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?
2 Answers
Mednet Member
Radiation Oncology · Vanderbilt-Ingram Cancer Center
Answered on
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 ...
Join for free or sign in to see the full answer
Mednet MemberInvited Expert
Medical Oncology · Winship Cancer Institute of Emory University
Answered on
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....
Join for free or sign in to see the full answer