Why the study?
Although rituximab improved PMBCL cure rates, mediastinal radiation was still commonly used with R-CHOP, prompting evaluation of R-CHOP alone without radiation.
Does R-CHOP alone without radiation provide high cure rates in patients with primary mediastinal B-cell lymphoma?
Does R-CHOP alone without radiation provide high cure rates in patients with primary mediastinal B-cell lymphoma?
R-CHOP alone without radiation demonstrates high progression-free and overall survival rates in primary mediastinal B-cell lymphoma, potentially avoiding radiation-related side effects.
R-CHOP alone may support radiation omission in PMBCL; hypothesis-generating, needs RCTs before practice change.
Prior to the introduction of rituximab, primary mediastinal B-cell lymphoma (PMBCL) had high rates of treatment failure with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), prompting the use of consolidative mediastinal radiation or more intensive chemotherapy regimens. Cure rates improved dramatically with rituximab, but mediastinal radiation was still commonly employed with R-CHOP. We performed a retrospective review of patients treated with R-CHOP alone without radiation for PMBCL. Of 43 patients with PMBCL, 16 received R-CHOP alone. High-risk factors included 56% with bulky disease, 75% with elevated LDH, 25% with SVC syndrome, and 13% with stage IV disease. Three-year progression-free survival (PFS) and overall survival (OS) were 93% and 100% respectively. These results suggest that R-CHOP alone has a high cure rate in PMBCL while avoiding the side effects of mediastinal radiation.
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Messmer et al. (2019) studied this question.
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