Outcome of primary mediastinal large B-cell lymphoma using R-CHOP: impact of a PET-adapted approach

Cure rates for primary mediastinal large B-cell lymphoma (PMBCL) have improved with the integration of rituximab. However, the type of primary therapy and role of radiotherapy (RT) remains ill-defined. Herein, we evaluated the outcome of PMBCL primarily treated with rituximab, cyclophosphamide, doxo...

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Published in:Blood Vol. 136; no. 24; p. 2803
Main Authors: Hayden, Anna R, Tonseth, Petter, Lee, Derrick G, Villa, Diego, Gerrie, Alina S, Scott, David W, Freeman, Ciara L, Slack, Graham W, Farinha, Pedro, Skinnider, Brian, Yenson, Paul R, Benard, Francois, Lo, Andrea, Pickles, Tom, Wilson, Donald, Connors, Joseph M, Sehn, Laurie H, Savage, Kerry J
Format: Journal Article
Language:English
Published: United States 10.12.2020
Subjects:
Adult
Aged
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols - administration & dosage
Cyclophosphamide - administration & dosage
Disease-Free Survival
Doxorubicin - administration & dosage
Female
Follow-Up Studies
Humans
Lymphoma, Large B-Cell, Diffuse - diagnostic imaging
Lymphoma, Large B-Cell, Diffuse - drug therapy
Lymphoma, Large B-Cell, Diffuse - mortality
Male
Mediastinal Neoplasms - diagnostic imaging
Mediastinal Neoplasms - drug therapy
Mediastinal Neoplasms - mortality
Middle Aged
Positron-Emission Tomography
Prednisone - administration & dosage
Rituximab - administration & dosage
Survival Rate
Vincristine - administration & dosage
ISSN:1528-0020, 1528-0020
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Summary:Cure rates for primary mediastinal large B-cell lymphoma (PMBCL) have improved with the integration of rituximab. However, the type of primary therapy and role of radiotherapy (RT) remains ill-defined. Herein, we evaluated the outcome of PMBCL primarily treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) and the impact of an end-of-treatment (EOT) 18F-fluorodeoxyglucose positron emission tomography (PET) scan to guide consolidative RT. Patients ≥18 years of age with PMBCL treated with curative intent rituximab-chemotherapy were identified. Prior to 2005, patients were recommended to receive R-CHOP + RT (RT era). Beginning in 2005, EOT PET was used to guide RT and only those with a PET-positive scan received RT (PET era). In total, 159 patients were identified, 94% were treated with R-CHOP and 44% received RT (78% in RT era, 28% in PET era). The 5-year time to progression (TTP) and overall survival (OS) for the entire cohort were 80% and 89%, respectively, similar across treatment eras. Overall, 10% had refractory disease. In total, 113 patients had an EOT PET scan: 63% negative and 37% positive with a 5-year TTP of 90% vs 71% and 5-year OS of 97% vs 88%, respectively. For those with Deauville (D)-scored PET scans (n = 103), the 5-year TTP for PET-negative cases by Deauville criteria (D1-D3, DX) was 91%, with inferior outcomes for D5 vs D4 (5-year TTP 33% vs 87%, P = .0002). Outcomes for PMBCL treated with RCHOP are favorable and use of a PET-adapted approach reduces RT in the majority of patients. A small proportion have refractory disease and may benefit from an alternate treatment.
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ISSN:1528-0020
1528-0020
DOI:10.1182/blood.2019004296