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. 2022 Jun 22;12(1):10551.
doi: 10.1038/s41598-022-14067-3.

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

Joanna Romejko-Jarosinska  1 , Beata Ostrowska  2 , Anna Dabrowska-Iwanicka  2 , Katarzyna Domanska-Czyz  2 , Grzegorz Rymkiewicz  3 , Ewa Paszkiewicz-Kozik  2 , Robert Konecki  2 , Anna Borawska  2 , Agnieszka Druzd-Sitek  2 , Elzbieta Lampka  2 , Wlodzimierz Osiadacz  2 , Michal Osowiecki  2 , Lidia Popławska  2 , Monika Swierkowska  2 , Lukasz Targonski  2 , Joanna Tajer  2 , Grazyna Lapinska  4 , Malwina Smorczewska  5 , Jan Walewski  2
Affiliations

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

Joanna Romejko-Jarosinska et al. Sci Rep. .

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.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
GMALL/B-ALLL/NHL2002 – treatment disposition. A1, B1, C1, A2, B2, C2 – cycles of GMALL/B-ALL/NHL2002.
Figure 2
Figure 2
Outcomes based on Kaplan–Meyer analysis: overall survival (A) at 5 year was 94% (95% CI 90–98%) and progression free survival (B) at 5 year was 92% (95% CI 88–96%). Median follow up 8.5 years.
Figure 3
Figure 3
Overall survival (OS) and progression free survival according to clinical stage (CS). OS (A) at 5 year was 100% for CS I, 98% for CS II, 100% for CS III and 78% for CS IV. PFS (B) at 5 year was 100% for CS I, 98.5% for CS II, 100% for CS III and 81% for CS IV.
Figure 4
Figure 4
Overall survival (OS) and progression free survival (PFS) according to IPI score. OS (A) at 5 year was 100% for IPI 1, 96% for IPI 2, 84% for IPI 3 and 50% for IPI 4. PFS (B) at 5 year was 100% for IPI 1, 965% for IPI 2, 80% for IPI 3 and 50% for IPI 4.
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