10, 9 Comparable rates of PFS and OS have been demonstrated with MACOP-B (methotrexate, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin) or VACOP-B (etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin) followed by RT. 6- 8 However, several retrospective studies have reported a high primary induction failure rate (21%) with R-CHOP, raising the possibility of limited efficacy of this regimen in PMBCL. 1 Formerly, the R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) and subsequent consolidation radiotherapy (RT) had been commonly used as a first-line treatment, resulting in a 5-year progression-free survival (PFS) of 80% and a 5-year overall survival (OS) of 87%. Morphologically and biologically, it is shown to be related to nodular sclerosing Hodgkin lymphoma. 1- 5 Clinically, PMBCL usually affects women in the age of 25–40 years and typically presents with bulky mediastinal involvement. Primary mediastinal B-cell lymphoma (PMBCL), previously considered a subtype of diffuse large B-cell lymphoma (DLBCL) is a rare aggressive hematological malignancy characterized by distinct clinical, morphological, and immunophenotypical features. Our findings suggest that this regimen may be considered as an alternative to DA-EPOCH-R in this patient population. R-CHOP/R-ICE is associated with lower toxicity and significantly reduced hospitalization. ConclusionĭA-EPOCH-R and R-CHOP/R-ICE provide similarly encouraging outcomes in newly-diagnosed PMBCL patients. However, DA-EPOCH-R was associated with significantly longer hospitalization required for its administration ( p < 0.001) and a trend for higher frequency of infections, stomatitis, thrombotic complications and febrile neutropenia-related hospitalizations. ResultsĪt a median follow-up of 1.9 years (IQR 3.1 years), similar progression-free survival (2.1 versus 2.4 years p = 0.7667), overall survival (2.5 versus 2.7 years p = 0.8047) and complete response (80%) were observed in both groups. The analysis included 56 patients: 31 received DA-EPOCH-R and 25 – R-CHOP/R-ICE. Patient demographic and clinical data were derived from institutional electronic medical records. The study included all patients with a histologically confirmed PMBCL diagnosis treated with DA-EPOCH-R or R-CHOP/R-ICE between 01/2013-12/2020 at two tertiary medical centers. To address this issue, the current retrospective bi-icenter analysis compared efficacy and toxicity of DA-EPOCH-R and a less toxic R-CHOP/R-ICE regimen used for the treatment of newly-diagnosed PMBCL. DA-EPOCH-R provides good clinical outcomes, albeit is associated with short- and long-term toxicity. While in recent years dose-adjusted (DA) EPOCH-R (rituximab, etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin) has become widely endorsed as first-line therapy for newly-diagnosed PMBCL, the optimal treatment for this disease and the role of radiotherapy (RT) remains unclear. Despite its aggressive course, PMBCL is considered curable. Primary mediastinal B-cell lymphoma (PMBCL) is a rare subtype of diffuse large B-cell lymphoma (DLBCL).
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