title: Primary mediastinal lymphoma: diagnosis and treatment options.
abstract: Primary mediastinal large B-cell lymphoma (PMBCL) is a unique B-cell lymphoma variant that arises from a putative thymic medulla B cell. It constitutes 2-4% of non-Hodgkin lymphomas and occurs most frequently in young females. PMBCL is characterized by a diffuse proliferation of medium-to-large B cells associated with sclerosis. Molecular analysis shows that PMBCL is a distinct entity compared to other types of diffuse large B-cell lymphomas. PMBCL is characterized by a locally invasive anterior mediastinal bulky mass. The combination of rituximab with CHOP/CHOP-like regimens followed by mediastinal radiation therapy (RT) is associated with a 5-year progression-free survival of 75-85%. However, the role of consolidation RT still remains uncertain. More intensive regimens, such as DA-EPOCH-R without mediastinal RT, have shown very promising results. The conclusive role of PET-CT scan requires prospective studies and there is hope that this may allow to de-escalate RT and accordingly yield reliable prognostic information.
authors.affiliation: Hematology, Department of Cellular Biotechnologies and Hematology, University 'Sapienza', Via Benevento 6, Roma 00161, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Martelli
authors.forename: Alice
authors.initials: A
authors.lastname: Di Rocco
authors.forename: Eleonora
authors.initials: E
authors.lastname: Russo
authors.forename: Salvatore
authors.initials: S
authors.lastname: Perrone
authors.forename: Robin
authors.initials: R
authors.lastname: Foà
mesh_terms: D018572:Disease-Free Survival; D006801:Humans; D016393:Lymphoma, B-Cell / Q000175:diagnosis* / Q000473:pathology; D008479:Mediastinal Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy
keywords: International Prognostic Index; JAK-STAT pathway; PET-CT scan; chemotherapy; histopathology; primary mediastinal lymphoma; programmed death ligand; radiotherapy; rituximab; third-generation regimen