title: Prognostic significance of pleural or pericardial effusion and the implication of optimal treatment in primary mediastinal large B-cell lymphoma: a multicenter retrospective study in Japan.
abstract: The prognosis of patients with primary mediastinal large B-cell lymphoma has improved over recent years. However, the optimal treatment strategy including the role of radiotherapy remains unknown. We retrospectively analyzed the clinical outcomes of 345 patients with newly diagnosed primary mediastinal large B-cell lymphoma in Japan. With a median follow up of 48 months, the overall survival at four years for patients treated with R-CHOP (n=187), CHOP (n=44), DA-EPOCH-R (n=9), 2(nd)- or 3(rd)-generation regimens, and chemotherapy followed by autologous stem cell transplantation were 90%, 67%, 100%, 91% and 92%, respectively. Focusing on patients treated with R-CHOP, a higher International Prognostic Index score and the presence of pleural or pericardial effusion were identified as adverse prognostic factors for overall survival in patients treated with R-CHOP without consolidative radiotherapy (IPI: hazard ratio 4.23, 95% confidence interval 1.48-12.13, P=0.007; effusion: hazard ratio 4.93, 95% confidence interval 1.37-17.69, P=0.015). Combined with the International Prognostic Index score and the presence of pleural or pericardial effusion for the stratification of patients treated with R-CHOP without radiotherapy, patients with lower International Prognostic Index score and the absence of effusion comprised approximately one-half of these patients and could be identified as curable patients (95% overall survival at 4 years). The DA-EPOCH-R regimen might overcome the effect of these adverse prognostic factors. Our simple indicators of International Prognostic Index score and the presence of pleural or pericardial effusion could stratify patients with primary mediastinal large B-cell lymphoma and help guide selection of treatment.
authors.affiliation: Department of Hematology and Oncology, Nagoya Daini Red Cross Hospital; Department of Hematology and Oncology, Nagoya University Graduate School of Medicine; iwbamasbytryf0305@yahoo.co.jp.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Aoki
authors.affiliation: Department of Hematology, Toranomon Hospital, Tokyo, Japan;
authors.forename: Koji
authors.initials: K
authors.lastname: Izutsu
authors.affiliation: Department of HSCT Data Management and Biostatistics, Nagoya University Graduate School of Medicine, Kyoto University, Kyoto;
authors.forename: Ritsuro
authors.initials: R
authors.lastname: Suzuki
authors.affiliation: Department of Hematology, Chiba University Hospital, Kyoto University, Kyoto;
authors.forename: Chiaki
authors.initials: C
authors.lastname: Nakaseko
authors.affiliation: Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto;
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Arima
authors.affiliation: Department of Hematology and Oncology, Nagoya University Graduate School of Medicine;
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Shimada
authors.affiliation: Department of Hematology and Oncology, Nagoya University Graduate School of Medicine;
authors.forename: Akihiro
authors.initials: A
authors.lastname: Tomita
authors.affiliation: Division of Hematology, Department of Internal Medicine, Juntendo University School of Medicine, Tokyo;
authors.forename: Makoto
authors.initials: M
authors.lastname: Sasaki
authors.affiliation: Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Tochigi;
authors.forename: Jun
authors.initials: J
authors.lastname: Takizawa
authors.affiliation: Department of Hematology and Oncology, Dokkyo Medical University of Medicine, Tochigi;
authors.forename: Kinuko
authors.initials: K
authors.lastname: Mitani
authors.affiliation: Department of Hematology and Oncology, Gunma Cancer Center, Oota;
authors.forename: Tadahiko
authors.initials: T
authors.lastname: Igarashi
authors.affiliation: Department of Hematology and Oncology, Okayama University Hospital, Sendai;
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Maeda
authors.affiliation: Department of Hematology and Rheumatology, Tohoku University Hospital, Sendai;
authors.forename: Noriko
authors.initials: N
authors.lastname: Fukuhara
authors.affiliation: Department of Biomedical Laboratory Sciences, Department of Hematology, Shinshu University School of Medicine, Matsumoto;
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Ishida
authors.affiliation: Department of Hematology, International Medical Center, Saitama Medical University, Hidaka;
authors.forename: Nozomi
authors.initials: N
authors.lastname: Niitsu
authors.affiliation: Department of Hematology, Tokai University, Isehara;
authors.forename: Ken
authors.initials: K
authors.lastname: Ohmachi
authors.affiliation: Department of Medical Oncology, Kanagawa Cancer Center, Yokohama;
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Takasaki
authors.affiliation: Department of Pathology, Tokai University, Isehara;
authors.forename: Naoya
authors.initials: N
authors.lastname: Nakamura
authors.affiliation: Department of Hematology and Cell Therapy, Aichi Cancer Center, Nagoya;
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Kinoshita
authors.affiliation: Department of Pathology and Laboratory Medicine, Nagoya University Hospital;
authors.forename: Shigeo
authors.initials: S
authors.lastname: Nakamura
authors.affiliation: Department of Hematology and Oncology, Nagoya Daini Red Cross Hospital; Department of Internal Medicine and Laboratory Medicine, National Hospital Organization Suzuka National Hospital, Japan.
authors.forename: Michinori
authors.initials: M
authors.lastname: Ogura
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008479:Mediastinal Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D009367:Neoplasm Staging; D010490:Pericardial Effusion / Q000175:diagnosis* / Q000209:etiology; D010996:Pleural Effusion / Q000175:diagnosis* / Q000209:etiology; D011241:Prednisone / Q000008:administration & dosage; D011379:Prognosis; D012189:Retrospective Studies; D000069283:Rituximab; D033581:Stem Cell Transplantation; D015996:Survival Rate; D014182:Transplantation, Autologous; D014750:Vincristine / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone