[en] 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.
Disciplines :
Hematology
Author, co-author :
Camus, Vincent; Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
Rossi, Cédric ; Department of Hematology, University Hospital, Dijon, France
Sesques, Pierre; Department of Hematology, Hospices Civils de Lyon, Pierre-Bénite, France
Lequesne, Justine; Clinical Research Unit, Centre Henri Becquerel, Rouen, France
Tonnelet, David ; Department of Nuclear Medicine and QUANTIF-LITIS, Centre Henri Becquerel, Rouen, France
Haioun, Corinne; Lymphoid Malignancies Unit, Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Créteil, France
Durot, Eric ; Department of Hematology, CHU de Reims, Reims, France
Willaume, Alexandre; Department of Hematology, Lille University Hospital-Hopital Claude Hurriez, Lille, France
Gauthier, Martin ; Department of Hematology, IUCT Oncopole, Toulouse, France
Moles-Moreau, Marie-Pierre; Department of Hematology, Angers University Hospital, Angers, France
Antier, Chloé; Department of Hematology, University Hospital, Nantes, France
Lazarovici, Julien; Department of Hematology, Institut Gustave Roussy, Villejuif, France
Monjanel, Hélène; Department of Hematology, CH Aurillac, Aurillac, France ; Department of Hematology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
Bernard, Sophie; Department of Hematology, CHU Saint Louis, Paris, France
Tardy, Magalie; Department of Hematology, Centre Antoine Lacassagne, Nice, France
Besson, Caroline ; Service d'Hémato-oncologie, Centre Hospitalier de Versailles, Le Chesnay, France
Lebras, Laure; Department of Hematology, Centre Léon Bérard, Lyon, France
Choquet, Sylvain; Department of Hematology, CHU La Pitié Salpetriere, Paris, France
Le Du, Katell ; Department of Hematology, Clinique Victor Hugo, Le Mans, France
BONNET, Christophe ; Centre Hospitalier Universitaire de Liège - CHU > > Service d'hématologie clinique
Bailly, Sarah; Department of Hematology, Cliniques Universitaires Saint Luc, Brussels, Belgium
Damaj, Ghandi ; Department of Hematology, Côte de Nacre University Hospital, Caen, France
Laribi, Kamel; Department of Hematology, CH Le Mans, Le Mans, France
Maisonneuve, Hervé; Department of Hematology, CH Départemental de Vendée, La-Roche-Sur-Yon, France
Houot, Roch; Department of Hematology, Rennes University Hospital, Rennes, France
Chauchet, Adrien; Department of Hematology, CH Besançon, Besançon, France
Jardin, Fabrice; Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
Traverse-Glehen, Alexandra; Department of Pathology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, UMR CNRS 5239, Pierre-Bénite, France, and
Decazes, Pierre ; Department of Nuclear Medicine and QUANTIF-LITIS, Centre Henri Becquerel, Rouen, France
Becker, Stéphanie; Department of Nuclear Medicine and QUANTIF-LITIS, Centre Henri Becquerel, Rouen, France
Berriolo-Riedinger, Alina ; Department of Nuclear Medicine, University Hospital, Dijon, France
Tilly, Hervé; Department of Hematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
Outcomes after first-line immunochemotherapy for primary mediastinal B-cell lymphoma: a LYSA study.
Publication date :
2021
Journal title :
Blood Advances
ISSN :
2473-9529
eISSN :
2473-9537
Publisher :
American Society of Hematology, United States
Volume :
5
Pages :
3862-3872
Peer reviewed :
Peer Reviewed verified by ORBi
Funding text :
Conflict-of-interest disclosure: V.C. reports honoraria from Roche, Amgen, Gilead-Kite, BMS, and Sanofi; and travel grants from Pfizer and Roche. H.T. reports honoraria from Celgene, Roche, Karyopharm, AstraZeneca, and Bristol Myers Squibb; and grants from Celgene. The remaining authors declare no competing financial interests.
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