Efficacy of an early intensification treatment integrating chemotherapy, autologous stem cell transplantation and radiotherapy for poor risk primary mediastinal large B cell lymphoma with sclerosis

Abstract

Summary:The aim of our study was to evaluate the impact of an early intensification programme including chemotherapy (CHT), autologous stem cell transplantation (ASCT) and radiation therapy (RT) in patients with primary mediastinal large B cell lymphoma (MLCL) with sclerosis presenting with adverse prognostic factors. Between 1993 and 1999, 19 patients with MLCL were referred to our institution. Four patients were classified as low risk according to the age-adjusted International Prognostic Index (AA-IPI). Fifteen (79%) were categorised in the high-intermediate or high risk group and were considered eligible for ASCT. Induction therapy consisted of VACOP-B (etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone and bleomycin) for 12 weeks. After induction therapy the four low risk patients achieved a complete remission (CR) and did not undergo ASCT. Of the 15 poor risk patients, five achieved CR, seven partial remission (PR), and three showed refractory disease (RD). All these patients received mobilising therapy consisting of high-dose cyclophosphamide. After peripheral stem cell (PSC) collection, to obtain a greater tumor mass reduction before transplantation, the seven patients in PR underwent further treatment with high-dose etoposide and those with RD received two cycles of DHAP (dexamethasone, cytarabine and cisplatin). At the time of ASCT, seven patients were in CR, six in PR and two had RD. After transplantation using BEAM as preparative regimen, all patients but one achieved a CR. Seven patients with minimal (Ͻ25%) residual mass at computed tomography scan received further mediastinal RT even if they had a negative Ga 67 scan. At a median follow-up of 35 months from transplantation the disease free survival is 93%. The outcome following this programme of early intensification in poor prognosis MLCL results in a high

Prognostic significance of pleural or pericardial effusion and the implication of optimal treatment in primary mediastinal large B-cell lymphoma: a multicenter retrospective study in Japan

“…Therefore, the number of institutions who could submit clinical data in the 1980s and 1990s was smaller than in the 2000s: 10 and 65 institutions before and after the year 2000, respectively. Furthermore, although gene expression or methylation profiling can help to diagnose PMBL correctly, for the moment we cannot use these tools in routine clinical pracPrognostic factor and optimal treatment in PMBL haematologica | 2014; 99 (12)tice. Further study of the utility of these biological tools is necessary to improve diagnosis and management of this disease.…”

Primary mediastinal B‐cell lymphoma

“…47 An early intensification program, cumulating in high-dose therapy in poor-risk patients with PMBL, resulted in 7 of 15 patients achieving CR and a further 7 patients with only minor residual mediastinal changes, with a disease-free survival of 93% reported at a median follow-up of 3 years. 63 In the Memorial Sloan Kettering experience high-dose therapy with progenitor cell rescue at first remission was not superior to dose-dense sequential therapy. 45 Based upon the results achieved with third-generation regimens and the likely benefit from the addition of rituximab, there is little at present to commend a high-dose therapy approach to consolidate first CR, even in poor-risk patients.…”

Primary Mediastinal Large B-Cell Lymphoma

“…Some researchers support using autologous stem cell transplant in the primary treatment of PMBCL, with a report of 15 patients achieving a disease-free survival rate of 93% after a median follow-up of 35 months with transplant [35]. However, all but two patients were in a PR or CR prior to transplant with induction therapy consisting of VACOP-B, and because of the high frequency of residual masses in this disease, many of the patients in PR according to imaging may be in pathological CR.…”