Primary mediastinal large B-cell lymphoma (PMLBCL): long-term results from a retrospective multicentre Italian experience in 138 patients treated with CHOP or MACOP-B/VACOP-B

Abstract

The optimal treatment of primary mediastinal large B-cell lymphoma (PMLBCL) is still undefined. In the absence of randomised studies, we retrospectively analysed:

Primary mediastinal B‐cell lymphoma

“…A similar comparison of 138 patients from 13 Italian institutions favored MACOP-B or VACOP-B over CHOP. 44 Eighty percent of the former patients entered a CR compared to 51% with CHOP (P < .001); significantly fewer patients failed to demonstrate a response or progressed on therapy (9% vs 42%; P < .01). Both event-free and OS were superior in the MACOP-B/ VACOP-B group.…”

“…This reflected in the observation that 50% of patients have low IPI scores at presentation. 42 The age-adjusted IPI has generally been reported to be of limited predictive value, [43][44][45] although in a recent series of 92 patients there was some clear discriminative value. 46 Elevation of LDH to greater than twice the upper limit of normal, age over 40 and performance status ≥ 2 all correlated with reduced survival in a population-based series from British Columbia, 43 while in a large series from the International Extranodal Lymphoma Study Group (IELSG) male sex, poor performance status and advancedstage disease were significant negative predictors of survival.…”

“…Salvage therapy for recurrence or progressive disease is of limited efficacy; 43,44 thus, the imperative is to cure at the first attempt where possible. There is, however, a tension between delivery of the highest possible cure fraction and minimizing long-term morbidity in this young population.…”

Primary mediastinal B‐cell lymphoma with sclerosis: Report of 11 cases treated with intensified‐CHOP plus radiotherapy

“…In the past, several studies described lower survival rates for PMBCL with bulky masses after standard treatment [4][5][6], as compared with other DLCLs, suggesting the need for more intensive chemotherapy. As a matter of fact, the efficacy of third-generation regimens, such as MACOP-B (methotrexate, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin), has been reported with a CR rate as high as 89%.…”

“…The aggressive clinical behavior and the patients' age require intensive treatment, and retrospective studies have reported the efficacy of third-generation regimens plus radiotherapy (RT) as compared to classical CHOP [4][5][6].…”