title: Consolidative Radioimmunotherapy After Chemoimmunotherapy in Patients With Histologic Transformation of Indolent Non-Hodgkin Lymphoma.
abstract: BACKGROUND
  Histologic transformation (HT) of indolent non-Hodgkin lymphomas is an event that results in considerable morbidity and mortality. The introduction of chemoimmunotherapy regimens has resulted in an improvement in the management of this disease, and consolidation of responses with autologous stem cell transplantation appears efficacious. Many patients are not eligible for high-dose therapy, however. Radioimmunotherapy (RIT) has demonstrated single-agent efficacy in HT and can be used safely as consolidation after chemoimmunotherapy. For these reasons, RIT consolidation after chemoimmunotherapy induction has been our standard treatment approach at the University of Rochester for patients with HT who were ineligible for autologous stem cell transplantation.
  
  
  METHODS
  A retrospective cohort study was performed to describe the clinical outcomes of these patients. Twenty-one patients were identified who received RIT consolidation. The Kaplan-Meier method was used to estimate the distributions of overall survival and progression-free survival. Comparisons were made between patients with pathologic HT and the combination of clinical HT and composite lymphoma using the log-rank test to compare survival curves.
  
  
  RESULTS
  The median overall survival of the cohort was 84 months, and progression-free survival was 38 months. The major toxicity was myelosuppression, and 2 deaths were attributed to therapy. One case of therapy-related acute myeloid leukemia was noted.
  
  
  CONCLUSIONS
  In a population of patients ineligible for high-dose therapy with autologous stem cell support, consolidation of response to chemoimmunotherapy with RIT was well tolerated and should be considered in patients with disease responsive to induction therapy.
authors.affiliation: Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY. Electronic address: patrick_reagan@urmc.rochester.edu.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Reagan
authors.affiliation: Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY.
authors.forename: Andrea
authors.initials: A
authors.lastname: Baran
authors.affiliation: Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Kelly
authors.affiliation: Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Barr
authors.affiliation: Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY.
authors.forename: Carla
authors.initials: C
authors.lastname: Casulo
authors.affiliation: Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY.
authors.forename: Vaseem U
authors.initials: VU
authors.lastname: Chengazi
authors.affiliation: Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY.
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Friedberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002423:Cause of Death; D002471:Cell Transformation, Neoplastic; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007167:Immunotherapy; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016499:Radioimmunotherapy / Q000379:methods; D019233:Retreatment; D012189:Retrospective Studies; D016019:Survival Analysis
keywords: (131)I-tositumomab; (90)Y-ibritumomab tiuxetan; indolent lymphoma; radioimmunoconjugate; transformed lymphoma