S519
Clinical - Haemotology
ESTRO 2026
Digital Poster 4298
RADIATION THERAPY AS A BRIDGING STRATEGY BEFORE CAR T-CELL INFUSION IN NON-HODGKIN LYMPHOMA Simonetta Saldi 1 , Federico Camilli 2 , Gianluca Ingrosso 3 , Anna Giulia Becchetti 4 , Leonardo Flenghi 5 , Loredana Ruggeri 1 , Vincenzo Maria Perriello 6 , Antonio Pierini 7 , Maria Paola Martelli 6 , Cynthia Aristei 8 1 Department of Medicine and Surgery, Radiation Oncology Section,Perugia University Hospital, Perugia, Italy. 2 Department of Medicine and Surgery,, Radiation Oncology Section,University Of Perugia, Perugia, Italy. 3 Department of Medicine and Surgery,, adiation Oncology Section, University of Perugia, Perugia, Italy. 4 Department of Medicine and Surgery, Radiation Oncology Section,Perugia University Hospital, Perugia, Italy. 5 Department of Medicine and Surgery, nstitutes of Hematology,Perugia University Hospital, Perugia, Italy. 6 Department of Medicine and Surgery, Institute of Hematology, Center for Hemato-Oncological Research (CREO), University of Perugia, Perugia, Italy. 7 Department of Medicine and Surgery, Institute of Hematology ,Center for Hemato-Oncological Research (CREO), University of Perugia, Perugia, Italy. 8 Department of Medicine and Surgery, Radiation Oncology Section,University Of Perugia, Perugia, Italy Purpose/Objective: Although anti-CD19 CAR T-cells have changed the management of relapsed/refractory B-cell lymphomas, the optimal bridging regimen during manufacturing is uncertain. We report the results achieved in a consecutive series of patients treated with bridging radiotherapy (RT) before CAR-T. Particularly, RT details (fields and dose), acute RT-related toxicity, CAR-T infusion-related toxicities (cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS) and overall survival are reported. Finally, we document the feasibility of combining RT with polatuzumab/bendamustine. Material/Methods: Between August 2020 and December 2024, 21 (11 males, 10 females) patients underwent bridging prior to CAR-T infusion. Median age was 57 years (range 25– 70). Diagnoses: Diffuse large B-cell lymphoma: 10; large B-cell lymphoma transformed from follicular lymphoma: 6; primary mediastinal B-cell lymphoma: 3; mantle cell lymphoma: 2. RT fields included extended fields (n=12) and single involved nodal sites (n=7); total nodal irradiation (TNI) was used in 2 patients. Extended fields were treated with helical IMRT using TomoTherapy, whereas single involved nodal sites were treated with the volumetric modulated arc therapy (VMAT) technique. Bridging regimens were RT alone (n=13) or RT plus polatuzumab/bendamustine ± rituximab (n=8).Median total dose was 30 Gy (range
Conclusion: Our data supports acceptable clinical outcomes from radiotherapy to manage orbital lymphoma in a series of patients, the majority of whom received low dose radiotherapy, with comparable local failure rates compared to prior data1-2. This data adds to the current trend towards in de-escalating treatment to reduce longerm toxicity with treatment, without compromising disease control. References: 1. Hoskin P, et al. 4 Gy versus 24 Gy radiotherapy for follicular and marginal zone lymphoma (FoRT): long- term follow-up of a multicentre, randomised, phase 3, non-inferiority trial. The Lancet Oncology, Volume 22, Issue 3, 332 – 340. 2. Pinnix CC, et al. Response- Adapted Ultralow-Dose Radiation Therapy for Orbital Indolent B-Cell Lymphoma: A Phase 2 Nonrandomized Controlled Trial. JAMA Oncol. 2024;10(9):1195–1203. doi:10.1001/jamaoncol.2024.2112. Keywords: lymphoma, orbital lymphoma, radiotherapy
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