Background: Primary Mediastinal B cell lymphoma is a distinct subtype of diffuse large B cell lymphoma that is more common in younger female age. Combined regimen of chemotherapy (CT) with involved field radiotherapy (IFRT) is considered the mainstay of treatment. In the pre-Rituximab era third generation regimens as MACOP-B has improved survival in PMBL patients (pts) over CHOP, but the current combination of Rituximab with CHOP regimen equalize this difference. The real need of consolidation mediastinal IFRT is still debated for the risk of secondary cancer and cardiac disease. We report the long term results on a large series of PMBL treated at our institute. Method: 107 pts with PMBL were treated between June 1991 and September 2006; 80 pts had stage II and 27 stage IIE-IV, 75% had elevated LDH, bulky disease was in 95 pts including 58 (55%) with clinical evidence of superior vena cava obstruction. Median age was 34 yrs (15-61), 71% were females. The IPI score was 0-1 in 60 pts and 2-3 in 47. Ninety-two pts were treated with standard MACOP-B regimen and 15 received a Rchemotherapy since March 2004. Overall 94% received IFRT at dose of 30-36 Gy. The response was evaluated at the end of CT and of IFRT. Results: At the end of the program, the CR/CRu was obtained in 76 pts (71%), PR in 23(21%), NR 1(1%), 7 pts were not evaluable: 6 pts received an early intensification for progressive disease and 1 died for toxicity by CT. At the end of the program: 14 of PR pts obtained a CR/CRu after IFRT with an overall CR/CRu rate of 89%; 9 pts relapsed within 10 months and 4 of them died of progressive disease. At a median follow-up of 111 months (1-238) the 10-yrs OS, PFS and EFS were 88%, 85% and 83% respectively. No statistically significant difference was recorded with MACOP-B +/- Rituximab in order to survival end-points. Pts with IPI 0-1 have significant better PFS p=0.020. In our experience 1/107 pt developed a secondary cancer (acute myeloid leukemia) after 164 months from the end of therapy and no breast cancer occurred. Four/107 (4%) presented late severe cardiotoxicity: 3 congestive heart failure and 1 sudden arrhythmic death. Conclusions: This is the largest reported series of PMBL treated at single center. MACOP-B +/- Rituximab plus IFRT is highly effective and devoid of a severe long term toxicity. Future randomized trials should evaluate the real need of a mediastinal IFRT in pts who obtained a PET negative CR after a R-chemotherapy regimen.

MACOP-B +/- RITUXIMAB FOLLOWED BY INVOLVED MEDIASTINAL RADIOTHERAPY IS A SAFE AND HIGH EFFECTIVE THERAPY FOR PRIMARY MEDIASTINAL LARGE B CELL LYMPHOMA (PMBL): LONG TERM RESULTS AND LATE TOXICITY FROM A SINGLE ITALIAN CENTER / Martelli, Maurizio; DE SANCTIS, Vitaliana; E., Finolezzi; DI ROCCO, Alice; L., Grapulin; C., Minotti; P., Paesano; A., Fama; Foa, Roberto. - In: ANNALS OF ONCOLOGY. - ISSN 0923-7534. - 22 (suppl 4):(2011), pp. 134-134. ((Intervento presentato al convegno 11th International Conference on Malignant Lymphoma tenutosi a Lugano, SWITZERLAND nel JUN 15-18, 2011 [10.1093/annonc/mdr210].

MACOP-B +/- RITUXIMAB FOLLOWED BY INVOLVED MEDIASTINAL RADIOTHERAPY IS A SAFE AND HIGH EFFECTIVE THERAPY FOR PRIMARY MEDIASTINAL LARGE B CELL LYMPHOMA (PMBL): LONG TERM RESULTS AND LATE TOXICITY FROM A SINGLE ITALIAN CENTER

MARTELLI, Maurizio;DE SANCTIS, Vitaliana;DI ROCCO, Alice;FOA, Roberto
2011

Abstract

Background: Primary Mediastinal B cell lymphoma is a distinct subtype of diffuse large B cell lymphoma that is more common in younger female age. Combined regimen of chemotherapy (CT) with involved field radiotherapy (IFRT) is considered the mainstay of treatment. In the pre-Rituximab era third generation regimens as MACOP-B has improved survival in PMBL patients (pts) over CHOP, but the current combination of Rituximab with CHOP regimen equalize this difference. The real need of consolidation mediastinal IFRT is still debated for the risk of secondary cancer and cardiac disease. We report the long term results on a large series of PMBL treated at our institute. Method: 107 pts with PMBL were treated between June 1991 and September 2006; 80 pts had stage II and 27 stage IIE-IV, 75% had elevated LDH, bulky disease was in 95 pts including 58 (55%) with clinical evidence of superior vena cava obstruction. Median age was 34 yrs (15-61), 71% were females. The IPI score was 0-1 in 60 pts and 2-3 in 47. Ninety-two pts were treated with standard MACOP-B regimen and 15 received a Rchemotherapy since March 2004. Overall 94% received IFRT at dose of 30-36 Gy. The response was evaluated at the end of CT and of IFRT. Results: At the end of the program, the CR/CRu was obtained in 76 pts (71%), PR in 23(21%), NR 1(1%), 7 pts were not evaluable: 6 pts received an early intensification for progressive disease and 1 died for toxicity by CT. At the end of the program: 14 of PR pts obtained a CR/CRu after IFRT with an overall CR/CRu rate of 89%; 9 pts relapsed within 10 months and 4 of them died of progressive disease. At a median follow-up of 111 months (1-238) the 10-yrs OS, PFS and EFS were 88%, 85% and 83% respectively. No statistically significant difference was recorded with MACOP-B +/- Rituximab in order to survival end-points. Pts with IPI 0-1 have significant better PFS p=0.020. In our experience 1/107 pt developed a secondary cancer (acute myeloid leukemia) after 164 months from the end of therapy and no breast cancer occurred. Four/107 (4%) presented late severe cardiotoxicity: 3 congestive heart failure and 1 sudden arrhythmic death. Conclusions: This is the largest reported series of PMBL treated at single center. MACOP-B +/- Rituximab plus IFRT is highly effective and devoid of a severe long term toxicity. Future randomized trials should evaluate the real need of a mediastinal IFRT in pts who obtained a PET negative CR after a R-chemotherapy regimen.
File allegati a questo prodotto
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11573/484990
 Attenzione

Attenzione! I dati visualizzati non sono stati sottoposti a validazione da parte dell'ateneo

Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus ND
  • ???jsp.display-item.citation.isi??? 0
social impact