Radiation myelopathy following transplantation and radiotherapy for non-Hodgkin's lymphoma.
BACKGROUND
Combined modality therapy with chemotherapy and radiotherapy has become increasingly popular in the management of solid malignancies. However, unexpected toxicities may arise from their interactions.


METHODS
We report the case of a young woman with a large mediastinal non-Hodgkin's lymphoma who underwent high-dose chemotherapy with autologous bone marrow transplantation and involved field radiotherapy, and who developed radiation myelopathy after a latent period of only 3 months. The spinal cord dose did not exceed 40.3 Gy in 22 fractions over 4.5 weeks, which is well within accepted tolerance limits. She had no other identifiable risk factors for radiation myelopathy, suggesting an adverse drug-radiation interaction as the most likely cause of her injury.


CONCLUSIONS
This represents the first report of radiation myelopathy at accepted safe radiation doses following high-dose chemotherapy with autologous bone marrow transplantation, and we recommend caution in the choice of radiotherapeutic dose in this setting.
Division of Radiation Oncology, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia.
M W
MW
Chao
A
A
Wirth
G
G
Ryan
M
M
MacManus
K H
KH
Liew
D000328:Adult; D016026:Bone Marrow Transplantation; D005260:Female; D006801:Humans; D016393:Lymphoma, B-Cell / Q000532:radiotherapy*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000532:radiotherapy*; D008479:Mediastinal Neoplasms / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000209:etiology*; D011879:Radiotherapy Dosage; D012016:Reference Values; D013116:Spinal Cord / Q000528:radiation effects*; D013997:Time Factors