Primary mediastinal large B-cell lymphomas treated with dose-intensified CHOP alone or CHOP combined with radiotherapy

We retrospectively reviewed 105 cases of primary mediastinal large B-cell lymphoma (PMLBL). Patients were treated with dose-intensified chemotherapy according to the GELA protocols without planned radiotherapy. Radiotherapy was delivered to patients with a lymphoma proven sensitive to CHOP who could receive irradiation for localised disease. Seventy-six patients achieved a complete remission (24%) or unconfirmed CR (49%), and 15 (14%), a partial remission. Patients treated with intensified induction therapy had a better FFP rate than patients treated with CHOP chemotherapy even when radiotherapy was restricted to partial responders to the dose-intensified chemotherapy regimen (p = 0.01). In the multivariate analysis for overall survival, a poor performance status and CHOP chemotherapy remained associated with a poor outcome (p = 0.02 and 0.02, respectively). Radiotherapy might not be necessary in PMLBL when a CR or a Cru is achieved with dose-intensified chemotherapy. CHOP chemotherapy yield inferior results compared to dose-intensified chemotherapy with more frequent progression on therapy.