Induction chemotherapy strategies for primary mediastinal large B-cell lymphoma with sclerosis: a retrospective multinational study on 426 previously untreated patients.
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.
Zinzani
Pier Luigi
PL
Institute of Hematology and Medical Oncology Seràgnoli, University of Bologna, Italy. plzinzo@med.unibo.it
Martelli
Maurizio
M
Bertini
Marilena
M
Gianni
Alessandro M
AM
Devizzi
Liliana
L
Federico
Massimo
M
Pangalis
Gerassimos
G
Michels
Jorg
J
Zucca
Emanuele
E
Cantonetti
Maria
M
Cortelazzo
Sergio
S
Wotherspoon
Andrew
A
Ferreri
Andrés J M
AJ
Zaja
Francesco
F
Lauria
Francesco
F
De Renzo
Amalia
A
Liberati
Marina A
MA
Falini
Brunangelo
B
Balzarotti
Monica
M
Calderoni
Antonello
A
Zaccaria
Alfonso
A
Gentilini
Patrizia
P
Fattori
Pier Paolo
PP
Pavone
Enzo
E
Angelopoulou
Maria K
MK
Alinari
Lapo
L
Brugiatelli
Maura
M
Di Renzo
Nicola
N
Bonifazi
Francesca
F
Pileri
Stefano A
SA
Cavalli
Franco
F
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