Main Session
Sep
28
PQA 04 - Breast Cancer, Patient Reported Outcomes/QoL/Survivorship, Functional Radiation Medicine, Hematologic Malignancies, Palliative Care, and International/Global Oncology
2725 - Inpatient Radiation Oncology Consultations for Hematologic Malignancies: Indications, Management Patterns, and Outcomes
Presenter(s)
Alok Deshane, MD - MSKCC, New York, NY
A. Deshane1, M. E. Freret2, A. J. Xu1, R. Taneja1, N. Chu1, G. Cederquist1, Z. R. Moore1, J. Yahalom1, D. Yerramilli1, and B. S. Imber1; 1Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, 2Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL
Purpose/Objective(s):
Patients (pts) with hematologic malignancies (HM) may require inpatient radiation (RT) consults for acute symptoms. Unlike solid tumors, inpatient management in HM is often in the context of curative treatment (e.g. stem cell transplantation, CAR T-cell therapy) with unique considerations for RT timing, dose, and fractionation. We characterized the landscape of inpatient RT consults for HM, hypothesizing that common, anatomically-driven indications could be identified with varying RT delivery patterns and a spectrum of pt survival.Materials/Methods:
We retrospectively analyzed all inpatient RT consults for HM at a tertiary cancer care hospital from 1/2019-2/2024. Demographics, histology, and recent systemic therapies were collected. Consults were categorized by anatomic grouping (bone, central nervous system [CNS], soft tissue, other) given perceived similarities in presenting symptoms, and possibly RT dose. We compared rates of RT use and 6- and 12-month overall survival (OS) from consult by histology using chi-square testing.Results:
675 consults for 498 HM pts were analyzed. The most common histologies were multiple myeloma (MM; n=193, 39%), aggressive B-cell lymphoma (ABCL; n=171, 34%), and leukemia (n=50, 10%). Anatomic groupings included bone (338, 50%), CNS (145, 21%), soft tissue/nodal (141, 21%), and other disease (51, 8%). 393 consults (58%) received RT. RT use post-consult was higher for bone vs. CNS disease (63% v. 46%, p=0.01). 120 pts (24%) had repeat consults and frequency of re-consult did not vary by anatomic grouping (p=0.54). Table 1 displays anatomic groupings for consult, and associated histologies, RT use, and dose. 6-month OS from initial consult was 65% for MM, 43% for ABCL, and 34% for leukemia (p<0.001). 12-month OS was 54% for MM, 34% for ABCL, and 24% for leukemia (p<0.001).Conclusion:
Inpatient HM RT consults commonly address bone disease and result in RT delivery. MM pts had better OS compared to other histologies, with over half surviving beyond one year. These data underscore the importance of tailoring inpatient RT approaches to prognosis and curative-intent systemic therapy integration. Collaborative efforts are warranted to establish evidence-based guidelines for emergent RT in HM that consider histology and context-specific approaches. Table 1 MM - Multiple Myeloma, ABCL – Aggressive B Cell Lymphoma, IBCL – Indolent B Cell Lymphoma, TCL- T cell Lymphoma, Leuk – Leukemia, PCNSL – Primary CNS Lymphoma, HL – Hodgkin Lymphoma| Anatomic Grouping | # of Consults | RT Used N (%) | RT dose (Gy) Median (Range) | Histology n (%) |
| Bone | 338 | 214 (63) | 20 (4-46) | MM 240 (71) ABCL 55 (16) IBCL 9 (2) TCL 4 (1) LEUK 17 (5) HL 5 (2) OTHER 8 (2) |
| CNS | 145 | 67 (46) | 23.4 (5.4 - 36) | MM 13 (9) ABCL 67 (46) IBCL 10 (7) TCL 6 (4) LEUK 38 (26) PCNSL 11 (8) |
| Soft Tissue | 141 | 82 (58) | 20 (0.6 - 56) | MM 27 (19) ABCL 74 (52) IBCL 10 (7) TCL 10 (7) LEUK 15 (11) HL 1 (1) OTHER 4 (3) |
| Other | 51 | 30 (59) | 20 (2 – 39) | MM 1 (2) ABCL 19 (37) IBCL 1 (2) TCL 26 (51) LEUK 3 (6) OTHER 1 (2) |