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(Radiology. 2000;214:421-425.)
© RSNA, 2000

Radiation Oncology

Hematologic Toxic Reaction to Radiation Therapy Adjuvant to Autologous Peripheral Blood Stem Cell Transplantation for Recurrent or Refractory Hodgkin Disease1

Jeffrey A. Bogart, MD, Carmen Ungureanu, MD, Samuel Ryu, MD, Chung T. Chung, MD and Kenneth W. Zamkoff, MD

1 From the Departments of Radiation Oncology (J.A.B., C.U., S.R., C.T.C.) and Medicine (K.W.Z.), State University of New York Health Science Center, 750 E Adams St, Syracuse, NY 13210. From the 1998 RSNA scientific assembly. Received March 5, 1999; revision requested April 28; revision received May 24; accepted June 14. Address reprint requests to J.A.B. (e-mail: bogartj@mailbox.hscsyr.edu).

PURPOSE: To evaluate the hematologic toxic reaction to external-beam radiation therapy after high-dose chemotherapy with peripheral blood stem cell (PBSC) support in patients with Hodgkin disease.

MATERIALS AND METHODS: A retrospective study of 30 cases of Hodgkin disease in patients who underwent high-dose carmustine, etoposide, and cyclophosphamide chemotherapy with PBSC support was performed. Thirteen patients underwent radiation therapy (28.8–39.0 Gy) a median of 45 days after PBSC repeat infusion.

RESULTS: Radiation therapy was delivered as planned, without interruption, in all patients. Five patients developed thrombocytopenia (one with grade 1 thrombocytopenia; two, grade 2; and two, grade 3) and included three with progressive disease prior to radiation therapy and two with a history of prior irradiation. None developed a bleeding complication or required transfusion support. Five patients who underwent irradiation had thrombocytopenia (three with grade 1 and two with grade 2) 100 days after PBSC repeat infusion, compared with three patients (two with grade 1 and one with grade 3) who did not undergo posttransplantation irradiation. At the most recent follow-up, no patient without evidence of disease had a platelet count of less than 100 x 109/L.

CONCLUSION: External-beam radiation therapy was well tolerated in the posttransplantation setting in patients with Hodgkin disease. Thrombocytopenia was common but was not related to clinical complications.

Index terms: Blood, platelets, 57.458, 57.47, 57.65 • Bone marrow, transplantation, 40.455 • Hodgkin disease, 99.8342 • Hodgkin disease, therapeutic radiology, 99.1299, 99.8342 • Hodgkin disease, therapy, 99.1299, 99.8342 • Stem cells