Outcomes of adults and children with primary mediastinal B-cell lymphoma treated with dose-adjusted EPOCH-R.
Lisa Giulino-RothTara O'DonohueZhengming ChenNancy L BartlettAnn LaCasceWilliam Martin-DoyleMatthew J BarthKimberly DaviesKristie A BlumBeth ChristianCarla CasuloSonali M SmithJames GodfreyAmanda TermuhlenMatthew J OberleySarah AlexanderSheila WeitzmanBurton AppelBenjamin MizukawaJakub SvobodaZeinab AfifyMelinda PaulyHema DaveRebecca GardnerDeborah M StephensWilliam A ZeitlerChristopher ForlenzaJennifer LevineMichael E WilliamsJody L SimaCatherine M BollardJohn P LeonardPublished in: British journal of haematology (2017)
Treatment with dose-adjusted EPOCH (etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone) chemotherapy and rituximab (DA-EPOCH-R) has become the standard of care for primary mediastinal B-cell lymphoma (PMBCL) at many institutions despite limited data in the multi-centre setting. We report a large, multi-centre retrospective analysis of children and adults with PMBCL treated with DA-EPOCH-R to characterize outcomes and evaluate prognostic factors. We assessed 156 patients with PMBCL treated with DA-EPOCH-R across 24 academic centres, including 38 children and 118 adults. All patients received at least one cycle of DA-EPOCH-R. Radiation therapy was administered in 14·9% of patients. With median follow-up of 22·6 months, the estimated 3-year event-free survival (EFS) was 85·9% [95% confidence interval (CI) 80·3-91·5] and overall survival was 95·4% (95% CI 91·8-99·0). Outcomes were not statistically different between paediatric and adult patients. Thrombotic complications were reported in 28·2% of patients and were more common in paediatric patients (45·9% vs. 22·9%, P = 0·011). Seventy-five per cent of patients had a negative fluorodeoxyglucose positron emission tomography (FDG-PET) scan at the completion of DA-EPOCH-R, defined as Deauville score 1-3. Negative FDG-PET at end-of-therapy was associated with improved EFS (95·4% vs. 54·9%, P < 0·001). Our data support the use of DA-EPOCH-R for the treatment of PMBCL in children and adults. Patients with a positive end-of-therapy FDG-PET scan have an inferior outcome.
Keyphrases
- positron emission tomography
- prognostic factors
- computed tomography
- end stage renal disease
- newly diagnosed
- pet ct
- radiation therapy
- chronic kidney disease
- ejection fraction
- young adults
- pet imaging
- peritoneal dialysis
- emergency department
- healthcare
- squamous cell carcinoma
- type diabetes
- magnetic resonance imaging
- free survival
- stem cells
- adipose tissue
- magnetic resonance
- intensive care unit
- drug delivery
- patient reported outcomes
- chronic pain
- high dose
- cross sectional
- health insurance
- weight loss
- electronic health record
- insulin resistance
- cell therapy