title: Primary mediastinal large B-cell lymphoma (PMLBCL): long-term results from a retrospective multicentre Italian experience in 138 patients treated with CHOP or MACOP-B/VACOP-B.
abstract: The optimal treatment of primary mediastinal large B-cell lymphoma (PMLBCL) is still undefined. In the absence of randomised studies, we retrospectively analysed: (a) the effectiveness of two chemotherapy regimens (CHOP vs MACOP-B/VACOP-B) in complete remission (CR) achievement and event-free survival (EFS) and (b) the role of mediastinal involved-field radiotherapy (IF-RT) as consolidation. From 1982 to 1999, 138 consecutive patients affected by PMLBCL were treated in 13 Italian institutions with CHOP (43) or MACOP-B/VACOP-B (95). The two groups of patients were similar as regard to age, gender, presence of bulky mediastinal mass, pleural effusion, stage and international prognostic indexes category of risk. Overall, 75.5% of patients in CR received IF-RT as consolidation. Complete remission was 51.1% in the CHOP group and 80% in MACOP-B/VACOP-B (P<0.001). Relapse occurred in 22.7% of CHOP- and in 9.2% of MACOP-B/VACOP-B-treated patients (n.s.). Event-free patients were 39.5% in CHOP and 75.7% in the MACOP-B/VACOP-B group (P<0.001). The addition of IF-RT as consolidation improved the outcome, irrespectively of the type of chemotherapy (P=0.04). At a multivariate analysis, achievement of CR (P<0.0001) and type of CT (MACOP-B/VACOP-B) retained the significance for OS (P=0.008) and EFS (P=0.03). In our experience, MACOP-B/VACOP-B appears to positively influence OS and EFS in patients affected by PMLBCL, as compared to CHOP. Consolidation IF-RT on mediastinum further improves the outcome of CR patients.
authors.affiliation: Department of Hematology, Verona University, Italy. giuseppe.todeschinil@tin.it
authors.forename: G
authors.initials: G
authors.lastname: Todeschini
authors.forename: S
authors.initials: S
authors.lastname: Secchi
authors.forename: E
authors.initials: E
authors.lastname: Morra
authors.forename: U
authors.initials: U
authors.lastname: Vitolo
authors.forename: E
authors.initials: E
authors.lastname: Orlandi
authors.forename: F
authors.initials: F
authors.lastname: Pasini
authors.forename: E
authors.initials: E
authors.lastname: Gallo
authors.forename: A
authors.initials: A
authors.lastname: Ambrosetti
authors.forename: C
authors.initials: C
authors.lastname: Tecchio
authors.forename: C
authors.initials: C
authors.lastname: Tarella
authors.forename: A
authors.initials: A
authors.lastname: Gabbas
authors.forename: A
authors.initials: A
authors.lastname: Gallamini
authors.forename: L
authors.initials: L
authors.lastname: Gargantini
authors.forename: M
authors.initials: M
authors.lastname: Pizzuti
authors.forename: G
authors.initials: G
authors.lastname: Fioritoni
authors.forename: L
authors.initials: L
authors.lastname: Gottin
authors.forename: G
authors.initials: G
authors.lastname: Rossi
authors.forename: M
authors.initials: M
authors.lastname: Lazzarino
authors.forename: F
authors.initials: F
authors.lastname: Menestrina
authors.forename: M
authors.initials: M
authors.lastname: Paulli
authors.forename: M
authors.initials: M
authors.lastname: Palestro
authors.forename: M G
authors.initials: MG
authors.lastname: Cabras
authors.forename: F
authors.initials: F
authors.lastname: Di Vito
authors.forename: G
authors.initials: G
authors.lastname: Pizzolo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage; D016393:Lymphoma, B-Cell / Q000188:drug therapy* / Q000473:pathology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000473:pathology; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008479:Mediastinal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D001761:Bleomycin; D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D002955:Leucovorin; D011241:Prednisone; D008727:Methotrexate