title: Single-institution experience in the treatment of primary mediastinal B cell lymphoma treated with immunochemotherapy in the setting of response assessment by 18fluorodeoxyglucose positron emission tomography.
abstract: OBJECTIVE
  Excellent outcomes obtained after infusional dose-adjusted etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone, and rituximab (R-EPOCH) alone have led some to question the role of consolidative radiation therapy (RT) in the treatment of primary mediastinal B cell lymphoma (PMBL). We reviewed the outcomes in patients treated with 1 of 3 rituximab-containing regimens (cyclophosphamide, doxorubicin, vincristine, prednisone [R-CHOP]; hyperfractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone [R-HCVAD], or R-EPOCH) with or without RT. We also evaluated the ability of positron emission tomography-computed tomography (PET-CT) to identify patients at risk of relapse.
  
  
  METHODS
  We retrospectively identified 97 patients with diagnoses of stage I/II PMBCL treated at our institution between 2001 and 2013. The clinical characteristics, treatment outcomes, and toxicity were assessed. We analyzed whether postchemotherapy PET-CT could identify patients at risk for progressive disease according to a 5 point scale (5PS) Deauville score assigned.
  
  
  RESULTS
  Among 97 patients (median follow-up time, 57 months), the 5-year overall survival rate was 99%. Of patients treated with R-CHOP, 99% received RT; R-HCVAD, 82%; and R-EPOCH, 36%. Of 68 patients with evaluable end-of-chemotherapy PET-CT scans, 62% had a positive scan (avidity above that of the mediastinal blood pool [Deauville 5PS = 3]), but only 9 patients experienced relapse (n=1) or progressive disease (n=8), all with a 5PS of 4 to 5. Of the 25 patients who received R-EPOCH, 4 experienced progression, all with 5PS of 4 to 5; salvage therapy (RT and autologous stem cell transplantation) was successful in all cases.
  
  
  CONCLUSIONS
  Combined modality immunochemotherapy and RT is well tolerated and effective for treatment of PMBCL. A postchemotherapy 5PS of 4 to 5, rather than 3 to 5, can identify patients at high risk of progression who should be considered for therapy beyond chemotherapy alone after R-EPOCH.
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Chelsea C
authors: CC
authors: Pinnix
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: bdabaja@mdanderson.org.
authors: Bouthaina
authors: B
authors: Dabaja
authors: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Mohamed Amin
authors: MA
authors: Ahmed
authors: Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Hubert H
authors: HH
authors: Chuang
authors: Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Colleen
authors: C
authors: Costelloe
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Christine F
authors: CF
authors: Wogan
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Valerie
authors: V
authors: Reed
authors: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Jorge E
authors: JE
authors: Romaguera
authors: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Sattva
authors: S
authors: Neelapu
authors: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Yasuhiro
authors: Y
authors: Oki
authors: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas; Office of Medical Affairs, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: M Alma
authors: MA
authors: Rodriguez
authors: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Luis
authors: L
authors: Fayad
authors: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Frederick B
authors: FB
authors: Hagemeister
authors: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Loretta
authors: L
authors: Nastoupil
authors: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Francesco
authors: F
authors: Turturro
authors: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Nathan
authors: N
authors: Fowler
authors: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Michelle A
authors: MA
authors: Fanale
authors: Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Yago
authors: Y
authors: Nieto
authors: Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Issa F
authors: IF
authors: Khouri
authors: Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Sairah
authors: S
authors: Ahmed
authors: Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: L Jeffrey
authors: LJ
authors: Medeiros
authors: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Richard Eric
authors: RE
authors: Davis
authors: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Jason
authors: J
authors: Westin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D003131:Combined Modality Therapy / Q000379:methods; D003520:Cyclophosphamide / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D019788:Fluorodeoxyglucose F18; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D008297:Male; D008479:Mediastinal Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods; D011241:Prednisone / Q000008:administration & dosage; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D000069283:Rituximab; D016879:Salvage Therapy / Q000379:methods; D014750:Vincristine / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D000069283:Rituximab; D014750:Vincristine; D005047:Etoposide; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone