Details

Autor(en) / Beteiligte

• 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.

Titel

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

Ist Teil von

• Blood, 2020-12, Vol.136 (24), p.2803-2811

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2020

Quelle

EZB-FREE-00999 freely available EZB journals

Beschreibungen/Notizen

• 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. •PMBCL patients managed with R-CHOP and a PET-guided approach to consolidative RT have favorable outcomes with a 64% reduction in RT use.•Approximately 10% of PMBCL patients have refractory disease and may benefit from integration of novel therapies in the frontline setting. [Display omitted]