What radiation dose do you typically use for relapsed DLBCL following 6 cycles of R-CHOP?

There are several potential scenarios, all with different answers, so I will illustrate a few.

Historically, second-line chemotherapy (e.g., R-ICE) would first be pursued for relapsed DLBCL, and if the disease was still responsive to chemotherapy (CR or PR), then the patient would proceed with high-dose chemotherapy (e.g., BEAM) and autologous stem cell transplant. In this setting, post-transplant RT is generally recommended for sites of bulk disease (the PARMA trial used a 5 cm cutoff), localized disease at the time of relapse, or areas not achieving a complete response. In the setting of a complete response, a dose of 30 Gy would be appropriate with higher doses reserved for PRs.

Two recent studies (ZUMA-7 [published] and TRANSFORM) have sh...