title: Induction chemotherapy strategies for primary mediastinal large B-cell lymphoma with sclerosis: a retrospective multinational study on 426 previously untreated patients.
abstract: OBJECTIVE
  This multinational retrospective study compares the outcomes of patients with primary mediastinal large B-cell lymphoma (PMLBCL) with sclerosis after first-generation (dose-intensive regimens), third-generation (alternating regimens) and high-dose chemotherapy strategies, frequently with adjuvant radiation therapy.
  
  
  METHODS
  Between August 1981 and December 1999, a total of 426 previously untreated patients with confirmed diagnosis were enrolled in 20 institutions to receive combination chemotherapy with either first generation (CHOP or CHOP-like) regimens, third generation (MACOP-B, VACOP-B, ProMACE CytaBOM) regimens or high-dose chemotherapy (HDS/ABMT).
  
  
  RESULTS
  With chemotherapy, complete response (CR) rates were 49% (50/105), 51% (142/277) and 53% (23/44) with first generation, third generation and high-dose chemotherapy strategies, respectively; partial response (PR) rates were 32%, 36% and 35%, respectively. All patients who achieved CR and 124/142 (84%) with PR had radiation therapy on the mediastinum. The final CR rates became 61% for CHOP/CHOP-like regimens, 79% for MACOP-B and other regimens, and 75% for HDS/ABMT. After median follow-ups from attaining CR of 48.5 months for CHOP/CHOP-like regimens, 51.7 months for MACOP-B type regimens and 32.4 months for HDS/ABMT, relapses occurred in 15/64 (23%), 27/218 (12%) and 0/33 (0%) patients, respectively. Projected 10-year progression-free survival rates were 35%, 67% and 78%, respectively (p=0.0000). Projected 10-year overall survival rates were 44%, 71% and 77%, respectively (p=0.0000), after median follow-ups from diagnosis of 52.3 months, 54.9 months and 35.8 months, respectively.
  
  
  CONCLUSIONS
  In patients with PMLBCL with sclerosis, MACOP-B plus radiation therapy may be a better strategy than other treatments; these retrospective data need to be confirmed by prospective studies. The encouraging survival results after high dose chemotherapy require confirmation in selected high-risk patients.
authors.affiliation: Institute of Hematology and Medical Oncology Seràgnoli, University of Bologna, Italy. plzinzo@med.unibo.it
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Zinzani
authors.forename: Maurizio
authors.initials: M
authors.lastname: Martelli
authors.forename: Marilena
authors.initials: M
authors.lastname: Bertini
authors.forename: Alessandro M
authors.initials: AM
authors.lastname: Gianni
authors.forename: Liliana
authors.initials: L
authors.lastname: Devizzi
authors.forename: Massimo
authors.initials: M
authors.lastname: Federico
authors.forename: Gerassimos
authors.initials: G
authors.lastname: Pangalis
authors.forename: Jorg
authors.initials: J
authors.lastname: Michels
authors.forename: Emanuele
authors.initials: E
authors.lastname: Zucca
authors.forename: Maria
authors.initials: M
authors.lastname: Cantonetti
authors.forename: Sergio
authors.initials: S
authors.lastname: Cortelazzo
authors.forename: Andrew
authors.initials: A
authors.lastname: Wotherspoon
authors.forename: Andrés J M
authors.initials: AJ
authors.lastname: Ferreri
authors.forename: Francesco
authors.initials: F
authors.lastname: Zaja
authors.forename: Francesco
authors.initials: F
authors.lastname: Lauria
authors.forename: Amalia
authors.initials: A
authors.lastname: De Renzo
authors.forename: Marina A
authors.initials: MA
authors.lastname: Liberati
authors.forename: Brunangelo
authors.initials: B
authors.lastname: Falini
authors.forename: Monica
authors.initials: M
authors.lastname: Balzarotti
authors.forename: Antonello
authors.initials: A
authors.lastname: Calderoni
authors.forename: Alfonso
authors.initials: A
authors.lastname: Zaccaria
authors.forename: Patrizia
authors.initials: P
authors.lastname: Gentilini
authors.forename: Pier Paolo
authors.initials: PP
authors.lastname: Fattori
authors.forename: Enzo
authors.initials: E
authors.lastname: Pavone
authors.forename: Maria K
authors.initials: MK
authors.lastname: Angelopoulou
authors.forename: Lapo
authors.initials: L
authors.lastname: Alinari
authors.forename: Maura
authors.initials: M
authors.lastname: Brugiatelli
authors.forename: Nicola
authors.initials: N
authors.lastname: Di Renzo
authors.forename: Francesca
authors.initials: F
authors.lastname: Bonifazi
authors.forename: Stefano A
authors.initials: SA
authors.lastname: Pileri
authors.forename: Franco
authors.initials: F
authors.lastname: Cavalli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D016393:Lymphoma, B-Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000401:mortality / Q000473:pathology / Q000628:therapy; D008297:Male; D008479:Mediastinal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D012598:Sclerosis; D016019:Survival Analysis; D016896:Treatment Outcome