Primary Mediastinal Large B-Cell Lymphoma (PMLCL): The Need for Prospective Controlled Clinical Trials

• Published in: Leukemia & lymphoma 1999-09, Vol.35 (1-2), p.139-146
• Main Authors: Bieri, Sabine, Roggero, Enrico, Zucca, Emanuele, Bertoni, Francesco, Pianca, Silvio, Sanna, Piero, Pedrinis, Ennio, Bernier, Jacques, Cavalli, Franco
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; chemotherapy; Controlled Clinical Trials as Topic; doxorubicin; Female; Humans; Lymphoma, B-Cell - drug therapy; Lymphoma, Large B-Cell, Diffuse - drug therapy; Male; Mediastinal Neoplasms - drug therapy; Middle Aged; outcome; Primary mediastinal large B-cell lymphoma; Prospective Studies; radiation therapy; Retrospective Studies; Treatment Outcome
• ISSN: 1042-8194; 1029-2403
• DOI: 10.3109/10428199909145713

Primary mediastinal large-B cell lymphomas (PMLCL) are considered to be a distinct clini-copathologic entity among the diffuse large B-cell lymphomas. This study evaluated the prognostic factors and therapeutic outcome of PMLCL in a single-institution series. Twenty seven patients were reviewed. Nineteen of the 27 had Stage I-II and 8 had Stage III-IV disease. B-symptoms were found in 11 (41%) patients and bulky disease in 10 (37%). All patients were initially given combination chemotherapy (CT): doxorubicin-containing regimens to 23 patients (11 patients had CHOP, 12 more intensive third-generation regimens) and 4 elderly (>70 years) patients received CVP. Eleven responders were consolidated with irradiation (RT) as part of their initial treatment, with a median total dose of 39 Gy. Nineteen patients (70%) achieved clinical remission (15 CR and 4 PR) with their initial therapy. Forty-four percent of patients remained progression-free and 59% are alive at 3 years. The actuarial 10-year TTP and OS were 44% and 50%. respectively. Age >60 years, performance status >1 and IPI intermediate-high to high risk were significantly associated with poorer 0s and TTP by univariate analysis (log-rank test). A better outcome was associated with the use of more aggressive chemotherapy regimens or with the inclusion of RT in the first-line treatment. In conclusion our analyses suggest that the application of radiotherapy in combination regimens and the use of more aggressive chemotherapy in the treatment of this particular lymphoma entity should be evaluated in prospective randomized trials.