Combination chemotherapy with or without radiotherapy achieved a 70% clinical remission rate and a 10-year overall survival of 50% in patients with primary mediastinal large B-cell lymphoma.
Cohort (n=27)
No
What are the prognostic factors and therapeutic outcomes of PMLCL treated with combination chemotherapy with or without radiotherapy?
In a single-institution cohort of PMLCL, more aggressive chemotherapy and the inclusion of radiotherapy were associated with better outcomes, highlighting the need for prospective randomized trials.
Primary mediastinal large-B cell lymphomas (PMLCL) are considered to be a distinct clinicopathologic entity among the diffuse large B-cell lymphomas. This study evaluated the prognostic factors and therapeutic outcome of PMLCL in a single-institution series. Twenty seven patients were reviewed. Nineteen of the 27 had Stage I-II and 8 had Stage III-IV disease. B-symptoms were found in 11 (41%) patients and bulky disease in 10 (37%). All patients were initially given combination chemotherapy (CT): doxorubicin-containing regimens to 23 patients (11 patients had CHOP, 12 more intensive third-generation regimens) and 4 elderly (>70 years) patients received CVP. Eleven responders were consolidated with irradiation (RT) as part of their initial treatment, with a median total dose of 39 Gy. Nineteen patients (70%) achieved clinical remission (15 CR and 4 PR) with their initial therapy. Forty-four percent of patients remained progression-free and 59% are alive at 3 years. The actuarial 10-year TTP and OS were 44% and 50%, respectively. Age >60 years, performance status >1 and IPI intermediate-high to high risk were significantly associated with poorer OS and TTP by univariate analysis (log-rank test). A better outcome was associated with the use of more aggressive chemotherapy regimens or with the inclusion of RT in the first-line treatment. In conclusion our analyses suggest that the application of radiotherapy in combination regimens and the use of more aggressive chemotherapy in the treatment of this particular lymphoma entity should be evaluated in prospective randomized trials.
Bieri et al. (Fri,) conducted a cohort in Primary mediastinal large B-cell lymphoma (PMLCL) (n=27). Combination chemotherapy with or without radiotherapy was evaluated on 10-year overall survival. Combination chemotherapy with or without radiotherapy achieved a 70% clinical remission rate and a 10-year overall survival of 50% in patients with primary mediastinal large B-cell lymphoma.