A retrospective analysis of outcomes for primary mediastinal large B-cell lymphoma treated with RCHOP followed by radiotherapy or front-line autologous stem cell transplantation

Liu, Xiaojian; Deng, Ting; Guo, Xu; Guo, Ye; Wang, Leiping; Zhang, Jian; Xia, Zhihao; Zhang, Quanling; Xue, Kai; Cao, Junning; Shi, Jumei; Hong, Xin

doi:10.1080/10245332.2016.1258846

Cited by 9 publications

(3 citation statements)

References 32 publications

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“…The use of CRT remains controversial among hematology centers worldwide; some centers choose to apply it systematically 9,11 or optionally (for metabolic partial responders) CRT [12][13][14] , and other centers no longer employ this approach [15][16][17] . Finally, the place of autologous stem cell transplant (ASCT) in first-line consolidation 18,19 , mainly guided by fluorodeoxyglucose (FDG) positron emission tomography (PET) response assessment 20 , also remains a cause of debate due to the paucity of available evidence in PMBL. Indeed, because PMBL is uncommon, there exist few prospective data, resulting in the present situation of no clearly established standard of care.…”

Section: Introductionmentioning

confidence: 99%

Outcomes after first-line immunochemotherapy for primary mediastinal B-cell lymphoma: a LYSA study

et al. 2021

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Primary mediastinal B-cell lymphoma (PMBL) is a rare type of aggressive lymphoma typically affecting young female patients. The first-line standard of care remains debated. We performed a large multicenter retrospective study in 25 centers in France and Belgium to describe PMBL patient outcomes after first-line treatment in real-life settings. Three hundred thirteen patients were enrolled and received rituximab (R) plus ACVBP (n=180) or CHOP delivered every 14 (R-CHOP14, n=76) or 21 days (R-CHOP21, n=57) and consolidation strategies in modalities that varied according to time and institution, mainly guided by positron emission tomography. Consolidation autologous stem cell transplantation was performed for 46 (25.6%), 24 (31.6%) and one (1.8%) patients in the R-ACVBP, R-CHOP14 and R-CHOP21 groups, respectively (p<0.001); only 17 (5.4%) patients received mediastinal radiotherapy. The end-of-treatment complete metabolic response rates were 86.3%, 86.8% and 76.6% (p=0.23) in the R-ACVBP, R-CHOP14 and R-CHOP21 groups, respectively. The median follow-up was 44 months, and the R-ACVBP, R-CHOP14 and R-CHOP21 3-year progression-free survival (PFS) probabilities were 89.4% [95% confidence interval: 84.8-94.2%], 89.4% [82.7-96.6%] and 74.7% [64-87.1%] (p=0.018), respectively. A baseline total metabolic tumor volume (TMTV) ≥360 cm3 was associated with a lower PFS (hazard ratio=2.18 [1.05-4.53]). Excess febrile neutropenia (24.4% vs 5.3% vs 5.3%, p<0.001) and mucositis (22.8% vs 3.9% vs 1.8%, p<0.001) were observed with R-ACVBP compared to R-CHOP regimens. PMBL patients treated with dose-dense immunochemotherapy without radiotherapy have excellent outcomes. R-ACVBP acute toxicity was higher than that of R-CHOP14. Our data confirmed the prognostic importance of baseline TMTV.

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Section: Introductionmentioning

confidence: 99%

Outcomes after first-line immunochemotherapy for primary mediastinal B-cell lymphoma: a LYSA study

et al. 2021

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“…Radiation technologies have evolved dramatically over the past decades, challenging the old concepts of RT. However, the role of radiation therapy has been controversial and the results of reported studies are contradictory [7][8][9][10]. So, it is time to rethink the value and necessity of RT in this new era.…”

Section: Introductionmentioning

confidence: 99%

The Value of Radiation Therapy for the Treatment of Diffuse Large B-Cell Lymphoma in a New Era

Yuan¹,

Zhang²,

Wu³

et al. 2022

COR

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As a highly heterogeneous disease, diffuse large B-cell lymphoma shows different clinical presentations, molecular and immunophenotypic characteristics, International Prognostic Index (IPI score) and response to therapy, which consequently brings about different prognoses and survival results. In addition to surgery and chemotherapy, radiation is also one important modality to treat diffuse large B-cell lymphoma. Over the past few decades, radiation therapy has stepped forward because of technological revolutions. The role of radiation in treating diffuse large B-cell lymphoma is discussed, including: i) advances in modern-day radiation technology ii) potential toxicity from radiation, iii) indications for radiation, and iv) available studies about the efficacy of radiation.

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“…Despite dramatic improvements in response rates with the introduction of rituximab (R), R-CHOP was historically administered with consolidative radiation [5]. Given the long-term risks of mediastinal radiation in this predominantly young, female population, including cardiovascular disease and secondary breast cancer, many investigators favored radiation-sparing regimens, such as R-CHOP with time intensification or R-CHOP followed by R-ICE or autologous bone marrow transplant [6][7][8]. A study at the NCI demonstrated 93% event free survival and 97% overall survival at 5 years with a regimen of dose adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (DA-R-EPOCH), with no patients receiving consolidative mediastinal radiation.…”

Section: Introductionmentioning

confidence: 99%

R-CHOP without radiation in frontline management of primary mediastinal B-cell lymphoma

Messmer

Tsai

Varadhan

et al. 2019

Leukemia & Lymphoma

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Prior to the introduction of rituximab, primary mediastinal B-cell lymphoma (PMBCL) had high rates of treatment failure with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), prompting the use of consolidative mediastinal radiation or more intensive chemotherapy regimens. Cure rates improved dramatically with rituximab, but mediastinal radiation was still commonly employed with R-CHOP. We performed a retrospective review of patients treated with R-CHOP alone without radiation for PMBCL. Of 43 patients with PMBCL, 16 received R-CHOP alone. High risk factors included 56% with bulky disease, 75% with elevated LDH, 25% with SVC syndrome, and 13% with stage IV disease. Three-year progression-free survival (PFS) and overall survival (OS) were 93% and 100% respectively. These results suggest that R-CHOP alone has a high cure rate in PMBCL, while avoiding the side effects of mediastinal radiation.

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A retrospective analysis of outcomes for primary mediastinal large B-cell lymphoma treated with RCHOP followed by radiotherapy or front-line autologous stem cell transplantation

Abstract: The PFS and OS rate of RCHOP/IFRT were found to be unsatisfied. RCHOP/ASCT showed a satisfactory PFS and OS rate.

Cited by 9 publications

References 32 publications

Outcomes after first-line immunochemotherapy for primary mediastinal B-cell lymphoma: a LYSA study

Outcomes after first-line immunochemotherapy for primary mediastinal B-cell lymphoma: a LYSA study

The Value of Radiation Therapy for the Treatment of Diffuse Large B-Cell Lymphoma in a New Era

R-CHOP without radiation in frontline management of primary mediastinal B-cell lymphoma

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