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Multicenter Study
. 2021 Oct 12;5(19):3862-3872.
doi: 10.1182/bloodadvances.2021004778.

Outcomes after first-line immunochemotherapy for primary mediastinal B-cell lymphoma: a LYSA study

Vincent Camus  1 , Cédric Rossi  2 , Pierre Sesques  3 , Justine Lequesne  4 , David Tonnelet  5 , Corinne Haioun  6 , Eric Durot  7 , Alexandre Willaume  8 , Martin Gauthier  9 , Marie-Pierre Moles-Moreau  10 , Chloé Antier  11 , Julien Lazarovici  12 , Hélène Monjanel  13   14 , Sophie Bernard  15 , Magalie Tardy  16 , Caroline Besson  17 , Laure Lebras  18 , Sylvain Choquet  19 , Katell Le Du  20 , Christophe Bonnet  21 , Sarah Bailly  22 , Ghandi Damaj  23 , Kamel Laribi  24 , Hervé Maisonneuve  25 , Roch Houot  26 , Adrien Chauchet  27 , Fabrice Jardin  1 , Alexandra Traverse-Glehen  28 , Pierre Decazes  5 , Stéphanie Becker  5 , Alina Berriolo-Riedinger  29 , Hervé Tilly  1
Affiliations
Multicenter Study

Outcomes after first-line immunochemotherapy for primary mediastinal B-cell lymphoma: a LYSA study

Vincent Camus et al. Blood Adv. .

Abstract

Primary mediastinal B-cell lymphoma (PMBL) is a rare type of aggressive lymphoma typically affecting young female patients. The first-line standard of care remains debated. We performed a large multicenter retrospective study in 25 centers in France and Belgium to describe PMBL patient outcomes after first-line treatment in real-life settings. A total of 313 patients were enrolled and received rituximab (R) plus ACVBP (doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone) (n = 180) or CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) delivered every 14 days (R-CHOP14, n = 76) or 21 days (R-CHOP21, n = 57) and consolidation strategies in modalities that varied according to time and institution, mainly guided by positron emission tomography. Consolidation autologous stem cell transplantation was performed for 46 (25.6%), 24 (31.6%), and 1 (1.8%) patient in the R-ACVBP, R-CHOP14, and R-CHOP21 groups, respectively (P < .001); only 17 (5.4%) patients received mediastinal radiotherapy. The end-of-treatment complete metabolic response rates were 86.3%, 86.8%, and 76.6% (P = .23) in the R-ACVBP, R-CHOP14, and R-CHOP21 groups. The median follow-up was 44 months, and the R-ACVBP, R-CHOP14, and R-CHOP21 three-year progression-free survival probabilities were 89.4% (95% confidence interval [CI], 84.8-94.2), 89.4% (95% CI, 82.7-96.6), and 74.7% (95% CI, 64-87.1) (P = .018). A baseline total metabolic tumor volume (TMTV) ≥360 cm3 was associated with a lower progression-free survival (hazard ratio, 2.18; 95% CI, 1.05-4.53). Excess febrile neutropenia (24.4% vs 5.3% vs 5.3%; P < .001) and mucositis (22.8% vs 3.9% vs 1.8%; P < .001) were observed with R-ACVBP compared with the R-CHOP regimens. Patients with PMBL treated with dose-dense immunochemotherapy without radiotherapy have excellent outcomes. R-ACVBP acute toxicity was higher than that of R-CHOP14. Our data confirmed the prognostic importance of baseline TMTV.

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Figures

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Graphical abstract
Figure 1.
Figure 1.
Study flowchart and treatment CMR rate. CMR was defined as follows: DS 1 to 3 (5-point scale, for PET performed in 2010 and after), or negative PET (IHP criteria, for PET examinations performed between 2007 and 2009).
Figure 2.
Figure 2.
PFS according to ACVBP, CHOP14, and CHOP21 plus anti-CD20 treatment groups.
Figure 3.
Figure 3.
OS according to ACVBP, CHOP14, and CHOP21 plus anti-CD20 treatment groups.
Figure 4.
Figure 4.
OS according to levels (DS1-3 vs DS4-5) at the end of the first-line treatment.
Figure 5.
Figure 5.
OS according to uptake levels (DS1-4 vs DS5) at the end of the first-line treatment.
See this image and copyright information in PMC

References

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    1. Liu PP, Wang KF, Xia Y, et al. Racial patterns of patients with primary mediastinal large B-cell lymphoma: SEER analysis. Medicine (Baltimore). 2016;95(27):e4054. - PMC - PubMed
    1. Massoud M, Koscielny S, Lapusan S, Bosq J, Ribrag V.. Primary mediastinal large B-cell lymphomas treated with dose-intensified CHOP alone or CHOP combined with radiotherapy. Leuk Lymphoma. 2008;49(8):1510-1515. - PubMed
    1. Dunleavy K, Pittaluga S, Maeda LS, et al. Dose-adjusted EPOCH-rituximab therapy in primary mediastinal B-cell lymphoma. N Engl J Med. 2013;368(15):1408-1416. - PMC - PubMed
    1. Gleeson M, Hawkes EA, Cunningham D, et al. R-CHOP in primary mediastinal B-cell lymphoma (PMBL): results from the UK NCRI R-CHOP 14 v 21 Trial. Blood. 2015;126(23):2689.

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