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. 2012;17(2):239-49.
doi: 10.1634/theoncologist.2011-0275. Epub 2012 Jan 26.

Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone with or without radiotherapy in primary mediastinal large B-cell lymphoma: the emerging standard of care

Theodoros P Vassilakopoulos  1 , Gerassimos A Pangalis, Andreas Katsigiannis, Sotirios G Papageorgiou, Nikos Constantinou, Evangelos Terpos, Alexandra Zorbala, Effimia Vrakidou, Panagiotis Repoussis, Christos Poziopoulos, Zacharoula Galani, Maria N Dimopoulou, Stella I Kokoris, Sotirios Sachanas, Christina Kalpadakis, Evagelia M Dimitriadou, Marina P Siakantaris, Marie-Christine Kyrtsonis, John Dervenoulas, Meletios A Dimopoulos, John Meletis, Paraskevi Roussou, Panayiotis Panayiotidis, Photis Beris, Maria K Angelopoulou
Affiliations

Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone with or without radiotherapy in primary mediastinal large B-cell lymphoma: the emerging standard of care

Theodoros P Vassilakopoulos et al. Oncologist. 2012.

Abstract

More aggressive treatment approaches (methotrexate, cytarabine, cyclophosphamide, vincristine, prednisone, and bleomycin [the MACOP-B regimen] or consolidation with high-dose therapy and autologous stem cell transplantation) have been considered to be superior to cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) in patients with primary mediastinal large B-cell lymphoma (PMLBCL). Rituximab-CHOP (R-CHOP) is the standard of care for diffuse large B-cell lymphoma, whereas efficacy in PMLBCL has not been adequately confirmed.

Patient and methods: Seventy-six consecutive PMLBCL patients who received R-CHOP with or without radiotherapy (RT) were compared with 45 consecutive historical controls treated with CHOP with or without RT. Baseline characteristics of the two groups were balanced.

Results: The rate of early treatment failure was much lower with R-CHOP with or without RT (9% versus 30%; p = .004). The 5-year freedom from progression rate after R-CHOP with or without RT was 81%, versus 48% for CHOP with or without RT (p < .0001). The 5-year event-free survival rates were 80% and 47% (p < .0001) and the 5-year overall and lymphoma-specific survival rates were 89% and 69% (p = .003) and 91% and 69% (p = .001), respectively, with only seven of 76 lymphoma-related deaths. Among R-CHOP responders, 52 of 68 received RT.

Conclusions: Based on these results, most patients with PMLBCL appear to be cured by R-CHOP in 21-day cycles with or without RT, which could be the current standard of care. Therefore, the need for more aggressive treatment strategies is questionable unless high-risk patients are adequately defined. Further studies are required to establish the precise role of RT.

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Conflict of interest statement

Disclosures: Theodoros P. Vassilakopoulos: None; Gerassimos A. Pangalis: None; Andreas Katsigiannis: None; Sotirios G. Papageorgiou: None; Nikos Constantinou: None; Evangelos Terpos: None; Alexandra Zorbala: None; Effimia Vrakidou: None; Panagiotis Repoussis: None; Christos Poziopoulos: None; Zacharoula Galani: Novartis (RF); Mario N. Dimopoulou: None; Stella I. Kokoris: None; Sotirios Sachanas: None; Christina Kalpadakis: None; Evagelia M. Dimitriadou: None; Marina P. Siakantaris: None; Maria-Christine Kyrtsonis: None; John Dervenoulas; None; Meletios A. Dimopoulos: None; John Meletis: None; Paraskevi Roussou: None; Panayiotis Panayiotidis: Novartis, GlaxoSmithKline, Bristol-Myers Squibb (C/A), Genesis (H), Novartis (RF); Photis Beris: None; Maria K. Angelopoulou: None.

Section Editor: George P. Canellos: Celgene Business Advisory Board (C/A).

Reviewers “A” and “B”: None.

Figures

Figure 1.
Figure 1.
Comparative outcomes of 76 patients with primary mediastinal large B-cell lymphoma treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) with or without radiotherapy and 45 historical controls treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) with or without radiotherapy. (A): Freedom from progression (FFP). (B): Event-free survival (EFS). (C): Lymphoma-specific survival (LSS). (D): Overall survival (OS).
See this image and copyright information in PMC

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