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Outcomes of adults and children with primary mediastinal B‐cell lymphoma treated with dose‐adjusted EPOCH ‐R
Author(s) -
GiulinoRoth Lisa,
O'Donohue Tara,
Chen Zhengming,
Bartlett Nancy L.,
LaCasce Ann,
MartinDoyle William,
Barth Matthew J.,
Davies Kimberly,
Blum Kristie A.,
Christian Beth,
Casulo Carla,
Smith Sonali M.,
Godfrey James,
Termuhlen Amanda,
Oberley Matthew J.,
Alexander Sarah,
Weitzman Sheila,
Appel Burton,
Mizukawa Benjamin,
Svoboda Jakub,
Afify Zeinab,
Pauly Melinda,
Dave Hema,
Gardner Rebecca,
Stephens Deborah M.,
Zeitler William A.,
Forlenza Christopher,
Levine Jennifer,
Williams Michael E.,
Sima Jody L.,
Bollard Catherine M.,
Leonard John P.
Publication year - 2017
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.14951
Subject(s) - medicine , epoch (astronomy) , vincristine , etoposide , rituximab , confidence interval , prednisone , lymphoma , chemotherapy , surgery , cyclophosphamide , stars , physics , astronomy
Summary 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.