Identification of Very Low-Risk Subgroups of Patients with Primary Mediastinal Large B-Cell Lymphoma Treated with R-CHOP

The oncologist

article

Theodoros P. Vassilakopoulos¹  Theoni Leonidopoulou²  Ioannis Kotsianidis³  Eleftheria Hatzimichael⁴  Maria Kotsopoulou⁵  Maria Dimou⁶  Eleni Variamis⁷  Dimitrios Boutsis⁸  Evangelos Terpos⁹  Maria N. Dimopoulou¹  Stamatios Karakatsanis^1,10  Michail Michail^1,11  Eurydiki Michalis^1,12  George Karianakis^1,13  Pantelis Tsirkinidis^1,14  Chryssa Vadikolia^1,15  Christos Poziopoulos^1,16  Anna Pigaditou^1,17  Effimia Vrakidou^1,13  Theophanis Economopoulos^1,17  Lydia Kyriazopoulou⁴  Marina P. Siakantaris¹  Sotirios Papageorgiou^1,18  Marie-Christine Kyrtsonis⁶  Argyris Symeonidis^1,19  Konstantinos Anargyrou^2,20  Maria Papaioannou^2,21  Evdoxia Hatjiharissi^2,22  Elissavet Vervessou^2,23  Maria Tsirogianni^2,24  Maria Palassopoulou^2,25  Gabriella Gainaru^1,13  Ekaterini Stefanoudaki^2,26  Georgia Kourti^1,10  Panayiotis Zikos^2,28  Panayiotis Tsirigotis^1,18  Gerasimos Tsourouflis^2,29  Theodora Assimakopoulou²  Pavlina Konstantinidou^2,22  Helen A. Papadaki^3,30  Katerina Megalakaki⁵  Meletios-Athanasios Dimopoulos⁹  Vassiliki Pappa^1,18  Themis Karmiris^2,27  Maria K. Angelopoulou¹  Paraskevi Roussou^1,10  Panayiotis Panayiotidis⁶  Kostas Konstantopoulos¹  Gerassimos A. Pangalis¹  Fotios Panitsas¹  Sotirios Sachanas^3,31  Christina Kalpadakis^3,30  Eirini Katodritou^2,22 

[1] Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital;Department of Hematology, Sismanoglion General Hospital;Department of Hematology, Democritus University of Thrace;Department of Hematology, University of Ioannina;Department of Hematology, Metaxa Anticancer Hospital;First Propedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital;First Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital;Department of Hematology, Athens Navy Hospital;Department of Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital;Third Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria Hospital;Department of Hematology, Nicosia General Hospital;Department of Clinical Hematology, “G.Gennimatas” Athens General Hospital;Department of Hematology, HYGEIA Hospital;Department of Hematology, 401 Army Hospital;Department of Hematology, 424 Army Hospital;Department of Hematology, Metropolitan Hospital;Department of Hematology, Athens Medical Center, Amaroussion Branch;Second Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon Hospital;Hematology Division, Dept of Internal Medicine, University of Patras;Department of Hematology, 251 Air Force Hospital;Hematology Unit, 1st Dept of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki;Department of Hematology, Theagenion Anticancer General Hospital;Department of Hematology, Henry Dynant Hospital;Department of Hematology, Aghios Savvas Anticancer Hospital;Department of Hematology, University of Thessalia Hospital;Department of Hematology, Amalia Fleming Hospital;Department of Hematology and Lymphoma, Evangelismos General Hospital;Hematology Division, Aghios Andreas Hospital;Second Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital;Department of Hematology, University of Crete;Department of Hematology, Athens Medical Center, Psychikon Branch

关键词: Prognostic factors;    Rituximab;    CHOP;    Large B-cell lymphoma;    Primary mediastinal;   

DOI  :  10.1002/onco.13789

学科分类：地质学

来源: AlphaMed Press Incorporated

【 摘 要 】

Background R-CHOP can cure approximately 75% of patients with primary mediastinal large B-cell lymphoma (PMLBCL), but prognostic factors have not been sufficiently evaluated yet. R-da- EPOCH is potentially more effective but also more toxic than R-CHOP. Reliable prognostic classification is needed to guide treatment decisions. Materials and Methods We analyzed the impact of clinical prognostic factors on the outcome of 332 PMLBCL patients ≤65 years treated with R-CHOP ± radiotherapy in a multicenter setting in Greece and Cyprus. Results With a median follow-up of 69 months, 5-year freedom from progression (FFP) was 78% and 5-year lymphoma specific survival (LSS) was 89%. On multivariate analysis, extranodal involvement (E/IV) and lactate dehydrogenase (LDH) ≥2 times upper limit of normal (model A) were significantly associated with FFP; E/IV and bulky disease (model B) were associated with LSS. Both models performed better than the International Prognostic Index (IPI) and the age-adjusted IPI by Harrel's C rank parameter and Akaike information criterion. Both models A and B defined high-risk subgroups (13%–27% of patients [pts]) with approximately 19%–23% lymphoma-related mortality. They also defined subgroups composing approximately one-fourth or one-half of the patients, with 11% risk of failure and only 1% or 4% 5-year lymphoma-related mortality. Conclusion The combination of E/IV with either bulky disease or LDH ≥2 times upper limit of normal defined high-risk but not very-high-risk subgroups. More importantly, their absence defined subgroups comprising approximately one-fourth or one-half of the pts, with 11% risk of failure and minimal lymphoma-related mortality, who may not need more intensive treatment such as R-da-EPOCH. Implications for Practice By analyzing the impact of baseline clinical characteristics on outcomes of a large cohort of patients with primary mediastinal large B-cell lymphoma homogeneously treated with R-CHOP with or without radiotherapy, we developed novel prognostic indices which can aid in deciding which patients can be adequately treated with R-CHOP and do not need more intensive regimens such as R-da-EPOCH. The new indices consist of objectively determined characteristics (extranodal disease or stage IV, bulky disease, and markedly elevated serum lactate dehydrogenase), which are readily available from standard initial staging procedures and offer better discrimination compared with established risk scores (International Prognostic Index [IPI] and age-adjusted IPI).

【 授权许可】

CC BY|CC BY-NC