The treatment of primary mediastinal large B-cell lymphoma: a two decades monocentric experience with 98 patients

Abstract

BackgroundThe purpose of this study is to investigate the most suitable first-line approach and the best combination treatment for primary mediastinal large B-cell lymphoma (PMLBCL) as they have been matter of debate for at least two decades.MethodsOur single centre experience in the treatment of 98 de novo PMLBCL patients over the last 20 years is reviewed. All patients received MACOP-B chemotherapy. Thirty-seven received both rituximab and mediastinal radiotherapy; 30 were irradiated after chemotherapy, although not receiving rituximab and 20 received rituximab without radiotherapy consolidation. Eleven patients received chemotherapy only.ResultsSixty-one (62.2%) patients achieved a complete response after MACOP-B (with or without rituximab); among the 27 (27.6%) partial responders, 21 obtained a complete response after radiotherapy. At the end of their scheduled treatment, 82 patients (83.7%) had a complete and 6 a partial response (6.1%). Eleven patients relapsed within the first 2 years of follow-up. The 17-year overall survival is 72.0% (15 patients died); progression-free and disease-free survival are 67.6% and 88.4%, respectively. A statistically significant difference in overall and progression-free survival was noted among treatment groups, although no disease-free survival difference was documented.ConclusionsOur data indicate that a third-generation regimen like MACOP-B could be considered a suitable first-line treatment. Mediastinal consolidation radiotherapy impacts on survival and complete response rates and remains a good strategy to convert partial into complete responses. Data suggest that radiotherapy may be avoided in patients obtaining a complete response after (immuno)chemotherapy, but this requires confirmation with further ad hoc studies.

Treatment and outcomes of primary mediastinal B cell lymphoma: a three-decade monocentric experience with 151 patients

“…Part of the cohort also received external mediastinal RT and/or anti-CD20 immunotherapy, depending on our institutional era-specific guidelines. The addition of rituximab did not imply a clear advantage as previously reported [ 27 ].…”

“…No formal sample size estimation and power calculation were made for this observational retrospective study as we consecutively enrolled all PMBCL patients who underwent MACOP-B as a first-line approach. Part of the cohort was the same used in our previous report which had the aim to assess the difference in the first-line approach (i.e., chemotherapy, radiotherapy, rituximab, or their combinations) [ 27 ]. The objective response rate (ORR) was calculated as the sum of partial and complete response rates.…”

Prognostic significance of clinical characteristics and 18Fluorodeoxyglucose-positron emission tomography/computed tomography quantitative parameters in patients with primary mediastinal B-cell lymphoma

“…Recent research recorded a complete response rate of 62.2% for MCOP-B as the first-line treatment. 20 Dose-dense RCHOP-ICE resulted in 5-year PFS and OS rates of 93% and 98%, respectively. 21 Studies also reported the outcomes of R-CHOP-21 and DA-EPOCH-R-28 in PMBCL and suggested that R-CHOP-21 may be an alternative treatment regimen.…”

High efficacy of intensive immunochemotherapy for primary mediastinal B-cell lymphoma with prolonged follow up

“…A prospect of cure for PMBL patients depends on the successful initial therapy because prognosis in case of disease progression or relapse is extremely poor 20 – 22 . The most common approach is currently R-CHOP 4 , 5 , 7 – 9 , 23 , 24 ± RT or DAEPOCH-R 11 , 12 , 23 , 24 ; more intensive protocols 13 , 15 , 25 , 26 are rarely used. Here we report the long term results of intensive alternating immunochemotherapy protocol GMALL/B-ALL/NHL2002 with high-dose cytarbine and intermediate-dose methotrexate followed by consolidative radiotherapy in 124 PMBL patients.…”