Haematological toxicity of radiotherapy following high-dose chemotherapy and autologous bone marrow transplantation in patients with recurrent Hodgkin's disease

Abstract

17 patients with recurrent Hodgkin's disease received 21 courses of radiotherapy (RT) 1–23 months after high-dose chemotherapy and autologous bone marrow transplantation. WHO grade III–IV haematological toxicity, of median duration 38 days (range 4–236), was observed following 10 courses of radiotherapy in 9 patients. This haematological morbidity could be predicted with an 80.0% sensitivity when the pre-RT white cell count was < 5 × 10 9/l or the platelet count < 100 × 10 9/l. It occurred in 9 11 patients wth initial stage III–IV disease, including all 6 given extended radiotherapy fields, but in no patients with initial stage II disease ( χ 2 = 9.35, P < 0.005). Age, histology, the presence of B symptoms, performance status, previous radiotherapy or chemotherapy, the interval between autologous bone marrow transplantation and radiotherapy, the high-dose regimen used, and the radiotherapy dose or field size, did not appear to affect haematological toxicity. The median survival was 18 months from the date of starting radiotherapy. 7 patients remain alive and progression-free 8–51 months (median 21 months) after radiotherapy. Radiotherapy may contribute to durable remissions in patients with relapsed or residual Hodgkin's disease after autologous bone marrow transplantation, but significant haematological toxicity may be expected in those with mild pancytopaenia prior to radiotherapy, particularly with initial stage III or IV disease.