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British Journal of Cancer (2004) 90, 372-376.
doi:10.1038/sj.bjc.6601460
Primary mediastinal large B-cell lymphoma (PMLBCL): long-term results from a retrospective multicentre Italian experience in 138 patients treated with CHOP or MACOP-B/VACOP-B
G Todeschini1, S Secchi1, E Morra2, U Vitolo3, E Orlandi4, F Pasini5, E Gallo3, A Ambrosetti1, C Tecchio1, C Tarella6, A Gabbas7, A Gallamini8,9, L Gargantini2, M Pizzuti10, G Fioritoni10, L Gottin11, G Rossi12, M Lazzarino4, F Menestrina13, M Paulli14, M Palestro15, M G Cabras16, F Di Vito17 and G Pizzolo1
1Department of Hematology, Verona University, Italy
2Department of Hematology, Ospedale Niguarda, Milano, Italy
3Department of Hematology, Ospedale S. Giovanni Battista, Torino, Italy
4Department of Hematology, Pavia University, Italy
5Department of Oncology, Verona University, Italy
6Department of Hematology, Torino University, Italy
7Department of Hematology, Ospedale S. Francesco, Nuoro, Italy
8Department of Hematology, Ospedale Santa Croce, Cuneo, Italy
9Department of Hematology, Ospedale S. Carlo, Potenza, Italy
10Department of Hematology, Ospedale Santo Spirito, Pescara, Italy
11Anesthesiology and Intensive Care Institute, Verona University, Italy
12Department of Hematology, Spedali Riuniti, Brescia, Italy
13Department of Pathology, Verona University, Italy
14Department of Pathology, Pavia University, Italy
15Department of Pathology, Torino University, Italy
16Department of Hematology, Ospedale Businco, Cagliari, Italy
17Department of Oncology, Ospedale Regionale, Aosta, Italy
Correspondence to: G Todeschini, Dipartimento di Medicina Clinica e Sperimentale, Sezione di Ematologia, Università degli Studi di Verona, Piazzale L. Scuro, Verona 37134, Italy. E-mail: giuseppe.todeschini1@tin.it
The optimal treatment of primary mediastinal large B-cell lymphoma (PMLBCL) is still undefined. In the absence of randomised studies, we retrospectively analysed: (a) the effectiveness of two chemotherapy regimens (CHOP vs MACOP-B/VACOP-B) in complete remission (CR) achievement and event-free survival (EFS) and (b) the role of mediastinal involved-field radiotherapy (IF-RT) as consolidation. From 1982 to 1999, 138 consecutive patients affected by PMLBCL were treated in 13 Italian institutions with CHOP (43) or MACOP-B/VACOP-B (95). The two groups of patients were similar as regard to age, gender, presence of bulky mediastinal mass, pleural effusion, stage and international prognostic indexes category of risk. Overall, 75.5% of patients in CR received IF-RT as consolidation. Complete remission was 51.1% in the CHOP group and 80% in MACOP-B/VACOP-B (P<0.001). Relapse occurred in 22.7% of CHOP- and in 9.2% of MACOP-B/VACOP-B-treated patients (n.s.). Event-free patients were 39.5% in CHOP and 75.7% in the MACOP-B/VACOP-B group (P<0.001). The addition of IF-RT as consolidation improved the outcome, irrespectively of the type of chemotherapy (P=0.04). At a multivariate analysis, achievement of CR (P<0.0001) and type of CT (MACOP-B/VACOP-B) retained the significance for OS (P=0.008) and EFS (P=0.03). In our experience, MACOP-B/VACOP-B appears to positively influence OS and EFS in patients affected by PMLBCL, as compared to CHOP. Consolidation IF-RT on mediastinum further improves the outcome of CR patients.
Keywords: PMLBCL; CHOP; MACOP-B/VACOP-B
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| Print ISSN: 0007-0920 | Online ISSN: 1532-1827 | © 2004 Cancer Research UK | ||
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