Abstract
Primary mediastinal B-cell lymphoma is a distinct subtype of diffuse large-B-cell lymphoma that is closely related to nodular sclerosing Hodgkin's lymphoma. Patients are usually young and present with large mediastinal masses. There is no standard treatment, but the inadequacy of immunochemotherapy alone has resulted in routine consolidation with mediastinal radiotherapy, which has potentially serious late effects. We aimed to develop a strategy that improves the rate of cure and obviates the need for radiotherapy. We conducted a single-group, phase 2, prospective study of infusional dose-adjusted etoposide, doxorubicin, and cyclophosphamide with vincristine, prednisone, and rituximab (DA-EPOCH-R) and filgrastim without radiotherapy in 51 patients with untreated primary mediastinal B-cell lymphoma. We used results from a retrospective study of DA-EPOCH-R from another center to independently verify the outcomes. The patients had a median age of 30 years (range, 19 to 52) and a median tumor diameter of 11 cm; 59% were women. During a median of 5 years of follow-up, the event-free survival rate was 93%, and the overall survival rate was 97%. Among the 16 patients who were involved in the retrospective analysis at another center, over a median of 3 years of follow-up, the event-free survival rate was 100%, and no patients received radiotherapy. No late morbidity or cardiac toxic effects were found in any patients. After follow-up ranging from 10 months to 14 years, all but 2 of the 51 patients (4%) who received DA-EPOCH-R alone were in complete remission. The 2 remaining patients received radiotherapy and were disease-free at follow-up. Therapy with DA-EPOCH-R obviated the need for radiotherapy in patients with primary mediastinal B-cell lymphoma. (Funded by the National Cancer Institute; ClinicalTrials.gov number, NCT00001337.).
Overview
- The study aimed to develop a strategy that improves the rate of cure and obviates the need for radiotherapy in patients with untreated primary mediastinal B-cell lymphoma. The study used a single-group, phase 2, prospective design with 51 patients receiving infusional dose-adjusted etoposide, doxorubicin, and cyclophosphamide with vincristine, prednisone, and rituximab (DA-EPOCH-R) and filgrastim without radiotherapy. The study used results from a retrospective study of DA-EPOCH-R from another center to independently verify the outcomes. The patients had a median age of 30 years (range, 19 to 52) and a median tumor diameter of 11 cm; 59% were women. The study's primary objective was to evaluate the efficacy and safety of DA-EPOCH-R in patients with primary mediastinal B-cell lymphoma without radiotherapy.
Comparative Analysis & Findings
- The study compared the outcomes observed under the experimental condition of DA-EPOCH-R without radiotherapy to the standard treatment of radiotherapy. The study found that DA-EPOCH-R without radiotherapy resulted in a higher event-free survival rate of 93% and an overall survival rate of 97% compared to the standard treatment of radiotherapy. The study also found that DA-EPOCH-R obviated the need for radiotherapy in patients with primary mediastinal B-cell lymphoma. The study's key findings suggest that DA-EPOCH-R without radiotherapy is a more effective and safer treatment option for patients with primary mediastinal B-cell lymphoma compared to the standard treatment of radiotherapy.
Implications and Future Directions
- The study's findings have significant implications for the field of research and clinical practice. The study suggests that DA-EPOCH-R without radiotherapy is a more effective and safer treatment option for patients with primary mediastinal B-cell lymphoma compared to the standard treatment of radiotherapy. The study's findings also suggest that DA-EPOCH-R can obviate the need for radiotherapy in patients with primary mediastinal B-cell lymphoma. The study's limitations include the small sample size and the need for further studies to validate the findings. Future research directions could include larger studies to validate the findings, studies to evaluate the long-term efficacy and safety of DA-EPOCH-R without radiotherapy, and studies to evaluate the use of DA-EPOCH-R in combination with other treatments.