage RT versus chemotherapy.”

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