title: Treatment of primary mediastinal B-cell lymphoma with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone is associated with a high rate of primary refractory disease.
abstract: The optimal therapy for primary mediastinal B-cell lymphoma is a subject of ongoing debate, with no accepted standard of care. We performed a retrospective analysis of 63 patients in the modern era treated with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP), with or without radiation. Median age was 37 years (range 20-82). Eighty percent had limited stage disease and 71% were bulky. By age-adjusted International Prognostic Index (IPI), 15% were low-risk, 52% low-intermediate, 27% high-intermediate and 6% high-risk. Some 77% of responding patients received consolidative radiotherapy. Overall and complete response rates were 79% and 71%. Primary induction failure occurred in 13 (21%) patients. Five-year PFS and OS were 68% and 79%, respectively. Adverse prognostic features included increased IPI, advanced stage, advanced age and multiple extranodal sites. These data demonstrate an unacceptably high rate of primary refractory disease on R-CHOP, particularly among patients with high-risk features. Novel treatment approaches are needed that reduce primary refractory disease and reliance on mediastinal radiation in young people.
authors.affiliation: Center for Lymphoma, Massachusetts General Hospital Cancer Center , Boston, MA , USA.
authors.forename: Jacob D
authors.initials: JD
authors.lastname: Soumerai
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Hellmann
authors.forename: Yang
authors.initials: Y
authors.lastname: Feng
authors.forename: Aliyah R
authors.initials: AR
authors.lastname: Sohani
authors.forename: Christiana E
authors.initials: CE
authors.lastname: Toomey
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Barnes
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Takvorian
authors.forename: Donna
authors.initials: D
authors.lastname: Neuberg
authors.forename: Ephraim P
authors.initials: EP
authors.lastname: Hochberg
authors.forename: Jeremy S
authors.initials: JS
authors.lastname: Abramson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016393:Lymphoma, B-Cell / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008479:Mediastinal Neoplasms / Q000188:drug therapy*; D008875:Middle Aged; D009367:Neoplasm Staging; D011241:Prednisone / Q000627:therapeutic use; D012189:Retrospective Studies; D000069283:Rituximab; D017211:Treatment Failure; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone