R-DA-EPOCH WITHOUT RADIOTHERAPY IN PRIMARY MEDIASTINAL LYMPHOMA PATIENTS RESULTS IN SIMILAR OUTCOME IN COMPARISON WITH A HISTORICAL COHORT TREATED WITH RADIOTHERAPY BASED REGIMENS.
(Abstract release date: 05/19/16)
EHA Library. Guidetti A. 06/09/16; 132507; E958
Dr. Anna Guidetti
Contributions
Contributions
Abstract
Abstract: E958
Type: Eposter Presentation
Background
Historically, patients with Primary Mediastinal B Cell Lymphoma (PMBCL) have been treated with chemotherapy according to R-CHOP or R-VACOP-B regimen followed by radiotherapy with favorable outcome. Omission of radiotherapy in treatment of PMBCL represents a challenge due to the long-term toxicity observed in young people affected by this disease. Recently, Rituximab Dose Adjusted EPOCH (R-DA-EPOCH) regimen based on continuous drugs infusion not followed by radiotherapy demontrated to be an attractive alternative treatment for these patients.
Aims
We retropsectively compared the outcome of R-DA-EPOCH without radiotherapy with R-CHOP, R-VACOP-B or high dose sequential therapy followed by radiotherapy in newly diagnosed PMBCL patients treated at Istituto Nazionale dei Tumori in Milano from 2002.
Methods
Clinical, laboratory and imaging data of patients with PMBCL at diagnosis have been retrospectively collected and analyzed for clinical characteristics, response rate, progression free survival (PFS) and overall survival (OS).
Results
Overall, 67 newly diagnosed PMBCL patients have been treated between 2002 and 2016, 26 patients treated after September 2009 received 6 cycles of R-DA-EPOCH (R-DA-EPOCH group), whereas from 2002 to 2009, 31 patients received 6 cycles of R-CHOP (n=15), 12 weeks of R-VACOP-B (n=13) or high dose sequential therapy supplemented with rituximab (n=3), followed by radiotherapy (RT group). Ten patients treated without Rituximab were excluded from this analysis. Median age at diagnosis was 30 years in both groups (range, 18-61 and 21-55). With the exception of an higher proportion of stage III/IV patients in RT group (42% vs 11%) (p=0.01), other clinical characteristics were similar: extranodal disease in 11% and 35%, elevated LDH in 65% and 48% and presence of bulky disease (diameter > 10 cm) in 77% and 68% of patients in R-DA-EPOCH and RT group respectively (p=ns). Eighteen patients (69%) completed R-DA-EPOCH without radiotherapy, 4 patients received radiotherapy because of residual disease at PET (Deauville Score 4), whereas 4 patients progressed. No patients relapsed after a median follow-up of 21 months (range, 3–79).In RT group, 24 patients (77%) completed the treatment with radiotherapy whereas 7 (22%) patients experienced disease progression before radiotherapy. Overall, 6 patients (19%) relapsed after a median of 7 months (range, 4-19). Eight out of 13 relapsed and refractory patients underwent autologous transplant and 5 of them are in complete remission. Median follow-up for RT patients was 73 months (range, 5-155).One patient developed a secondary malignancy 3 years after R-VACOP-B, whereas until today no secondary tumors have been observed among R-DA-EPOCH patients.3-yrs OS and PFS for the whole population were 80% and 66%. In R-DA-EPOCH group 3-yrs PFS was 82% and in RT group was 57% (p=0.07); 3-yrs OS was 88% and 76% in R-DA-EPOCH and RT group, respectively (p=ns). 3-yrs PFS was 46%, 76% and 82% in R-CHOP, R-VACOP-B and R-DA-EPOCH (p=0.02), whereas 3-yrs OS was 62%, 92% and 88% in the three subgroups respectively (p=ns).
Conclusion
Omitting radiotherapy is feasible in patients treated with R-DA-EPOCH regimen. At the present, no significative differences in PFS and OS have been observed when R-DA-EPOCH patients are compared with a retrospective cohort treated with chemotherapy and radiotherapy. A longer follow-up of R-DA-EPOCH patients could assess significativity of the slighty advantage observed in term of PFS and will allow a proper assessment of long-term toxicity.
Session topic: E-poster
Keyword(s): Chemotherapy, Lymphoma therapy, Radiotherapy
Type: Eposter Presentation
Background
Historically, patients with Primary Mediastinal B Cell Lymphoma (PMBCL) have been treated with chemotherapy according to R-CHOP or R-VACOP-B regimen followed by radiotherapy with favorable outcome. Omission of radiotherapy in treatment of PMBCL represents a challenge due to the long-term toxicity observed in young people affected by this disease. Recently, Rituximab Dose Adjusted EPOCH (R-DA-EPOCH) regimen based on continuous drugs infusion not followed by radiotherapy demontrated to be an attractive alternative treatment for these patients.
Aims
We retropsectively compared the outcome of R-DA-EPOCH without radiotherapy with R-CHOP, R-VACOP-B or high dose sequential therapy followed by radiotherapy in newly diagnosed PMBCL patients treated at Istituto Nazionale dei Tumori in Milano from 2002.
Methods
Clinical, laboratory and imaging data of patients with PMBCL at diagnosis have been retrospectively collected and analyzed for clinical characteristics, response rate, progression free survival (PFS) and overall survival (OS).
Results
Overall, 67 newly diagnosed PMBCL patients have been treated between 2002 and 2016, 26 patients treated after September 2009 received 6 cycles of R-DA-EPOCH (R-DA-EPOCH group), whereas from 2002 to 2009, 31 patients received 6 cycles of R-CHOP (n=15), 12 weeks of R-VACOP-B (n=13) or high dose sequential therapy supplemented with rituximab (n=3), followed by radiotherapy (RT group). Ten patients treated without Rituximab were excluded from this analysis. Median age at diagnosis was 30 years in both groups (range, 18-61 and 21-55). With the exception of an higher proportion of stage III/IV patients in RT group (42% vs 11%) (p=0.01), other clinical characteristics were similar: extranodal disease in 11% and 35%, elevated LDH in 65% and 48% and presence of bulky disease (diameter > 10 cm) in 77% and 68% of patients in R-DA-EPOCH and RT group respectively (p=ns). Eighteen patients (69%) completed R-DA-EPOCH without radiotherapy, 4 patients received radiotherapy because of residual disease at PET (Deauville Score 4), whereas 4 patients progressed. No patients relapsed after a median follow-up of 21 months (range, 3–79).In RT group, 24 patients (77%) completed the treatment with radiotherapy whereas 7 (22%) patients experienced disease progression before radiotherapy. Overall, 6 patients (19%) relapsed after a median of 7 months (range, 4-19). Eight out of 13 relapsed and refractory patients underwent autologous transplant and 5 of them are in complete remission. Median follow-up for RT patients was 73 months (range, 5-155).One patient developed a secondary malignancy 3 years after R-VACOP-B, whereas until today no secondary tumors have been observed among R-DA-EPOCH patients.3-yrs OS and PFS for the whole population were 80% and 66%. In R-DA-EPOCH group 3-yrs PFS was 82% and in RT group was 57% (p=0.07); 3-yrs OS was 88% and 76% in R-DA-EPOCH and RT group, respectively (p=ns). 3-yrs PFS was 46%, 76% and 82% in R-CHOP, R-VACOP-B and R-DA-EPOCH (p=0.02), whereas 3-yrs OS was 62%, 92% and 88% in the three subgroups respectively (p=ns).
Conclusion
Omitting radiotherapy is feasible in patients treated with R-DA-EPOCH regimen. At the present, no significative differences in PFS and OS have been observed when R-DA-EPOCH patients are compared with a retrospective cohort treated with chemotherapy and radiotherapy. A longer follow-up of R-DA-EPOCH patients could assess significativity of the slighty advantage observed in term of PFS and will allow a proper assessment of long-term toxicity.
Session topic: E-poster
Keyword(s): Chemotherapy, Lymphoma therapy, Radiotherapy
Abstract: E958
Type: Eposter Presentation
Background
Historically, patients with Primary Mediastinal B Cell Lymphoma (PMBCL) have been treated with chemotherapy according to R-CHOP or R-VACOP-B regimen followed by radiotherapy with favorable outcome. Omission of radiotherapy in treatment of PMBCL represents a challenge due to the long-term toxicity observed in young people affected by this disease. Recently, Rituximab Dose Adjusted EPOCH (R-DA-EPOCH) regimen based on continuous drugs infusion not followed by radiotherapy demontrated to be an attractive alternative treatment for these patients.
Aims
We retropsectively compared the outcome of R-DA-EPOCH without radiotherapy with R-CHOP, R-VACOP-B or high dose sequential therapy followed by radiotherapy in newly diagnosed PMBCL patients treated at Istituto Nazionale dei Tumori in Milano from 2002.
Methods
Clinical, laboratory and imaging data of patients with PMBCL at diagnosis have been retrospectively collected and analyzed for clinical characteristics, response rate, progression free survival (PFS) and overall survival (OS).
Results
Overall, 67 newly diagnosed PMBCL patients have been treated between 2002 and 2016, 26 patients treated after September 2009 received 6 cycles of R-DA-EPOCH (R-DA-EPOCH group), whereas from 2002 to 2009, 31 patients received 6 cycles of R-CHOP (n=15), 12 weeks of R-VACOP-B (n=13) or high dose sequential therapy supplemented with rituximab (n=3), followed by radiotherapy (RT group). Ten patients treated without Rituximab were excluded from this analysis. Median age at diagnosis was 30 years in both groups (range, 18-61 and 21-55). With the exception of an higher proportion of stage III/IV patients in RT group (42% vs 11%) (p=0.01), other clinical characteristics were similar: extranodal disease in 11% and 35%, elevated LDH in 65% and 48% and presence of bulky disease (diameter > 10 cm) in 77% and 68% of patients in R-DA-EPOCH and RT group respectively (p=ns). Eighteen patients (69%) completed R-DA-EPOCH without radiotherapy, 4 patients received radiotherapy because of residual disease at PET (Deauville Score 4), whereas 4 patients progressed. No patients relapsed after a median follow-up of 21 months (range, 3–79).In RT group, 24 patients (77%) completed the treatment with radiotherapy whereas 7 (22%) patients experienced disease progression before radiotherapy. Overall, 6 patients (19%) relapsed after a median of 7 months (range, 4-19). Eight out of 13 relapsed and refractory patients underwent autologous transplant and 5 of them are in complete remission. Median follow-up for RT patients was 73 months (range, 5-155).One patient developed a secondary malignancy 3 years after R-VACOP-B, whereas until today no secondary tumors have been observed among R-DA-EPOCH patients.3-yrs OS and PFS for the whole population were 80% and 66%. In R-DA-EPOCH group 3-yrs PFS was 82% and in RT group was 57% (p=0.07); 3-yrs OS was 88% and 76% in R-DA-EPOCH and RT group, respectively (p=ns). 3-yrs PFS was 46%, 76% and 82% in R-CHOP, R-VACOP-B and R-DA-EPOCH (p=0.02), whereas 3-yrs OS was 62%, 92% and 88% in the three subgroups respectively (p=ns).
Conclusion
Omitting radiotherapy is feasible in patients treated with R-DA-EPOCH regimen. At the present, no significative differences in PFS and OS have been observed when R-DA-EPOCH patients are compared with a retrospective cohort treated with chemotherapy and radiotherapy. A longer follow-up of R-DA-EPOCH patients could assess significativity of the slighty advantage observed in term of PFS and will allow a proper assessment of long-term toxicity.
Session topic: E-poster
Keyword(s): Chemotherapy, Lymphoma therapy, Radiotherapy
Type: Eposter Presentation
Background
Historically, patients with Primary Mediastinal B Cell Lymphoma (PMBCL) have been treated with chemotherapy according to R-CHOP or R-VACOP-B regimen followed by radiotherapy with favorable outcome. Omission of radiotherapy in treatment of PMBCL represents a challenge due to the long-term toxicity observed in young people affected by this disease. Recently, Rituximab Dose Adjusted EPOCH (R-DA-EPOCH) regimen based on continuous drugs infusion not followed by radiotherapy demontrated to be an attractive alternative treatment for these patients.
Aims
We retropsectively compared the outcome of R-DA-EPOCH without radiotherapy with R-CHOP, R-VACOP-B or high dose sequential therapy followed by radiotherapy in newly diagnosed PMBCL patients treated at Istituto Nazionale dei Tumori in Milano from 2002.
Methods
Clinical, laboratory and imaging data of patients with PMBCL at diagnosis have been retrospectively collected and analyzed for clinical characteristics, response rate, progression free survival (PFS) and overall survival (OS).
Results
Overall, 67 newly diagnosed PMBCL patients have been treated between 2002 and 2016, 26 patients treated after September 2009 received 6 cycles of R-DA-EPOCH (R-DA-EPOCH group), whereas from 2002 to 2009, 31 patients received 6 cycles of R-CHOP (n=15), 12 weeks of R-VACOP-B (n=13) or high dose sequential therapy supplemented with rituximab (n=3), followed by radiotherapy (RT group). Ten patients treated without Rituximab were excluded from this analysis. Median age at diagnosis was 30 years in both groups (range, 18-61 and 21-55). With the exception of an higher proportion of stage III/IV patients in RT group (42% vs 11%) (p=0.01), other clinical characteristics were similar: extranodal disease in 11% and 35%, elevated LDH in 65% and 48% and presence of bulky disease (diameter > 10 cm) in 77% and 68% of patients in R-DA-EPOCH and RT group respectively (p=ns). Eighteen patients (69%) completed R-DA-EPOCH without radiotherapy, 4 patients received radiotherapy because of residual disease at PET (Deauville Score 4), whereas 4 patients progressed. No patients relapsed after a median follow-up of 21 months (range, 3–79).In RT group, 24 patients (77%) completed the treatment with radiotherapy whereas 7 (22%) patients experienced disease progression before radiotherapy. Overall, 6 patients (19%) relapsed after a median of 7 months (range, 4-19). Eight out of 13 relapsed and refractory patients underwent autologous transplant and 5 of them are in complete remission. Median follow-up for RT patients was 73 months (range, 5-155).One patient developed a secondary malignancy 3 years after R-VACOP-B, whereas until today no secondary tumors have been observed among R-DA-EPOCH patients.3-yrs OS and PFS for the whole population were 80% and 66%. In R-DA-EPOCH group 3-yrs PFS was 82% and in RT group was 57% (p=0.07); 3-yrs OS was 88% and 76% in R-DA-EPOCH and RT group, respectively (p=ns). 3-yrs PFS was 46%, 76% and 82% in R-CHOP, R-VACOP-B and R-DA-EPOCH (p=0.02), whereas 3-yrs OS was 62%, 92% and 88% in the three subgroups respectively (p=ns).
Conclusion
Omitting radiotherapy is feasible in patients treated with R-DA-EPOCH regimen. At the present, no significative differences in PFS and OS have been observed when R-DA-EPOCH patients are compared with a retrospective cohort treated with chemotherapy and radiotherapy. A longer follow-up of R-DA-EPOCH patients could assess significativity of the slighty advantage observed in term of PFS and will allow a proper assessment of long-term toxicity.
Session topic: E-poster
Keyword(s): Chemotherapy, Lymphoma therapy, Radiotherapy
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