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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Vydáno v:	Blood Ročník 136; číslo 24; s. 2803
Hlavní autoři:	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
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States 10.12.2020
Témata:	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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Shrnutí:	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.
Bibliografie:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23
ISSN:	1528-0020 1528-0020
DOI:	10.1182/blood.2019004296