The beneficial effect of splenic irradiation in frail patients with chronic lymphocytic leukaemia
A.M. Aalbers, M.F. Aarts, Y. Kusumanto, S.D. Krol, C.A.M. Marijnen, E.F.M. Posthuma
Voorzitter(s): prof. dr. Y. Smulders, VUmc, Amsterdam & dr. Y.W.J. Sijpkens, Bronovo Ziekenhuis, Den Haag
Woensdag 22 april 2015
15:00 - 16:00u
in Auditorium 2
Categorieën: parallelsessie (case reports/research)
Parallel sessie: Parallelsessie 2: Case reports/research
Background:
Chronic lymphocytic leukaemia (CLL) is a common hematologic malignancy that mainly occurs in the elderly population. The standard chemoimmunotherapy for young and fit symptomatic patients consists of fludarabine, cyclophosphamide, and rituximab, while for the less fit it consists of chlorambucil monotherapy or in combination with rituximab. In addition, drugs directly targeting the B-cell receptor signaling pathway are about to be added to the therapeutic armamentarium. All therapy options are palliative. Elderly CLL patients frequently have comorbidities, and sometimes even mild chemoimmunotherapy is not an option for palliation. Splenic irradiation (SI) was historically used as primary treatment of CLL.
Cases:
We report the incidence of comorbidities in CLL patients as present in the cancer registry of the Comprehensive Cancer Centre South (IKZ). We next present four elderly patients with symptomatic advanced stage CLL with multiple comorbidities who were unfit to undergo systemic chemoimmunotherapy. Instead, palliative SI was given consisting of 12 fractions of 0.5 Gy. All patients obtained good partial or complete hematologic response, with a dramatic reduction in leukocyte counts and normalisation of hemoglobin and thrombocyte levels. Treatment was well tolerated. Response duration was 17 and 20 months in two patients, after which a second course of SI was initiated with similar beneficial effect. Two other patients were well at last follow-up 6 and 10 months after start of radiotherapy.
Conclusion:
Our results show that, although an old tool, SI should not be forgotten as a potentially effective palliative treatment option in frail patients with symptomatic CLL.
