Primary mediastinal B-cell lymphoma treated with CHOP-like chemotherapy with or without rituximab: results of the Mabthera International Trial Group study.
BACKGROUND
The aim of this subgroup analysis of the Mabthera International Trial Group study was to evaluate the impact of chemotherapy and rituximab in primary mediastinal B-cell lymphoma (PMBCL) in comparison to other diffuse large B-cell lymphoma (DLBCL).


METHODS
Patients were randomly assigned to six cycles of CHOP-like regimens with or without rituximab.


RESULTS
Of 824 patients enrolled, 87 had PMBCL and 627 other types of DLBCL. Rituximab increased the rates of complete remission (unconfirmed) in both PMBCL (from 54% to 80%, P = 0.015) and DLBCL (from 72% to 87%, P < 0.001). In PMBCL, rituximab virtually eliminated progressive disease (PD) (2.5% versus 24%, P < 0.001), whereas without rituximab, PD was more frequent in PMBCL than in DLBCL (24% versus 10%, P = 0.010). With a median observation time of 34 months, 3-year event-free survival (EFS) was improved by rituximab for PMBCL (78% versus 52%, P = 0.012) and for DLBCL (81% versus 61%, P < 0.001). Overall survival benefit was similar for DLBCL (93% versus 85%, P < 0.001) and PMBCL (89% versus 78%, P = 0.158).


CONCLUSIONS
In young patients with PMBCL (age-adjusted International Prognostic Index 0-1), rituximab added to six cycles of CHOP-like chemotherapy increases response rate and EFS to the same extent as other DLBCL. The combination of rituximab with CHOP chemotherapy is an effective treatment in PMBCL with good prognosis features.
Rieger
M
M
Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany. Electronic address: michael.rieger@med.uni-heidelberg.de.
Österborg
A
A
Departments of Oncology, Haematology, Karolinska University Hospital, Stockholm, Sweden.
Pettengell
R
R
St George's University of London, UK.
White
D
D
Dalhousie University, Halifax, Nova Scotia for the NCIC Clinical Trials Group, Kingston, Ontario, Canada.
Gill
D
D
Department of Haematology, Princess Alexandra Hospital, Queensland, Australia.
Walewski
J
J
Department of Lymphoma, Maria Sklodowska-Curie Institute and Oncology Centre, Warszawa, Poland.
Kuhnt
E
E
Clinical Trial Centre Leipzig, University of Leipzig, Leipzig.
Loeffler
M
M
Institute of Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig.
Pfreundschuh
M
M
Saarland University Medical School, Homburg, Germany.
Ho
A D
AD
Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany.
D000293:Adolescent; D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001761:Bleomycin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D002955:Leucovorin / Q000008:administration & dosage; D016393:Lymphoma, B-Cell / Q000188:drug therapy* / Q000532:radiotherapy; D008297:Male; D008479:Mediastinal Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage; D015999:Multivariate Analysis; D011239:Prednisolone / Q000008:administration & dosage; D011241:Prednisone / Q000008:administration & dosage; D016016:Proportional Hazards Models; D011446:Prospective Studies; D000069283:Rituximab; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage; D055815:Young Adult
D058846:Antibodies, Monoclonal, Murine-Derived; D001761:Bleomycin; D000069283:Rituximab; D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone; D008942:Mitoxantrone; D002955:Leucovorin; D011241:Prednisone; D008727:Methotrexate