From the Guidelines
Radiotherapy (RT) should be considered as part of a combined modality treatment with chemotherapy for relapsed or refractory classical Hodgkin's lymphoma (HL), taking into account prior irradiation, disease localization, and response to salvage chemotherapy. When deciding to include RT in the salvage strategy, it is essential to weigh the potential benefits against the risks, such as radiation myelitis and pulmonary toxicity 1. The expert panel recommends using involved-field RT (IFRT) with a dose of at least 30 Gy, potentially with an additional 6-10 Gy, especially if the disease was not in metabolic complete remission (CR) prior to high-dose therapy (HDT) 1.
Key considerations for RT in HL include:
- Prior irradiation: RT should be used cautiously in patients with prior radiation therapy to minimize the risk of toxicity 1.
- Disease localization: RT can be effective for localized relapses, but should always be integrated with chemotherapy 1.
- Response to salvage chemotherapy: Patients with disease not achieving a metabolic CR prior to HDT may benefit from limited-field RT 1.
- Risk of pulmonary toxicity: RT should be used after transplantation to minimize the risk of pulmonary toxicity, unless in highly selected patients at high risk for disease progression 1.
The goal of RT in HL is to improve disease-specific survival while minimizing toxicity, and individualized treatment planning is crucial to achieve this goal. By carefully considering the benefits and risks of RT and integrating it with chemotherapy, patients with relapsed or refractory HL can achieve improved outcomes 1.
From the Research
RBt Therapy Overview
- RBt therapy, also known as rabies post-exposure prophylaxis (PEP), is a crucial treatment for preventing rabies after exposure to the virus 2, 3.
- The treatment consists of several steps, including wound washing, assessing the need for rabies biologicals, administering rabies immunoglobulin or monoclonal antibodies, and starting a vaccination regimen 2.
Vaccination Regimens
- The World Health Organization (WHO) recommends an intradermal 1-week vaccination regimen, which is as safe as other regimens but has cost-, dose-, and time-sparing benefits 2, 3.
- Abridged vaccination schedules with less doses have been shown to be effective and can improve patient compliance and access to treatment 3.
- The 1-week, 2-site ID PEP schedule is considered the most advantageous, as it is safe, immunogenic, and involves the least direct costs compared to other schedules 3.
Special Populations
- There is limited evidence on the safety and immunogenicity of novel PEP schedules in special populations, such as infants and immunocompromised individuals 3.
- Administering rabies vaccines during pregnancy is considered safe and effective 3.
Importance of RBt Therapy
- Rabies is a fatal disease if left untreated, and prompt administration of PEP is crucial for preventing the disease 4, 5, 6.
- RBt therapy is highly effective in preventing rabies after recognized exposures, and it is essential for healthcare providers to be aware of the latest guidelines and recommendations for administering PEP 2, 3, 5.