Open AccessRituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone with or Without Radiotherapy in Primary Mediastinal Large B‐Cell Lymphoma: The Emerging Standard of Care
Author(s) -
Vassilakopoulos Theodoros P.,
Pangalis Gerassimos A.,
Katsigiannis Andreas,
Papageorgiou Sotirios G.,
Constantinou Nikos,
Terpos Evangelos,
Zorbala Alexandra,
Vrakidou Effimia,
Repoussis Panagiotis,
Poziopoulos Christos,
Galani Zacharoula,
Dimopoulou Maria N.,
Kokoris Stella I.,
Sachanas Sotirios,
Kalpadakis Christina,
Dimitriadou Evagelia M.,
Siakantaris Marina P.,
Kyrtsonis MarieChristine,
Dervenoulas John,
Dimopoulos Meletios A.,
Meletis John,
Roussou Paraskevi,
Panayiotidis Panayiotis,
Beris Photis,
Angelopoulou Maria K.
Publication year - 2012
Publication title -
the oncologist
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.176
H-Index - 164
eISSN - 1549-490X
pISSN - 1083-7159
DOI - 10.1634/theoncologist.2011-0275
Subject(s) - medicine , vincristine , rituximab , chop , prednisone , cyclophosphamide , lymphoma , oncology , chemotherapy , gastroenterology , surgery
Learning Objectives After completing this course, the reader will be able to: Describe the effect of the addition of rituximab to standard CHOP chemotherapy on the outcome of patients with primary mediastinal large B‐cell lymphoma. Explain potential changes in the use of radiotherapy and aggressive chemotherapy in the rituximab era.This article is available for continuing medical education credit at CME.TheOncologist.comMore 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.