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

Abstract

UNLABELLED:

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.

• Authors: Theodoros P Vassilakopoulos, 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
• Journal: The oncologist (Oncologist) Vol. 17 Issue 2 Pg. 239-49 ( 2012) ISSN: 1549-490X [Electronic] England
• PMID: 22282906 (Publication Type: Journal Article)

Chemical References

• Antibodies, Monoclonal, Murine-Derived
• Rituximab
• Vincristine
• Doxorubicin
• Cyclophosphamide
• Prednisolone

Topics

• Adult
• Aged
• Antibodies, Monoclonal, Murine-Derived (administration & dosage)
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, therapeutic use)
• Chemoradiotherapy
• Cyclophosphamide (administration & dosage)
• Doxorubicin (administration & dosage)
• Female
• Humans
• Lymphoma, Large B-Cell, Diffuse (drug therapy, mortality, radiotherapy)
• Male
• Middle Aged
• Multimodal Imaging
• Positron-Emission Tomography
• Prednisolone (administration & dosage)
• Rituximab
• Tomography, X-Ray Computed
• Vincristine (administration & dosage)