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

Casadei, Beatrice; Argnani, Lisa; Morigi, Alice; Lolli, Ginevra; Broccoli, Alessandro; Pellegrini, Cinzia; Nanni, Laura; Stefoni, Vittorio; Coppola, Paolo Elia; Carella, Matteo; Cavo, Michèle; Zinzani, Pier Luigi

doi:10.1007/s00277-020-04364-0

Cited by 5 publications

(2 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In total, 4.5% of patients were older than 60 years. This small proportion of elderly PMBL is consistent with other data in the literature 12,[35][36][37] . Higher median age of the R-CHOP21 group (40 years and almost 20% over 60 years) probably influenced the decision to not treat these patients with R-CHOP14 or R-ACVBP.…”

Section: Discussionsupporting

confidence: 92%

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

et al. 2021

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 92%

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

et al. 2021

View full text Add to dashboard Cite

show abstract

“…The 21-year OS was 82.6%; the PFS and DFS rates were 69.3% and 86.4%, respectively. This study also presented long-term follow-up data, indicating that third-generation chemotherapy such as MACOP-B is feasible in the treatment of PMBCL (70).…”

Section: Frontline Treatmentmentioning

confidence: 58%

Primary Mediastinal B-Cell Lymphoma: Novel Precision Therapies and Future Directions

Chen

Zeng

et al. 2021

Front. Oncol.

View full text Add to dashboard Cite

Primary mediastinal large B-cell lymphoma (PMBCL) is a distinct clinicopathologic disease from other types of diffuse large B-cell lymphoma (DLBCL) with unique prognostic features and limited availability of clinical data. The current standard treatment for newly diagnosed PMBCL has long been dependent on a dose-intensive, dose-adjusted multi-agent chemotherapy regimen of rituximab plus etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (DA-R-EPOCH). Recent randomized trials have provided evidence that R-CHOP followed by consolidation radiotherapy (RT) is a valuable alternative option to first-line treatment. For recurrent/refractory PMBCL (rrPMBCL), new drugs such as pembrolizumab and CAR-T cell therapy have proven to be effective in a few studies. Positron emission tomography-computed tomography (PET-CT) is the preferred imaging modality of choice for the initial phase of lymphoma treatment and to assess response to treatment. In the future, baseline quantitative PET-CT can be used to predict prognosis in PMBCL. This review focuses on the pathology of PMBCL, underlying molecular basis, treatment options, radiotherapy, targeted therapies, and the potential role of PET-CT to guide treatment choices in this disease.

show abstract

Optimizing outcomes in primary mediastinal B-Cell lymphoma: is R-CHOP enough?

Cook

Dunleavy

2021

Blood Advances

View full text Add to dashboard Cite

Primary mediastinal B-cell lymphoma (PMBL) is recognized as a unique clinicopathologic entity. It has a predilection for female adolescents and young adults, and is characterized by distinct morphologic, immunophenotypic, and molecular features. PMBL is rare, and this has resulted in a paucity of prospective data and lack of randomized studies, leading to controversy regarding optimal frontline therapy. In this issue of Blood Advances, Camus and colleagues describe real-world patient outcomes following frontline immunochemotherapy across 25 centers in France and Belgium.Three hundred and thirteen treatment-naïve patients with PMBL were retrospectively evaluated in the study. A total of 180 received rituximab, doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone (R-ACVBP), 76 received rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone every 14 days (R-CHOP-14), and 57 received R-CHOP every 21 days (R-CHOP-21), respectively. Outcomes were excellent with high end-of-treatment (EOT) complete metabolic response rates between 76% and 86%, and mediastinal radiation was administered in just 5.4%. Progression-free survival at 3 years favored R-ACVBP and R-CHOP-14 (89.4%, 89.4%), with statistically lower rates for R-CHOP-21 (74.7%). Overall survival at 3 years also supported the dose-intensive options (R-ACVBP, 92.4%; R-CHOP-14, 100%; R-CHOP-21, 87.5%). The results presented here are of interest and importance, especially considering the high number of patients included, and the authors raise many provocative questions regarding optimal management of the disease. Despite this, the study is limited to answer the key question of whether or not increased dose-intensity approaches are superior to R-CHOP-21. Following R-ACVBP and R-CHOP-14 therapy, a low proportion of patients needed radiation. However, a significant number of these patients underwent consolidation transplantation (25.6% and 31.6%, respectively), which may have affected outcomes. Additionally, transplantation is associated with high added toxicity and is not a standard approach in upfront management of PMBL. Further data that confounds interpretation of results were the higher proportion of older patients (.60 years), who are frequently not considered candidates for doseintensive approaches, in the R-CHOP-21 cohort.Early retrospective studies in PMBL demonstrated that more aggressive chemotherapy regimens were associated with higher response rates in comparison with CHOP. 1 This has not proven to be the case in diffuse large B-cell lymphoma, where R-CHOP remains the optimal approach following comparisons with higher intensity, more toxic therapies. Higher sensitivity of PMBL to dose intensity may potentially be explained by its much younger age distribution as well as its close biological resemblance to classic Hodgkin lymphoma, a disease that benefits from increased therapeutic intensity. 2 Although R-CHOP has been commonly used in studies of PMBL, its use has relied quite significantly on consolidation m...

show abstract

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

Cited by 5 publications

References 36 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

Primary Mediastinal B-Cell Lymphoma: Novel Precision Therapies and Future Directions

Optimizing outcomes in primary mediastinal B-Cell lymphoma: is R-CHOP enough?

Contact Info

Product

Resources

About