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. 2024 Sep 27;9(12):101648.
doi: 10.1016/j.adro.2024.101648. eCollection 2024 Dec.

Ultra-Low-Dose Radiation for Extranodal Marginal Zone Lymphoma of the Lung

Susan Y Wu  1 , Penny Q Fang  1 , Ahmed Fetooh  2 , Gohar S Manzar  1 , Kelsey L Corrigan  1 , Benjamin R Schrank  1 , Lewis Nasr  3 , Dai Chihara  2 , Luis E Malpica Castillo  2 , Ranjit Nair  2 , Raphael E Steiner  2 , Preetesh Jain  2 , Sattva S Neelapu  2 , Paolo Strati  2 , Loretta J Nastoupil  2 , Bouthaina S Dabaja  1 , Chelsea C Pinnix  1 , Jillian R Gunther  1
Affiliations

Ultra-Low-Dose Radiation for Extranodal Marginal Zone Lymphoma of the Lung

Susan Y Wu et al. Adv Radiat Oncol. .

Abstract

Purpose: Definitive intent radiation therapy (RT) for early-stage mucosa-associated lymphoid tissue (MALT) lymphoma typically includes a dose of 24 to 30 Gy. While modest, these doses may have associated toxicity. For patients with indolent B-cell lymphoma, there is increasing support for the use of ultra-low-dose RT (ULDRT) using 4 Gy in 2 fractions as part of a response-adapted approach, as high rates of complete response have been documented. This paradigm has been prospectively evaluated in the management of orbital and gastric indolent B-cell lymphomas; however, there is limited data guiding the use of ULDRT for lung MALT.

Methods: We conducted a retrospective review of 20 patients at our institution with lung MALT treated with ULDRT as part of a response-adapted approach. Clinical variables including prior systemic therapy and symptoms were abstracted from the electronic health record. Responses were assessed using the revised Lugano criteria.

Results: At a median follow up of 17 months following 4 Gy (IQR, 8-37 months), we observed 100% local control. Nineteen patients (95%) experienced a complete response. No patients with stage IE disease at RT (17/20; 85%) experienced distant progression. Nine patients (45%) were symptomatic prior to RT, with improvement or resolution of symptoms in 7 (7/9; 78%). One patient developed grade 2 pleuritic pain following RT, which resolved with a brief course of steroids. No other toxicities were noted.

Conclusions: ULDRT, given in a response-adapted approach, is effective and well tolerated by patients with lung MALT.

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Conflict of interest statement

Bouthaina S. Dabaja reports research support from Seattle Genetics. Dai Chihara reports grants from BMS, Genmab, Morphosys, Ono, and Ipsen. He reports honoraria from Ono and BeiGene. Loretta J. Nastoupil reports grants from BMS, Caribou Biosciences, Epizyme, Genentech, Inc, Gilead/Kite, IGM Bioscience, Janssen, Novartis, and Takeda. She reports consulting fees from Sirpant and Interius BioTherapeutics and honoraria from ADC therapeutics, Atara, BMS, Caribou Biosciences, Epizyme, Genentech Gilead/Kite, Janssen, Novartis, and Takeda, and payment for expert testimony from Genentech, Inc/F. Hoffman-La Roche Ltd. Paolo Strati reports grants from AstraZeneca-Acerta, ADC Therapeutics, and ALX Oncology, and consulting fees from Roche-Genentech, Kite Gilead, Hutchinson Medipharma, AstraZeneca-Acerta, Sobi and TB Therapeutics, and ADC Therapeutics. Susan Y. Wu reports grants from Kite/Gilead, and consulting feeds RadOnc Questions. Sattva S. Neelapu reports grants from Kite/Gilead, BMS, Allogene, Precision Biosciences, Adicet Bio, Sana Biotechnology, and Cargo Therapeutics. He reports consulting fees from Kite/Gilead, Merck, Sellas Life Sciences, Athenex, Allogene, Incyte, Adicet Bio, BMS, Bluebird Bio, Fosun Kite, Sana Biotechnology, Caribou, Astellas Pharma, Morphosys, Janssen, Chimagen, ImmunoACT, Orna Therapeutics, Takeda, Synthekine, Carsgen, Appia Bio, and GlaxoSmithKline. He reports stock from Longbow Immunotherapeutics and intellectual property related to cell therapy. Preetesh Jain reports grants from Seagen, BMS, Rafale Pharmaceuticals, and GSK. Raphael Steiner reports grants from Seagen, BMS, Rafale Pharmaceuticals, and GSK.

Figures

Figure 1
Figure 1
A 47-year-old man with a history of recurrent lung infections refractory to antibiotics and biopsy-proven lung mucosa-associated lymphoid tissue lymphoma (A) prior to therapy, (B) after weekly rituximab × 4 with improvement, (C) subsequent progression on positron emission tomography (PET)/computed tomography (CT), (D) with slight improvement following a 3-month trial of zanubrutinib, which was discontinued due to hemoptysis. He had a biopsy redemonstrating mucosa-associated lymphoid tissue lymphoma prior to (E) ultra–low-dose radiation therapy, 4 Gy in 2 fractions, with (F) a complete metabolic response on PET/CT 2 months later with a Deauville score of 2, and (G) ongoing response 26 months following radiation.
See this image and copyright information in PMC

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