TY - JOUR
T1 - Outcomes of adults and children with primary mediastinal B-cell lymphoma treated with dose-adjusted EPOCH-R
AU - Giulino-Roth, Lisa
AU - O'Donohue, Tara
AU - Chen, Zhengming
AU - Bartlett, Nancy L.
AU - LaCasce, Ann
AU - Martin-Doyle, William
AU - Barth, Matthew J.
AU - Davies, Kimberly
AU - Blum, Kristie A.
AU - Christian, Beth
AU - Casulo, Carla
AU - Smith, Sonali M.
AU - Godfrey, James
AU - Termuhlen, Amanda
AU - Oberley, Matthew J.
AU - Alexander, Sarah
AU - Weitzman, Sheila
AU - Appel, Burton
AU - Mizukawa, Benjamin
AU - Svoboda, Jakub
AU - Afify, Zeinab
AU - Pauly, Melinda
AU - Dave, Hema
AU - Gardner, Rebecca
AU - Stephens, Deborah M.
AU - Zeitler, William A.
AU - Forlenza, Christopher
AU - Levine, Jennifer
AU - Williams, Michael E.
AU - Sima, Jody L.
AU - Bollard, Catherine M.
AU - Leonard, John P.
N1 - Publisher Copyright:
© 2017 John Wiley & Sons Ltd
PY - 2017/12
Y1 - 2017/12
N2 - 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.
AB - 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.
KW - DA-EPOCH-R
KW - non-Hodgkin lymphoma
KW - paediatric oncology
KW - primary mediastinal B-cell lymphoma
UR - http://www.scopus.com/inward/record.url?scp=85032349219&partnerID=8YFLogxK
U2 - 10.1111/bjh.14951
DO - 10.1111/bjh.14951
M3 - Article
C2 - 29082519
AN - SCOPUS:85032349219
SN - 0007-1048
VL - 179
SP - 739
EP - 747
JO - British Journal of Haematology
JF - British Journal of Haematology
IS - 5
ER -