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Cook MR, Williams LS, Dorris CS, Luo Y, Makambi K, Dunleavy K. Improved survival for dose-intensive chemotherapy in primary mediastinal B-cell lymphoma: a systematic review and meta-analysis of 4,068 patients. Haematologica 2024; 109:846-856. [PMID: 37646662 PMCID: PMC10905081 DOI: 10.3324/haematol.2023.283446] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/23/2023] [Indexed: 09/01/2023] Open
Abstract
Primary mediastinal B-cell lymphoma (PMBCL) is a distinct clinicopathologic entity. Currently, there is a paucity of randomized prospective data to inform on optimal front-line chemoimmunotherapy (CIT) and use of consolidative mediastinal radiation (RT). To assess if distinct CIT approaches are associated with disparate survival outcomes, we performed a systematic review and meta-analysis comparing dose-intensive (DI-CIT) versus standard CIT for the front-line treatment of PMBCL. Standard approach (S-CIT) was defined as R-CHOP-21/CHOP-21, with or without RT. DI-CIT were defined as regimens with increased frequency, dose, and/or number of systemic agents. We reviewed data on 4,068 patients (2,517 DI-CIT; 1,551 S-CIT) with a new diagnosis of PMBCL. Overall survival for DI-CIT patients was 88% (95% CI: 85-90) compared to 80% for the S-CIT cohort (95% CI: 74-85). Meta-regression revealed an 8% overall survival (OS) benefit for the DI-CIT group (P<0.01). Survival benefit was maintained when analyzing rituximab only regimens; OS was 91% (95% CI: 89-93) for the rituximab-DI-CIT arm compared to 86% (95% CI: 82-89) for the R-CHOP-21 arm (P=0.03). Importantly, 55% (95% CI: 43-65) of the S-CIT group received RT compared to 22% (95% CI: 15-31) of DI-CIT patients (meta-regression P<0.01). To our knowledge, this is the largest meta-analysis reporting efficacy outcomes for the front-line treatment of PMBCL. DI-CIT demonstrates a survival benefit, with significantly less radiation exposure, curtailing long-term toxicities associated with radiotherapy. As we await results of randomized prospective trials, our study supports the use of dose-intensive chemoimmunotherapy for the treatment of PMBCL.
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Affiliation(s)
- Michael R Cook
- Perelman School of Medicine, University of Pennsylvania, Abramson Cancer Center, Philadelphia, PA.
| | - Lacey S Williams
- Lombardi Comprehensive Cancer Center and Georgetown University Hospital, Washington, DC
| | | | - Yutong Luo
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University
| | - Kepher Makambi
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University
| | - Kieron Dunleavy
- Lombardi Comprehensive Cancer Center and Georgetown University Hospital, Washington, DC.
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2
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Outcomes after first-line immunochemotherapy for primary mediastinal B-cell lymphoma: a LYSA study. Blood Adv 2021; 5:3862-3872. [PMID: 34461634 DOI: 10.1182/bloodadvances.2021004778] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/04/2021] [Indexed: 11/20/2022] Open
Abstract
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. A total of 313 patients were enrolled and received rituximab (R) plus ACVBP (doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone) (n = 180) or CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) delivered every 14 days (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 1 (1.8%) patient in the R-ACVBP, R-CHOP14, and R-CHOP21 groups, respectively (P < .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 = .23) in the R-ACVBP, R-CHOP14, and R-CHOP21 groups. The median follow-up was 44 months, and the R-ACVBP, R-CHOP14, and R-CHOP21 three-year progression-free survival probabilities were 89.4% (95% confidence interval [CI], 84.8-94.2), 89.4% (95% CI, 82.7-96.6), and 74.7% (95% CI, 64-87.1) (P = .018). A baseline total metabolic tumor volume (TMTV) ≥360 cm3 was associated with a lower progression-free survival (hazard ratio, 2.18; 95% CI, 1.05-4.53). Excess febrile neutropenia (24.4% vs 5.3% vs 5.3%; P < .001) and mucositis (22.8% vs 3.9% vs 1.8%; P < .001) were observed with R-ACVBP compared with the R-CHOP regimens. Patients with PMBL 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.
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Primary mediastinal Large B-cell Lymphoma. Blood 2021; 140:955-970. [PMID: 34496020 DOI: 10.1182/blood.2020008376] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/23/2021] [Indexed: 11/20/2022] Open
Abstract
Primary mediastinal large B-cell lymphoma (PMBCL) is a separate entity in the WHO classification based on clinico-pathologic features and a distinct molecular signature which overlaps with nodular sclerosis classical Hodgkin lymphoma (NScHL). Molecular classifiers can distinguish PMBCL from diffuse large B-cell lymphoma (DLBCL) using RNA derived from paraffin-embedded tissue and are integral to future studies. However, given that ~5% of DLBCL can have a 'molecular' PMBCL phenotype in the absence of mediastinal involvement, clinical information will remain critical for diagnosis. Studies over the last 10-20 years have elucidated the biologic hallmarks of PMBCL which are reminiscent of cHL, including the importance of JAK-STAT and NFKB signaling pathways as well as an immune evasion phenotype through multiple converging genetic aberrations. The outcome of PMBCL has improved in the modern rituximab era, however controversies remain whether there is a single standard treatment for all patients and when to integrate radiotherapy. Regardless of the frontline therapy, refractory disease can occur in up to 10% of patients and correlates with poor outcome. With emerging data supporting high efficacy of PD1 inhibitors in PMBCL, studies are underway integrating them into the up-front setting.
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Camus V, Bigenwald C, Ribrag V, Lazarovici J, Jardin F, Sarkozy C. Pembrolizumab in the treatment of refractory primary mediastinal large B-cell lymphoma: safety and efficacy. Expert Rev Anticancer Ther 2021; 21:941-956. [PMID: 34233557 DOI: 10.1080/14737140.2021.1953986] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: Primary mediastinal large B-cell lymphoma (PMBL) is a rare subtype of lymphoma, clinically and biologically distinct from diffuse large B-cell lymphoma (DLBCL) that shows overlapping features with classical Hodgkin lymphoma (cHL). If first-line strategies lead to 80-85% of curability, relapse occurs early with a chemo-refractory disease and a poor outcome. The presence of 9p24.1 rearrangement, conducting to the overexpression of the immune checkpoint molecules PDL1 and 2, has paved the way for immune checkpoint blockers development in these entities. Pembrolizumab, an anti PD-1 checkpoint antibody, was initially approved in solid cancer and later on in the lymphoma field in cHL.Areas covered: We summarize the biology and clinical need in PMBL, leading to the rationale for checkpoint inhibitors development, as well as pembrolizumab clinical studies in this entity. To do so, we performed a PubMed search using the terms: 'PMBCL,' 'lymphoma,' 'Immune checkpoint,' and 'Pembrolizumab.'Expert opinion: Pembrolizumab showed tolerable safety profile and efficacy data in patients with PMBL who have relapsed after, or are ineligible for autologous stem cell transplant (ASCT). Some combination strategies have shown promising preliminary results, while others are currently being conducted.
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Affiliation(s)
- Vincent Camus
- Département D'hématologie, Centre Henri Becquerel, Rouen, France
| | - Camille Bigenwald
- Département D'hématologie, Institut Gustave Roussy, Villejuif, France
| | - Vincent Ribrag
- Département D'hématologie, Institut Gustave Roussy, Villejuif, France.,Département d'Innovation Thérapeutique Et Des Essais Précoces (DITEP), Institut Gustave Roussy, Villejuif, France
| | - Julien Lazarovici
- Département D'hématologie, Institut Gustave Roussy, Villejuif, France
| | - Fabrice Jardin
- Département D'hématologie, Centre Henri Becquerel, Rouen, France
| | - Clémentine Sarkozy
- Département d'Innovation Thérapeutique Et Des Essais Précoces (DITEP), Institut Gustave Roussy, Villejuif, France
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5
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Ahmed Z, Afridi SS, Shahid Z, Zamani Z, Rehman S, Aiman W, Khan M, Mir MA, Awan FT, Anwer F, Iftikhar R. Primary Mediastinal B-Cell Lymphoma: A 2021 Update on Genetics, Diagnosis, and Novel Therapeutics. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:e865-e875. [PMID: 34330673 DOI: 10.1016/j.clml.2021.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/08/2021] [Accepted: 06/19/2021] [Indexed: 12/21/2022]
Abstract
Primary mediastinal large B-cell lymphoma (PMBCL) is an aggressive B-cell lymphoma arising from thymic B-cells having clinicopathologic features distinct from systemic diffuse large B-cell lymphoma (DLBCL). PMBCL comprises 2% to 4% of all non-Hodgkin lymphomas (NHL), 7% of DLBCL and seen predominantly in young females with a median age of 35 years at diagnosis. The annual incidence of PMBCL is 0.4 per million with a 5-year survival rate exceeding 70% with improving supportive care and genetic characterization of the disease. Pathogenesis involves dysregulation of Janus kinase-signal transducer and activator of transcription (JAK-STAT), nuclear factor-kB (NF-kB) pathways and amplification of the 9p24.1 region of chromosome 9. PMBCL patients have a prolonged life expectancy necessitating the need for treatment approaches that are based on maximizing cure with minimal long-term toxicity. Due to rarity and its recognition as a distinct entity, therapeutic decisions are guided by clinical presentation, clinician and center experience, and analysis of patients with PMBCL within DLBCL registries. Historically R-CHOP has been the usual first line treatment for PMBCL followed by involved site radiotherapy (ISRT), however clinical practice varies across centers with emerging consensus to avoid upfront RT by utilizing dose intense regimens (DA-EPOCH-R) in younger and fit patients. Prognosis of relapsed refractory PMBCL not responding to salvage chemotherapy is dismal, however there are many emerging options including Brentuximab Vedotin, immune check point inhibitors and chimeric antigen receptor T-cell therapy. In this article, we focus on the pathogenesis, current and evolving treatments, and provide recommendations for optimal management of patients with PMBCL.
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Affiliation(s)
- Zahoor Ahmed
- Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan
| | - Safa Saadat Afridi
- Department of Internal Medicine, Khyber Medical College Peshawar, Peshawar, Pakistan
| | | | - Zarlakhta Zamani
- Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan
| | - Sana Rehman
- Shaikh Khalifa Bin Zayyed al Nahyan Medical and Dental College, Lahore, Pakistan
| | - Wajeeha Aiman
- Department of Internal Medicine, Nishtar Medical College, Multan, Pakistan
| | - Maryam Khan
- Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan
| | | | - Farrukh T Awan
- Department of Medicine, Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, TX
| | - Faiz Anwer
- Hematology, Oncology, Stem Cell Transplantation, Multiple Myeloma Program, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH
| | - Raheel Iftikhar
- Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan.
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6
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Vassilakopoulos TP, Michail M, Papageorgiou S, Kourti G, Angelopoulou MK, Panitsas F, Sachanas S, Kalpadakis C, Katodritou E, Leonidopoulou T, Kotsianidis I, Hatzimichael E, Kotsopoulou M, Dimou M, Variamis E, Boutsis D, Terpos E, Dimopoulou MN, Karakatsanis S, Michalis E, Karianakis G, Tsirkinidis P, Vadikolia C, Poziopoulos C, Pigaditou A, Vrakidou E, Economopoulos T, Kyriazopoulou L, Siakantaris MP, Kyrtsonis MC, Symeonidis A, Anargyrou K, Papaioannou M, Hatjiharissi E, Vervessou E, Tsirogianni M, Palassopoulou M, Gainaru G, Stefanoudaki E, Zikos P, Tsirigotis P, Tsourouflis G, Assimakopoulou T, Konstantinidou P, A Papadaki H, Megalakaki K, Dimopoulos MA, Pappa V, Karmiris T, Roussou P, Panayiotidis P, Konstantopoulos K, Pangalis GA. Identification of Very Low-Risk Subgroups of Patients with Primary Mediastinal Large B-Cell Lymphoma Treated with R-CHOP. Oncologist 2021; 26:597-609. [PMID: 33870594 DOI: 10.1002/onco.13789] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 04/02/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND R-CHOP can cure approximately 75% of patients with primary mediastinal large B-cell lymphoma (PMLBCL), but prognostic factors have not been sufficiently evaluated yet. R-da- EPOCH is potentially more effective but also more toxic than R-CHOP. Reliable prognostic classification is needed to guide treatment decisions. MATERIALS AND METHODS We analyzed the impact of clinical prognostic factors on the outcome of 332 PMLBCL patients ≤65 years treated with R-CHOP ± radiotherapy in a multicenter setting in Greece and Cyprus. RESULTS With a median follow-up of 69 months, 5-year freedom from progression (FFP) was 78% and 5-year lymphoma specific survival (LSS) was 89%. On multivariate analysis, extranodal involvement (E/IV) and lactate dehydrogenase (LDH) ≥2 times upper limit of normal (model A) were significantly associated with FFP; E/IV and bulky disease (model B) were associated with LSS. Both models performed better than the International Prognostic Index (IPI) and the age-adjusted IPI by Harrel's C rank parameter and Akaike information criterion. Both models A and B defined high-risk subgroups (13%-27% of patients [pts]) with approximately 19%-23% lymphoma-related mortality. They also defined subgroups composing approximately one-fourth or one-half of the patients, with 11% risk of failure and only 1% or 4% 5-year lymphoma-related mortality. CONCLUSION The combination of E/IV with either bulky disease or LDH ≥2 times upper limit of normal defined high-risk but not very-high-risk subgroups. More importantly, their absence defined subgroups comprising approximately one-fourth or one-half of the pts, with 11% risk of failure and minimal lymphoma-related mortality, who may not need more intensive treatment such as R-da-EPOCH. IMPLICATIONS FOR PRACTICE By analyzing the impact of baseline clinical characteristics on outcomes of a large cohort of patients with primary mediastinal large B-cell lymphoma homogeneously treated with R-CHOP with or without radiotherapy, we developed novel prognostic indices which can aid in deciding which patients can be adequately treated with R-CHOP and do not need more intensive regimens such as R-da-EPOCH. The new indices consist of objectively determined characteristics (extranodal disease or stage IV, bulky disease, and markedly elevated serum lactate dehydrogenase), which are readily available from standard initial staging procedures and offer better discrimination compared with established risk scores (International Prognostic Index [IPI] and age-adjusted IPI).
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Affiliation(s)
- Theodoros P Vassilakopoulos
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Michail Michail
- Department of Hematology, Nicosia General Hospital, Nicosia, Cyprus
| | - Sotirios Papageorgiou
- Second Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | - Georgia Kourti
- Third Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece.,Department of Hematology and Lymphoma, Evangelismos General Hospital, Athens, Greece
| | - Maria K Angelopoulou
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Fotios Panitsas
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Sotirios Sachanas
- Department of Hematology, Athens Medical Center, Psychikon Branch, Athens, Greece
| | | | - Eirini Katodritou
- Department of Hematology, Theagenion Anticancer General Hospital, Thessaloniki, Greece
| | | | - Ioannis Kotsianidis
- Department of Hematology, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Maria Kotsopoulou
- Department of Hematology, Metaxa Anticancer Hospital, Piraeus, Greece
| | - Maria Dimou
- First Propedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Eleni Variamis
- First Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | | - Evangelos Terpos
- Department of Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Maria N Dimopoulou
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Stamatios Karakatsanis
- Third Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
| | - Eurydiki Michalis
- Department of Clinical Hematology, "G.Gennimatas" Athens General Hospital, Athens, Greece
| | | | | | | | | | - Anna Pigaditou
- Department of Hematology, Athens Medical Center, Amaroussion Branch, Athens, Greece
| | | | | | | | - Marina P Siakantaris
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Marie-Christine Kyrtsonis
- First Propedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Argyris Symeonidis
- Hematology Division, Dept of Internal Medicine, University of Patras, Patras, Greece
| | | | - Maria Papaioannou
- Hematology Unit, 1st Dept of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evdoxia Hatjiharissi
- Department of Hematology, Theagenion Anticancer General Hospital, Thessaloniki, Greece.,Hematology Unit, 1st Dept of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Maria Tsirogianni
- Department of Hematology, Aghios Savvas Anticancer Hospital, Athens, Greece
| | | | | | | | | | - Panayiotis Tsirigotis
- Second Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | - Gerasimos Tsourouflis
- Second Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | | | | - Helen A Papadaki
- Department of Hematology, University of Crete, Iraklion, Crete, Greece
| | | | | | - Vassiliki Pappa
- Second Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | - Themis Karmiris
- Department of Hematology and Lymphoma, Evangelismos General Hospital, Athens, Greece
| | - Paraskevi Roussou
- Third Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
| | - Panayiotis Panayiotidis
- First Propedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Kostas Konstantopoulos
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Gerassimos A Pangalis
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.,Department of Hematology, Athens Medical Center, Psychikon Branch, Athens, Greece
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7
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Jain H, Kapoor A, Sengar M, Chanana R, Menon H, Sridhar E, Laskar S, Agarwal A, Shastri J, Khanna N, Rangarajan V, Bagal B, Thorat J, Shet T, Gujral S. Outcomes of Patients with Primary Mediastinal B-Cell Lymphoma Treated with Dose Adjusted R-EPOCH Regimen: A Single Centre Experience. Indian J Hematol Blood Transfus 2021; 37:379-385. [PMID: 34267455 DOI: 10.1007/s12288-020-01372-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/20/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction Primary Mediastinal B cell lymphoma (PMBCL) is a biologically and clinically distinct subset of diffuse large B cell lymphoma. We analysed the outcomes of our cohort of PMBCL patients treated with Dose adjusted (DA)-R-EPOCH regimen. Patients and Methods This is a retrospective analysis of consecutive PMBCL patients who received chemotherapy consisting of DA-R-EPOCH with filgrastim support. Survival analysis was done using Kaplan-Meier method. All calculations were performed using SPSS version 20 for windows. Results A total of 43 consecutive suspected PMBCL patients were reviewed for this study, 6 patients were excluded as diagnosis of PMBCL could not be established. All patients except one (97.3%) received 6 cycles of R-DA-EPOCH regimen. Median age of the patients was 27 years (range 15-58). Bulky disease (> 7 cm) was present in 97% patients and 54% patients had extranodal disease. With a median follow up of 40 months, 3-year overall survival was 80.6% (95% CI: 74.0-87.2). The 3-year event free survival was 78.4% (95% CI: 71.6-85.2). There were 6 (16.2%) relapses, 1 (2.7%) primary progression and 7 (23%) deaths. Mediastinal radiotherapy was administered to 17 (45.9%) patients. All the deaths were due to disease progression. Grade III/IV toxicities were seen in 28 (75.7%) patients, febrile neutropenia being the most common one. Conclusions DA-R-EPOCH regimen is an effective and tolerable regimen in PMBCL patients even with adverse features.
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Affiliation(s)
- Hasmukh Jain
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National University, E. Borges Marg, Parel, Mumbai, Maharashtra 400012 India
| | - Akhil Kapoor
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National University, E. Borges Marg, Parel, Mumbai, Maharashtra 400012 India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National University, E. Borges Marg, Parel, Mumbai, Maharashtra 400012 India
| | - Raajit Chanana
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National University, E. Borges Marg, Parel, Mumbai, Maharashtra 400012 India
| | - Hari Menon
- Medical Oncologist, Cytecare hospital, Bengaluru, India
| | - Epari Sridhar
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - Siddhartha Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - Archi Agarwal
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, India
| | - Jayant Shastri
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - Nehal Khanna
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | | | - Bhausaheb Bagal
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National University, E. Borges Marg, Parel, Mumbai, Maharashtra 400012 India
| | - Jayashree Thorat
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National University, E. Borges Marg, Parel, Mumbai, Maharashtra 400012 India
| | - Tanuja Shet
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - Sumeet Gujral
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
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8
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González-Barca E, Coronado M, Martín A, Montalbán C, Montes-Moreno S, Panizo C, Rodríguez G, Sancho JM, López-Hernández A. Spanish Lymphoma Group (GELTAMO) guidelines for the diagnosis, staging, treatment, and follow-up of diffuse large B-cell lymphoma. Oncotarget 2018; 9:32383-32399. [PMID: 30190794 PMCID: PMC6122355 DOI: 10.18632/oncotarget.25892] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 07/23/2018] [Indexed: 01/23/2023] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) accounts for approximately 30% of non-Hodgkin lymphoma (NHL) cases in adult series. DLBCL is characterized by marked clinical and biological heterogeneity, encompassing up to 16 distinct clinicopathological entities. While current treatments are effective in 60% to 70% of patients, those who are resistant to treatment continue to die from this disease. An expert panel performed a systematic review of all data on the diagnosis, prognosis, and treatment of DLBCL published in PubMed, EMBASE and MEDLINE up to December 2017. Recommendations were classified in accordance with the Grading of Recommendations Assessment Development and Evaluation (GRADE) framework, and the proposed recommendations incorporated into practical algorithms. Initial discussions between experts began in March 2016, and a final consensus was reached in November 2017. The final document was reviewed by all authors in February 2018 and by the Scientific Committee of the Spanish Lymphoma Group GELTAMO.
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Affiliation(s)
- Eva González-Barca
- Department of Hematology, Institut Català d' Oncologia and IDIBELL, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Mónica Coronado
- Department of Nuclear Medicine, Hospital Universitario La Paz, Madrid, Spain
| | - Alejandro Martín
- Department of Hematology, Hospital Universitario de Salamanca, IBSAL, CIBERONC, Salamanca, Spain
| | - Carlos Montalbán
- Department of Hematology, MD Anderson Cancer Center, Madrid, Spain
| | - Santiago Montes-Moreno
- Department of Pathology and Translational Hematopathology Lab, Hospital Universitario Marqués de Valdecilla/IDIVAL, Santander, Spain
| | - Carlos Panizo
- Department of Hematology, Clínica Universidad de Navarra and Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Guillermo Rodríguez
- Department of Hematology, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | - Juan Manuel Sancho
- Department of Hematology, ICO-IJC-Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
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9
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Melani C, Advani R, Roschewski M, Walters KM, Chen CC, Baratto L, Ahlman MA, Miljkovic MD, Steinberg SM, Lam J, Shovlin M, Dunleavy K, Pittaluga S, Jaffe ES, Wilson WH. End-of-treatment and serial PET imaging in primary mediastinal B-cell lymphoma following dose-adjusted EPOCH-R: a paradigm shift in clinical decision making. Haematologica 2018; 103:1337-1344. [PMID: 29748435 PMCID: PMC6068044 DOI: 10.3324/haematol.2018.192492] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/10/2018] [Indexed: 11/28/2022] Open
Abstract
Dose-adjusted-EPOCH-R obviates the need for radiotherapy in most patients with primary mediastinal B-cell lymphoma. End-of-treatment PET, however, does not accurately identify patients at risk of treatment failure, thereby confounding clinical decision making. To define the role of PET in primary mediastinal B-cell lymphoma following dose-adjusted-EPOCH-R, we extended enrollment and follow up on our published phase II trial and independent series. Ninety-three patients received dose-adjusted-EPOCH-R without radiotherapy. End-of-treatment PET was performed in 80 patients, of whom 57 received 144 serial scans. One nuclear medicine physician from each institution blindly reviewed all scans from their respective institution. End-of-treatment PET was negative (Deauville 1-3) in 55 (69%) patients with one treatment failure (8-year event-free and overall survival of 96.0% and 97.7%). Among 25 (31%) patients with a positive (Deauville 4-5) end-of-treatment PET, there were 5 (20%) treatment failures (8-year event-free and overall survival of 71.1% and 84.3%). Linear regression analysis of serial scans showed a significant decrease in SUVmax in positive end-of-treatment PET non-progressors compared to an increase in treatment failures. Among 6 treatment failures, the median end-of-treatment SUVmax was 15.4 (range, 1.9-21.3), and 4 achieved long-term remission with salvage therapy. Virtually all patients with a negative end-of-treatment PET following dose-adjusted-EPOCH-R achieved durable remissions and should not receive radiotherapy. Among patients with a positive end-of-treatment PET, only 5/25 (20%) had treatment-failure. Serial PET imaging distinguished end-of-treatment PET positive patients without treatment failure, thereby reducing unnecessary radiotherapy by 80%, and should be considered in all patients with an initial positive PET following dose-adjusted-EPOCH-R (clinicaltrials.gov identifier 00001337).
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Affiliation(s)
- Christopher Melani
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Mark Roschewski
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Clara C Chen
- Nuclear Medicine Division, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Lucia Baratto
- Nuclear Medicine and Molecular Imaging Division, Stanford University, CA
| | - Mark A Ahlman
- Nuclear Medicine Division, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Milos D Miljkovic
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Seth M Steinberg
- Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Jessica Lam
- Stanford Cancer Institute, Stanford University, CA
| | - Margaret Shovlin
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Stefania Pittaluga
- Laboratory of Pathology, Clinical Center, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Elaine S Jaffe
- Laboratory of Pathology, Clinical Center, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Wyndham H Wilson
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
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10
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Liu X, Deng T, Guo X, Guo Y, Wang L, Zhang J, Xia Z, Zhang Q, Xue K, Cao J, Shi J, Hong X. A retrospective analysis of outcomes for primary mediastinal large B-cell lymphoma treated with RCHOP followed by radiotherapy or front-line autologous stem cell transplantation. Hematology 2016; 22:258-264. [DOI: 10.1080/10245332.2016.1258846] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Xiaojian Liu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical Collage, Fudan University, Shanghai, People’s Republic of China
| | - Ting Deng
- Department of Gastrointestinal Medical Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin, People’s Republic of China
| | - Xianzhi Guo
- Department of Medical Oncology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, People’s Republic of China
| | - Ye Guo
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical Collage, Fudan University, Shanghai, People’s Republic of China
| | - Leiping Wang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical Collage, Fudan University, Shanghai, People’s Republic of China
| | - Jian Zhang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical Collage, Fudan University, Shanghai, People’s Republic of China
| | - Zuguang Xia
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical Collage, Fudan University, Shanghai, People’s Republic of China
| | - Quanling Zhang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical Collage, Fudan University, Shanghai, People’s Republic of China
| | - Kai Xue
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical Collage, Fudan University, Shanghai, People’s Republic of China
| | - Junning Cao
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical Collage, Fudan University, Shanghai, People’s Republic of China
| | - Jumei Shi
- Department of Hematology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Xiaonan Hong
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China
- Department of Oncology, Shanghai Medical Collage, Fudan University, Shanghai, People’s Republic of China
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11
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Liu PP, Wang KF, Xia Y, Bi XW, Sun P, Wang Y, Li ZM, Jiang WQ. Racial patterns of patients with primary mediastinal large B-cell lymphoma: SEER analysis. Medicine (Baltimore) 2016; 95:e4054. [PMID: 27399089 PMCID: PMC5058818 DOI: 10.1097/md.0000000000004054] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 05/14/2016] [Accepted: 06/02/2016] [Indexed: 01/21/2023] Open
Abstract
The aim of this study is to investigate the incidence and clinical outcomes of primary mediastinal large B-cell lymphoma (PMBL).Here we did a retrospective analysis using the surveillance, epidemiology, and end results (SEER) database to analyze the incidences and survival of patients with PMBL diagnosed during 2001-2012 among major ethnic groups.During 2001-2012, a total of 426 PMBL patients were identified, including 336 whites, 46 blacks, and 44 others. The incidence rates of female to male ratios in white, black, and other were 1.4938, 1.1202, and 1.7303 respectively, suggesting that the female-prominent disease occurrence was seen only in whites and others, but not in black population. Compared to white, the other had a worse 5-year overall survival (OS); however, factors including age, race, socioeconomic status, and stage associated with OS showed no significant difference among ethnic groups; thus, biology factors should be explored to explain the racial difference in OS.In conclusion, our findings revealed diversities in demographic features and prognosis among different racial groups.
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Affiliation(s)
- Pan-Pan Liu
- Department of Medical Oncology, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in South China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Ke-Feng Wang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in South China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Yi Xia
- Department of Medical Oncology, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in South China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Xi-Wen Bi
- Department of Medical Oncology, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in South China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Peng Sun
- Department of Medical Oncology, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in South China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Yu Wang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in South China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Zhi-Ming Li
- Department of Medical Oncology, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in South China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Wen-Qi Jiang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center
- State Key Laboratory of Oncology in South China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China
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12
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Petković I. Current trends in the treatment of primary mediastinal large B-cell lymphoma - an overview. Contemp Oncol (Pozn) 2015; 19:428-35. [PMID: 26843837 PMCID: PMC4731448 DOI: 10.5114/wo.2015.56388] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 01/23/2015] [Indexed: 11/17/2022] Open
Abstract
Primary mediastinal large B-cell lymphoma has been recognised as a distinct entity with unique clinical, pathologic, and genetic features. According to WHO 2008 classification it is marked as a variant of diffuse large B-cell lymphoma but shares characteristics with classic Hodgkin lymphoma. Genetic analysis has shown that amplification of the 9p24.1 region is the disease's specific structural alteration. Aggressive behaviour and a tendency to invade surrounding tissues of the thoracic cavity, often causing superior vena cava syndrome, or pleural or pericardial effusions, are the clinical hallmarks of this disease. For a long period of time it has been considered as a disease with poor prognosis, which responds poorly to the conventional treatment created for diffuse large B-cell lymphoma. An elective treatment has not yet been established, but recently the situation has became much more favourable. After the introduction of rituximab the cure rates have risen to over 80%, and the most recent results have demonstrated a new insight with dose-adjusted intensified continuous treatments, in which the cure rates have exceeded 90%. Current trends have led to the introduction of dose-adjusted intensified protocols becoming a standard of care, whereas the use of radiotherapy remains controversial because of the questionable predictive value of post-treatment PET/CT validity. The relapse rate is very low after two years of sustained complete remission. If the disease relapses or is resistant the outcome is very poor regardless of the applied treatment modality.
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13
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Wang J, Liu X, Ma F, Huang M, Kallychurn YS, Hu C. Role of radiotherapy in the treatment of primary mediastinal large B-cell lymphoma. Oncol Lett 2015; 10:2925-2930. [PMID: 26722265 DOI: 10.3892/ol.2015.3700] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 07/28/2015] [Indexed: 11/06/2022] Open
Abstract
The role of radiotherapy (RT) in the treatment of primary mediastinal large B-cell lymphoma (PMLBCL) is unclear. In the present study, a retrospective analysis of 63 patients with PMLBCL treated with or without RT was performed to evaluate the role of RT. Clinical outcomes were calculated using the Kaplan-Meier method and were compared between patients who did and did not receive RT, using the log-rank test. A multivariate analysis was performed using Cox proportional hazards model. After chemotherapy, 35 patients received RT, and RT was found to be associated with significantly improved 5-year overall survival (OS) (87 vs. 58%; P=0.001) and 5-year progression-free survival (PFS) (75 vs. 39%; P=0.001) rates compared with patients without RT. The subgroup analysis on 35 patients who received rituximab plus chemotherapy showed that RT did not improve the 5-year OS (88 vs. 92%; P=0.814) or the 5-year PFS (78 vs. 65%; P=0.511) rates compared with patients without RT. On multivariate analysis, RT and the addition of rituximab were predictive of increased OS [RT: Hazard ratio (HR), 0.157; P=0.018; rituximab: HR, 0.156; P=0.009] and PFS (RT: HR 0.111, P=0.001; Rituximab: HR 0.231, P=0.002) rates. However, the role of RT in PMLBCL in the rituximab era is unclear. Further investigation of the role of RT in the era of targeted therapy is required.
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Affiliation(s)
- Jingjing Wang
- Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Xianling Liu
- Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Fang Ma
- Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Ming Huang
- Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Yashpal Singh Kallychurn
- Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Chunhong Hu
- Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
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14
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Pinnix CC, Dabaja B, Ahmed MA, Chuang HH, Costelloe C, Wogan CF, Reed V, Romaguera JE, Neelapu S, Oki Y, Rodriguez MA, Fayad L, Hagemeister FB, Nastoupil L, Turturro F, Fowler N, Fanale MA, Nieto Y, Khouri IF, Ahmed S, Medeiros LJ, Davis RE, Westin J. Single-institution experience in the treatment of primary mediastinal B cell lymphoma treated with immunochemotherapy in the setting of response assessment by 18fluorodeoxyglucose positron emission tomography. Int J Radiat Oncol Biol Phys 2015; 92:113-21. [PMID: 25863759 DOI: 10.1016/j.ijrobp.2015.02.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 01/29/2015] [Accepted: 02/02/2015] [Indexed: 12/28/2022]
Abstract
PURPOSE Excellent outcomes obtained after infusional dose-adjusted etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone, and rituximab (R-EPOCH) alone have led some to question the role of consolidative radiation therapy (RT) in the treatment of primary mediastinal B cell lymphoma (PMBL). We reviewed the outcomes in patients treated with 1 of 3 rituximab-containing regimens (cyclophosphamide, doxorubicin, vincristine, prednisone [R-CHOP]; hyperfractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone [R-HCVAD], or R-EPOCH) with or without RT. We also evaluated the ability of positron emission tomography-computed tomography (PET-CT) to identify patients at risk of relapse. METHODS AND MATERIALS We retrospectively identified 97 patients with diagnoses of stage I/II PMBCL treated at our institution between 2001 and 2013. The clinical characteristics, treatment outcomes, and toxicity were assessed. We analyzed whether postchemotherapy PET-CT could identify patients at risk for progressive disease according to a 5 point scale (5PS) Deauville score assigned. RESULTS Among 97 patients (median follow-up time, 57 months), the 5-year overall survival rate was 99%. Of patients treated with R-CHOP, 99% received RT; R-HCVAD, 82%; and R-EPOCH, 36%. Of 68 patients with evaluable end-of-chemotherapy PET-CT scans, 62% had a positive scan (avidity above that of the mediastinal blood pool [Deauville 5PS = 3]), but only 9 patients experienced relapse (n=1) or progressive disease (n=8), all with a 5PS of 4 to 5. Of the 25 patients who received R-EPOCH, 4 experienced progression, all with 5PS of 4 to 5; salvage therapy (RT and autologous stem cell transplantation) was successful in all cases. CONCLUSION Combined modality immunochemotherapy and RT is well tolerated and effective for treatment of PMBCL. A postchemotherapy 5PS of 4 to 5, rather than 3 to 5, can identify patients at high risk of progression who should be considered for therapy beyond chemotherapy alone after R-EPOCH.
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Affiliation(s)
- Chelsea C Pinnix
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bouthaina Dabaja
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Mohamed Amin Ahmed
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hubert H Chuang
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Colleen Costelloe
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Christine F Wogan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Valerie Reed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jorge E Romaguera
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sattva Neelapu
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yasuhiro Oki
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - M Alma Rodriguez
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas; Office of Medical Affairs, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Luis Fayad
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Frederick B Hagemeister
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Loretta Nastoupil
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Francesco Turturro
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nathan Fowler
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michelle A Fanale
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yago Nieto
- Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Issa F Khouri
- Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sairah Ahmed
- Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Richard Eric Davis
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason Westin
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
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15
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Aoki T, Izutsu K, Suzuki R, Nakaseko C, Arima H, Shimada K, Tomita A, Sasaki M, Takizawa J, Mitani K, Igarashi T, Maeda Y, Fukuhara N, Ishida F, Niitsu N, Ohmachi K, Takasaki H, Nakamura N, Kinoshita T, Nakamura S, Ogura M. 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. Haematologica 2014; 99:1817-25. [PMID: 25216682 DOI: 10.3324/haematol.2014.111203] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The prognosis of patients with primary mediastinal large B-cell lymphoma has improved over recent years. However, the optimal treatment strategy including the role of radiotherapy remains unknown. We retrospectively analyzed the clinical outcomes of 345 patients with newly diagnosed primary mediastinal large B-cell lymphoma in Japan. With a median follow up of 48 months, the overall survival at four years for patients treated with R-CHOP (n=187), CHOP (n=44), DA-EPOCH-R (n=9), 2(nd)- or 3(rd)-generation regimens, and chemotherapy followed by autologous stem cell transplantation were 90%, 67%, 100%, 91% and 92%, respectively. Focusing on patients treated with R-CHOP, a higher International Prognostic Index score and the presence of pleural or pericardial effusion were identified as adverse prognostic factors for overall survival in patients treated with R-CHOP without consolidative radiotherapy (IPI: hazard ratio 4.23, 95% confidence interval 1.48-12.13, P=0.007; effusion: hazard ratio 4.93, 95% confidence interval 1.37-17.69, P=0.015). Combined with the International Prognostic Index score and the presence of pleural or pericardial effusion for the stratification of patients treated with R-CHOP without radiotherapy, patients with lower International Prognostic Index score and the absence of effusion comprised approximately one-half of these patients and could be identified as curable patients (95% overall survival at 4 years). The DA-EPOCH-R regimen might overcome the effect of these adverse prognostic factors. Our simple indicators of International Prognostic Index score and the presence of pleural or pericardial effusion could stratify patients with primary mediastinal large B-cell lymphoma and help guide selection of treatment.
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Affiliation(s)
- Tomohiro Aoki
- Department of Hematology and Oncology, Nagoya Daini Red Cross Hospital; Department of Hematology and Oncology, Nagoya University Graduate School of Medicine;
| | - Koji Izutsu
- Department of Hematology, Toranomon Hospital, Tokyo, Japan
| | - Ritsuro Suzuki
- Department of HSCT Data Management and Biostatistics, Nagoya University Graduate School of Medicine, Kyoto University, Kyoto
| | - Chiaki Nakaseko
- Department of Hematology, Chiba University Hospital, Kyoto University, Kyoto
| | - Hiroshi Arima
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto
| | - Kazuyuki Shimada
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine
| | - Akihiro Tomita
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine
| | - Makoto Sasaki
- Division of Hematology, Department of Internal Medicine, Juntendo University School of Medicine, Tokyo
| | - Jun Takizawa
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Tochigi
| | - Kinuko Mitani
- Department of Hematology and Oncology, Dokkyo Medical University of Medicine, Tochigi
| | | | - Yoshinobu Maeda
- Department of Hematology and Oncology, Okayama University Hospital, Sendai
| | - Noriko Fukuhara
- Department of Hematology and Rheumatology, Tohoku University Hospital, Sendai
| | - Fumihiro Ishida
- Department of Biomedical Laboratory Sciences, Department of Hematology, Shinshu University School of Medicine, Matsumoto
| | - Nozomi Niitsu
- Department of Hematology, International Medical Center, Saitama Medical University, Hidaka
| | - Ken Ohmachi
- Department of Hematology, Tokai University, Isehara
| | | | | | | | - Shigeo Nakamura
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital
| | - Michinori Ogura
- Department of Hematology and Oncology, Nagoya Daini Red Cross Hospital; Department of Internal Medicine and Laboratory Medicine, National Hospital Organization Suzuka National Hospital, Japan
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16
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Abstract
Primary mediastinal B-cell lymphoma (PMBCL) is a relatively rare lymphoma subtype affecting mainly young adults. Its molecular signature and clinical features resemble classical Hodgkin lymphoma. The optimal chemotherapy for this lymphoma subtype has not been established. The addition of rituximab to anthracycline based chemotherapy improved response rates and survival. Many centers use R-CHOP as standard treatment, but the role of the intensified regimens and consolidation radiotherapy has to be clarified. Recent data coming from retrospective analyses and an ongoing prospective study addressing the problem of consolidation radiotherapy will help to better identify risk groups and apply risk-adapted and effective treatment strategies. The latest research has helped to understand molecular mechanisms of PMBCL pathogenesis and indicated targets of directed therapy for the future.
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Affiliation(s)
- Anna Dabrowska-Iwanicka
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie Institute and Oncology Centre, 5 WK Roentgen Str, 02-781 Warszawa, Poland
| | - Jan A. Walewski
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie Institute and Oncology Centre, 5 WK Roentgen Str, 02-781 Warszawa, Poland
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17
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Hamlin PA. Evolving treatment paradigms for primary mediastinal diffuse large B-cell lymphoma. J Clin Oncol 2014; 32:1751-3. [PMID: 24799491 DOI: 10.1200/jco.2014.55.2810] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Paul A Hamlin
- Memorial Sloan Kettering Cancer Center; Weill Cornell Medical College, New York, NY
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18
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Pytlík R, Belada D, Kubáčková K, Vášová I, Kozák T, Pirnos J, Bolomská I, Matuška M, Přibylová J, Campr V, Burešová L, Sýkorová A, Berková A, Klener P, Trněný M. Treatment of high-risk aggressive B-cell non-Hodgkin lymphomas with rituximab, intensive induction and high-dose consolidation: long-term analysis of the R-MegaCHOP-ESHAP-BEAM Trial. Leuk Lymphoma 2014; 56:57-64. [PMID: 24628294 DOI: 10.3109/10428194.2014.904509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We have studied the feasibility and efficacy of intensified R-MegaCHOP-ESHAP-BEAM therapy in high-risk aggressive B-cell lymphomas. Altogether 105 patients (19-64 years) with diffuse large B-cell lymphoma (DLBCL), primary mediastinal B-cell lymphoma (PMBL) or follicular lymphoma grade 3 (FL3) with an age-adjusted International Prognostic Index of 2-3 were recruited. Treatment consisted of three cycles of high-dose R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone), followed by three cycles of R-ESHAP (rituximab, etoposide, methylprednisolone, cytarabine, cisplatin) and high-dose consolidation with BEAM (BCNU, etoposide, cytarabine, melphalan) and autologous stem cell transplant. The 5-year progression-free survival (PFS) was 72% (DLBCL 60%, PMBL 89%) and overall survival (OS) was 74% (DLBCL 61%, PMBL 89%) after a median follow-up of 85 months. However, an independent prognostic factor was age only, with patients ≤ 45 years having 5-year PFS 90% and patients > 45 years having PFS 54%. PMBL had better prognosis than DLBCL/FL3 in patients > 45 years (PFS, 88% vs. 48%), but not in younger patients (PFS, 91% vs. 94%).
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Affiliation(s)
- Robert Pytlík
- First Department of Medicine, General University Hospital and First Medical Faculty, Charles University , Prague , Czech Republic
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