How do you approach pelvic radiation therapy for a patient with multiple myeloma who needs more intensive therapy (e.g., Dara-KRd or impending CAR-T) with a risk of cytopenias?

For example, a large iliac or sacral plasmacytoma causing symptoms. Both medical oncologists and radiation oncologists get nervous about RT-related cytopenias (in areas with lots of bone marrow like the hip) causing problems with IMiDs, cyclophosphamide, or other therapies that can cause cytopenias, including CAR-T therapy. Is this something that should be avoided?

Answer from: Radiation Oncologist at Academic Institution

The role of RT in MM is palliative in nature, and the focus should be on symptomatic improvement while minimizing marrow toxicity.Rad Oncs, as a whole, should not generally be using solid tumor palliative doses (such as 3 Gy x 10) routinely in MM as that ablates the marrow in that area without hope ...

Comments

Medical Oncologist at University of Washington, Fred Hutchinson Cancer Research Center
This is very very helpful, thank you!!

Radiation Oncologist at Case Western Reserve University
Not arguing with your overall point, but 30 Gy in ...

Answer from: Medical Oncologist at Community Practice

It depends on the patient. Those patients with pancytopenia related to significant prior therapy are at higher risk of hematologic toxicity from radiation, and this is generally radiation dose-dependent.This needs to be balanced by the likelihood that the patient will respond to systemic therapy, e....

Comments

Medical Oncologist at University of Washington, Fred Hutchinson Cancer Research Center
Very well stated! I think we all learn in fellowsh...

Medical Oncologist at University of Chicago
I haven’t had bad experiences mixing radiati...

Radiation Oncologist at University of Pittsburgh Medical Center
Could always consider low-dose radiotherapy if con...

Medical Oncologist at University of Washington, Fred Hutchinson Cancer Research Center
This is amazingly helpful to hear from our radiati...

Radiation Oncologist at Rush University Medical Center
If you have so much disease that it results in a r...

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How do you approach pelvic radiation therapy for a patient with multiple myeloma who needs more intensive therapy (e.g., Dara-KRd or impending CAR-T) with a risk of cytopenias?

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