Treatment of primary mediastinal B-cell lymphoma with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone is associated with a high rate of primary refractory disease

被引:74
作者
Soumerai, Jacob D. [1 ,2 ]
Hellmann, Matthew D. [1 ,2 ]
Feng, Yang [3 ]
Sohani, Aliyah R. [2 ,4 ]
Toomey, Christiana E. [1 ]
Barnes, Jeffrey A. [1 ,2 ]
Takvorian, Ronald W. [1 ,2 ]
Neuberg, Donna [3 ]
Hochberg, Ephraim P. [1 ,2 ]
Abramson, Jeremy S. [1 ,2 ]
机构
[1] Massachusetts Gen Hosp, Ctr Canc, Ctr Lymphoma, Boston, MA 02114 USA
[2] Harvard Univ, Sch Med, Boston, MA USA
[3] Dana Farber Canc Inst, Dept Biostat, Boston, MA 02115 USA
[4] Massachusetts Gen Hosp, Dept Pathol, Boston, MA 02114 USA
关键词
Diffuse large B-cell lymphoma; DLBCL; non-Hodgkin lymphoma; PMBCL; primary mediastinal B-cell lymphoma; R-CHOP; CHEMOTHERAPY PLUS RITUXIMAB; RANDOMIZED CONTROLLED-TRIAL; CHOP-LIKE CHEMOTHERAPY; ELDERLY-PATIENTS; THERAPY; MULTICENTER; FEATURES; TERM;
D O I
10.3109/10428194.2013.810738
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
The optimal therapy for primary mediastinal B-cell lymphoma is a subject of ongoing debate, with no accepted standard of care. We performed a retrospective analysis of 63 patients in the modern era treated with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP), with or without radiation. Median age was 37 years (range 20 -82). Eighty percent had limited stage disease and 71% were bulky. By age-adjusted International Prognostic Index (IPI), 15% were low-risk, 52% low-intermediate, 27% high-intermediate and 6% high-risk. Some 77% of responding patients received consolidative radiotherapy. Overall and complete response rates were 79% and 71%. Primary induction failure occurred in 13 (21%) patients. Five-year PFS and OS were 68% and 79%, respectively. Adverse prognostic features included increased IPI, advanced stage, advanced age and multiple extranodal sites. These data demonstrate an unacceptably high rate of primary refractory disease on R-CHOP, particularly among patients with high-risk features. Novel treatment approaches are needed that reduce primary refractory disease and reliance on mediastinal radiation in young people.
引用
收藏
页码:538 / 543
页数:6
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