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High efficacy of intensive immunochemotherapy for primary mediastinal B-cell lymphoma with prolonged follow up

Authors :
Joanna Romejko-Jarosinska
Beata Ostrowska
Anna Dabrowska-Iwanicka
Katarzyna Domanska-Czyz
Grzegorz Rymkiewicz
Ewa Paszkiewicz-Kozik
Robert Konecki
Anna Borawska
Agnieszka Druzd-Sitek
Elzbieta Lampka
Wlodzimierz Osiadacz
Michal Osowiecki
Lidia Popławska
Monika Swierkowska
Lukasz Targonski
Joanna Tajer
Grazyna Lapinska
Malwina Smorczewska
Jan Walewski
Source :
Scientific reports. 12(1)
Publication Year :
2021

Abstract

Primary mediastinal B-cell lymphoma (PMBL) is currently curable in 85–95% of patients. Treatment regimens frequently used include RCHOP ± radiotherapy, DAEPOCH-R, or occasionally more intensive protocols. Here we present results of treatment of 124 patients with PMBL over a period between 2004 and 2017 with the use of a protocol designed for aggressive B-cell lymphoma GMALL/B-ALL/NHL2002 including 6 cycles of alternating immunochemotherapy with intermediate-dose methotrexate in each cycle, and reduced total doxorubicin dose (100 mg/m2 for whole treatment). Majority of patients (77%) received consolidative radiotherapy. A median (range) age of patients was 30 (18–59) years, and 60% were female. With a median (range) follow up of 9 (1–17) years, 5-year overall survival (OS) and 5-year progression free survival (PFS) were 94% and 92%, respectively. Positron emission tomography—computed tomography (PET-CT) results at the end of chemotherapy were predictive for outcome: OS and PFS at 5 year were 96% and 94% in PET-CT negative patients, respectively, and 70% and 70% in PET-CT-positive patients (p = 0.004 for OS, p = 0.01 for PFS). Eight (6%) patients had recurrent/refractory disease, however, no central nervous system (CNS) relapse was observed. Acute toxicity included pancytopenia grade 3/4, neutropenic fever, and treatment related mortality rate of 0.8%. Second malignancies and late cardiotoxicity occurred in 2.4% and 2.4% of patients, respectively. Intensive alternating immunochemotherapy protocol GMALL/B-ALL/NHL2002 is curative for more than 90% of PMBL patients and late toxicity in young patients is moderated. The attenuated dose of doxorubicin and intermediate dose of methotrexate may contribute to low incidence of late cardiotoxicity and effective CNS prophylaxis.

Details

ISSN :
20452322
Volume :
12
Issue :
1
Database :
OpenAIRE
Journal :
Scientific reports
Accession number :
edsair.doi.dedup.....af9b15336befcb166137b64a28d8d7d6