Contributions
Abstract: PB1766
Type: Publication Only
Background
Primary mediastinal large B-cell lymphoma (PMBCL) is a subtype of aggressive B-cell non-Hodgkin lymphoma, with a usual presentation being a bulky anterior mediastinal mass. It affects predominantly females in their third-fourth decade of life, who present signs and symptoms related to the mediastinal mass. Historically, R-CHOP (Rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) has been the standard treatment for PMBCL, in combination with consolidative radiotherapy. An Italian retrospective study (Zinzani PL et al. 2009) showed that regimens R-MACOP(Rituximab/methotrexate/leukovorin/cyclophosphamide/doxorubicin/vincristine/prednisone/bleomycin)/R-VACOP-B (Rituximab, etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone, bleomycin) with radiotherapy is an effective therapy for the treatment of PMBCL; recently, a comparison study demonstrates a superiority of Dose Adjust (DA)-R-EPOCH (rituximab, etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin) towards R-CHOP. In literature there are no comparison study between DA-R-EPOCH and R-VACOP-B.
Aims
The aim of this study was to compare the long-term efficacy and the most relevant side effects of the R-VACOP-B and DA-R-EPOCH regimens in PMBCL patients from a single institution.
Methods
We conducted a retrospective study on 49 patients (30 females, 19 males) affected by PMBCL, based on WHO criteria 2008, referred to the Hematology Division of Padua University Hospital. Median age at the diagnosis was 33 years (18-58). Fifteen patients (30.6%) were treated with DA-R-EPOCH with a median of 6 cycles (6-8), 34 patients (69.3%) were treated with R-VACOP-B followed by consolidative radiotherapy (RT) (30 Gy in 17 fractions).
Results
During a median follow up of 63 months, 8 patients out of 49 relapsed and 4 died (3 for progression, 1 for heart attack). The estimated 5-year progression free survival (PFS) and OS for the whole population were 81.8% and 92.5%, respectively. In the R-VACOP-B group with a follow up of 95 months, we found a 5-years PFS of 82% and a OS of 97%, for the DA-R-EPOCH group the median follow-up is shorter (13 months) with a 1-year PFS and a OS of 89% and 84%, respectively. Regarding the serious adverse events, we found an increase of haematological toxicities in the DA-R-EPOCH group (p<0.00001) without a significant incidence of major infections. We found a similar rate of cardiological events between the two groups, but a higher pulmonary toxicity in the R-VACOP-B + RT group (p<0.0006).
Conclusion
With the limitations of a retrospective survey with a small number of patients, our data suggest that both regimens are equally effective for the treatment of PMBCL. Regarding the toxicities, DA-R-EPOCH causes more G3/G4 neutropenia than R-VACOP-B regimen, with no increase in major infections. Likewise, there is no difference in the cardiological toxicity between the two regimens probably due to the presence of a comparable cumulative dose of anthracyclines in both treatment schemes. On the contrary, Bleomycin and consolidative mediastinal radiotherapy in the R-VACOP-B regimen may account for the significant difference in pulmonary side-effect observed. In conclusion, our study provide evidence that both DA-R-EPOCH and R-VACOP-B regimens are very effective for the treatment of PMBCL, with response rates higher than those reported in the literature for R-CHOP+RT, DA-R-EPOCH showed a worse though manageable toxicity profile than R-VACOP-B + RT, however, in the latter regimen the role of consolidative RT is still controversial.
Session topic: 21. Aggressive Non-Hodgkin lymphoma - Clinical
Keyword(s): Chemotherapy toxicity, Lymphoma therapy, NHL, Therapy
Abstract: PB1766
Type: Publication Only
Background
Primary mediastinal large B-cell lymphoma (PMBCL) is a subtype of aggressive B-cell non-Hodgkin lymphoma, with a usual presentation being a bulky anterior mediastinal mass. It affects predominantly females in their third-fourth decade of life, who present signs and symptoms related to the mediastinal mass. Historically, R-CHOP (Rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) has been the standard treatment for PMBCL, in combination with consolidative radiotherapy. An Italian retrospective study (Zinzani PL et al. 2009) showed that regimens R-MACOP(Rituximab/methotrexate/leukovorin/cyclophosphamide/doxorubicin/vincristine/prednisone/bleomycin)/R-VACOP-B (Rituximab, etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone, bleomycin) with radiotherapy is an effective therapy for the treatment of PMBCL; recently, a comparison study demonstrates a superiority of Dose Adjust (DA)-R-EPOCH (rituximab, etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin) towards R-CHOP. In literature there are no comparison study between DA-R-EPOCH and R-VACOP-B.
Aims
The aim of this study was to compare the long-term efficacy and the most relevant side effects of the R-VACOP-B and DA-R-EPOCH regimens in PMBCL patients from a single institution.
Methods
We conducted a retrospective study on 49 patients (30 females, 19 males) affected by PMBCL, based on WHO criteria 2008, referred to the Hematology Division of Padua University Hospital. Median age at the diagnosis was 33 years (18-58). Fifteen patients (30.6%) were treated with DA-R-EPOCH with a median of 6 cycles (6-8), 34 patients (69.3%) were treated with R-VACOP-B followed by consolidative radiotherapy (RT) (30 Gy in 17 fractions).
Results
During a median follow up of 63 months, 8 patients out of 49 relapsed and 4 died (3 for progression, 1 for heart attack). The estimated 5-year progression free survival (PFS) and OS for the whole population were 81.8% and 92.5%, respectively. In the R-VACOP-B group with a follow up of 95 months, we found a 5-years PFS of 82% and a OS of 97%, for the DA-R-EPOCH group the median follow-up is shorter (13 months) with a 1-year PFS and a OS of 89% and 84%, respectively. Regarding the serious adverse events, we found an increase of haematological toxicities in the DA-R-EPOCH group (p<0.00001) without a significant incidence of major infections. We found a similar rate of cardiological events between the two groups, but a higher pulmonary toxicity in the R-VACOP-B + RT group (p<0.0006).
Conclusion
With the limitations of a retrospective survey with a small number of patients, our data suggest that both regimens are equally effective for the treatment of PMBCL. Regarding the toxicities, DA-R-EPOCH causes more G3/G4 neutropenia than R-VACOP-B regimen, with no increase in major infections. Likewise, there is no difference in the cardiological toxicity between the two regimens probably due to the presence of a comparable cumulative dose of anthracyclines in both treatment schemes. On the contrary, Bleomycin and consolidative mediastinal radiotherapy in the R-VACOP-B regimen may account for the significant difference in pulmonary side-effect observed. In conclusion, our study provide evidence that both DA-R-EPOCH and R-VACOP-B regimens are very effective for the treatment of PMBCL, with response rates higher than those reported in the literature for R-CHOP+RT, DA-R-EPOCH showed a worse though manageable toxicity profile than R-VACOP-B + RT, however, in the latter regimen the role of consolidative RT is still controversial.
Session topic: 21. Aggressive Non-Hodgkin lymphoma - Clinical
Keyword(s): Chemotherapy toxicity, Lymphoma therapy, NHL, Therapy