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

Aoki, Tomohiro; Izutsu, Koji; Suzuki, Ritsuro; Nakaseko, Chiaki; Arima, Hiroshi; Shimada, Kazuyuki; Tomita, Akihiro; Sasaki, Makoto; Takizawa, Jun; Mitani, Kinuko; Igarashi, Tadahiko; Maeda, Yoshinobu; Fukuhara, Noriko; Ishida, Fumihiro; Niitsu, Nozomi; Ohmachi, Ken; Takasaki, Hirotaka; Nakamura, Naoya; Kinoshita, Tomohiro; Nakamura, Shigeo; Ogura, Michinori

doi:10.3324/haematol.2014.111203

Cited by 45 publications

(46 citation statements)

References 39 publications

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“…The significance of vena cava syndrome and pleural or pericardial effusion is a specific characteristic of PMBCL 19 that might explain why these factors were not relevant in the report by Evens et al that included less than 50% of patients with a mediastinal presentation. The presence of an altered ECOG-PS was the most important prognostic factor for EFS in our series, as in Evens et al 11 In contrast to other reports, 11,13 disease stage or lymphopenia were not associated with outcome, but anemia was the only factor independently associated with poor OS.…”

Section: Discussionmentioning

confidence: 88%

Mediastinal gray zone lymphoma: clinico-pathological characteristics and outcomes of 99 patients from the Lymphoma Study Association

et al. 2016

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Mediastinal gray zone lymphoma, B-cell lymphomas with intermediate features between classical Hodgkin lymphoma and primary mediastinal B-cell lymphoma, have not been well described in the literature. We report the clinical characteristics and outcomes of a large retrospective series of 99 cases centrally reviewed by a panel of hematopathologists, with a consensus established for the diagnosis. Cases were defined as classical Hodgkin lymphoma-like morphology (64.6%) with primary mediastinal B-cell lymphoma immunophenotype, primary mediastinal B-cell lymphoma-like morphology (30.3%) with classical Hodgkin lymphoma or composite (5.1%) (synchronous occurrence of classical Hodgkin lymphoma and primary mediastinal B-cell lymphoma). The median age was 32 years (13-83 years); 55% were women. Thirteen of 81 evaluable cases (16%) were Epstein-Barr virus-positive. Twenty-eight percent of patients presented primary refractory disease (progression under first-line treatment or relapse within one year). The 3-year event-free and overall survival rates were 63% and 80%, respectively. Patients treated with a standard regimen (RCHOP/ABVD) had worse event-free survival (P=0.003) and overall survival (P=0.02) than those treated with a dose-intensive chemotherapy (high-dose RCHOP/escalated BEACOPP). Rituximab added to chemotherapy was not associated with better event-free survival (P=0.55) or overall survival (P=0.88). Radiotherapy for patients in complete remission had no impact on eventfree survival. In multivariate prognostic analysis, ECOG-PS and anemia were the strongest factors associated with a shorter event-free survival and overall survival, respectively. In conclusion, this report describes the largest series of mediastinal gray zone lymphoma. Our data suggest that a dose-intensive treatment might improve the outcome of this rare and aggressive disease.

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Section: Discussionmentioning

confidence: 88%

Mediastinal gray zone lymphoma: clinico-pathological characteristics and outcomes of 99 patients from the Lymphoma Study Association

et al. 2016

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“…These results have appeared also in other studies. 12,13,[26][27][28][29] There was one, however, where the outcome in patients treated with R-CHOP was poor. 22 Surprisingly, we observed a trend toward an increased relapse rate after an initial DA-EPOCH-R treatment compared to R-CHOP.…”

Section: Response Assessment and Survival Analysismentioning

confidence: 99%

“…HSCT had a better OS (HR 0.11, 95% CI 0.01-0.84, P = .03) but not PFS (HR 0.45, 95% CI 0.06-3.35, P = .43). However, that subgroup of patients was younger (median age26 vs 38, mean age [SD]: 27.1 [6.37] vs 43.6 [18.4] years, P = .012, unpaired t test). comparing these patients (R-CHOP-21 with auto-HSCT) to those treated with DA-EPOCH-R, no differences in their PFS (HR 0.38, 95% CI 0.09-1.6, P = .19) or OS (HR 0.23, 95% CI 0.03-2.04,…”

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confidence: 99%

Outcomes of treatment with dose‐adjusted EPOCH‐R or R‐CHOP in primary mediastinal large B‐cell lymphoma

Malenda

Kołkowska‐Leśniak

Puła

et al. 2019

European J of Haematology

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Background The standard first‐line treatment for primary mediastinal B‐cell lymphoma (PMBCL) patients is rituximab‐based immunochemotherapy; however, this is not due to the result of randomized clinical trials. Aims We retrospectively investigated 53 PMBCL patient outcomes treated either with R‐CHOP‐21 or DA‐EPOCH‐R‐28. The primary endpoint was overall survival (OS). Secondary endpoints were complete remission (CR), overall response rate (ORR), progression‐free survival (PFS), and treatment‐related complications. Results Treatment with R‐CHOP‐21 resulted in a 92.0% ORR (60% CR), while DA‐EPOCH‐R yielded a 92.6% ORR (70.4% CR). There were no differences in the occurrence of grade 3‐4 hematological adverse events, but grade 1‐2 cardiologic complications (P = .003) were observed more frequently in the DA‐EPOCH‐R arm. Median PFS and OS were not achieved. The differences in estimated 12‐month PFS in R‐CHOP and DA‐EPOCH‐R group (87% vs 73.9%) and OS (100% vs 92%) were insignificant. Patients treated with R‐CHOP‐21 and autologous hematopoietic stem cell transplantation (auto‐HSCT) had an improved OS (P = .03) but not PFS (P = .43) compared to those treated solely with R‐CHOP‐21. No differences in PFS or OS were observed between patients treated with R‐CHOP‐21/auto‐HSCT and DA‐EPOCH‐R. Conclusion The results of this study suggest that R‐CHOP‐21 may be an alternative to DA‐EPOCH‐R treatment for PMBCL patients.

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“…Risk stratification with IPI in PMBCL is of limited value due to the young age and limited stage of PMBCL at presentation. Aoki et al identified a subgroup of patients with favorable prognostic factors (low IPI and without pleural or pericardial effusion) given R‐CHOP without RT with an excellent 4‐year PFS and OS of 87% and 95%, respectively, compared with those with high IPI and pleural or pericardial effusion (4‐year PFS and OS 54% and 81%, respectively) . These findings require further validation but suggest low‐risk patients may be adequately treated with R‐CHOP alone, while high‐risk patients may require a more intensive approach.…”

Section: Introductionmentioning

confidence: 99%

Real world experience of R‐CHOP with or without consolidative radiotherapy vs DA‐EPOCH‐R in the first‐line treatment of primary mediastinal B‐cell lymphoma

et al. 2019

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Primary mediastinal large B‐cell lymphoma (PMBCL) is a distinct clinico‐pathological subtype of diffuse large B‐cell lymphoma with unclear prognostic factors and limited clinical data. Optimal treatment and role for radiotherapy is not fully defined. We performed a multicenter retrospective review of 124 patients with newly diagnosed PMBCL between 2001 and 2016. Treatment regimens were R‐CHOP (n = 41), R‐CHOP + RT (n = 37), and DA‐EPOCH‐R (n = 46). 6% (n = 3) in the DA‐EPOCH‐R group received RT. With a median follow up of 45 months, the overall 5‐year OS and PFS was 89.4% and 82.4%, respectively. The type of chemo‐radiotherapy regimen, B symptoms and Ann‐Arbor staging showed a significant association with OS on univariate analysis but only B symptoms remained prognostic ( P = 0.012) after multivariate analysis. The chemo‐radiotherapy regimen, Japanese IPI and Ann‐Arbor stage was significantly associated with PFS in univariate analysis, but only chemo‐radiotherapy regimen remained significant ( P = 0.02) after multivariate analysis. Patients who received R‐CHOP + RT or DA‐EPOCH‐R had better PFS than those receiving R‐CHOP alone, with 5‐year PFS of 90% vs 88.5% vs 56%, respectively ( P = 0.02). In the subgroup analysis of patients with bulk (n = 71), R‐CHOP alone (n = 21) had inferior 5‐year PFS 56.6% compared to those who received R‐CHOP + RT (n = 23) 91.3% or DA‐EPOCH‐R (n = 27) 92.6% ( P = 0.007). In contrast, in patients without bulk (n = 42), there was no impact of treatment regimen on PFS ( P = 0.25). In conclusion, R‐CHOP + RT and DA‐EPOCH‐R provide excellent outcomes in patients with PMBCL. In patients with bulky disease, the use of DA‐EPOCH‐R may be preferable as it allows omission of RT without reduction in efficacy.

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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

Cited by 45 publications

References 39 publications

Mediastinal gray zone lymphoma: clinico-pathological characteristics and outcomes of 99 patients from the Lymphoma Study Association

Mediastinal gray zone lymphoma: clinico-pathological characteristics and outcomes of 99 patients from the Lymphoma Study Association

Outcomes of treatment with dose‐adjusted EPOCH‐R or R‐CHOP in primary mediastinal large B‐cell lymphoma

Real world experience of R‐CHOP with or without consolidative radiotherapy vs DA‐EPOCH‐R in the first‐line treatment of primary mediastinal B‐cell lymphoma

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