Outcomes of adults and children with primary mediastinal B-cell lymphoma treated with dose-adjusted EPOCH-R Journal Article

Authors: Giulino-Roth, L.; O'Donohue, T.; Chen, Z.; Bartlett, N. L.; LaCasce, A.; Martin-Doyle, W.; Barth, M. J.; Davies, K.; Blum, K. A.; Christian, B.; Casulo, C.; Smith, S. M.; Godfrey, J.; Termuhlen, A.; Oberley, M. J.; Alexander, S.; Weitzman, S.; Appel, B.; Mizukawa, B.; Svoboda, J.; Afify, Z.; Pauly, M.; Dave, H.; Gardner, R.; Stephens, D. M.; Zeitler, W. A.; Forlenza, C.; Levine, J.; Williams, M. E.; Sima, J. L.; Bollard, C. M.; Leonard, J. P.
Article Title: Outcomes of adults and children with primary mediastinal B-cell lymphoma treated with dose-adjusted EPOCH-R
Abstract: 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. © 2017 John Wiley & Sons Ltd
Keywords: adolescent; adult; cancer survival; child; controlled study; event free survival; treatment outcome; treatment response; aged; middle aged; retrospective studies; young adult; major clinical study; overall survival; prednisone; doxorubicin; dose response; heart left ventricle failure; cancer radiotherapy; radiotherapy, adjuvant; rituximab; cancer staging; positron emission tomography; follow up; antineoplastic agent; neoplasm staging; low drug dose; multiple cycle treatment; etoposide; antineoplastic combined chemotherapy protocols; drug administration schedule; cyclophosphamide; vincristine; age factors; pathology; diagnostic imaging; retrospective study; age; b cell lymphoma; multicenter study; vein thrombosis; thrombosis; positron-emission tomography; lymphoma, large b-cell, diffuse; kaplan meier method; heart arrhythmia; drug administration; adjuvant radiotherapy; mediastinum tumor; mediastinal neoplasms; fluorodeoxyglucose; cardiomyopathy; pericarditis; non-hodgkin lymphoma; kaplan-meier estimate; diffuse large b cell lymphoma; humans; prognosis; human; male; female; priority journal; article; chemically induced; paediatric oncology; primary mediastinal b cell lymphoma; da-epoch-r; primary mediastinal b-cell lymphoma; heart septum defect
Journal Title: British Journal of Haematology
Volume: 179
Issue: 5
ISSN: 0007-1048
Publisher: John Wiley & Sons  
Date Published: 2017-12-01
Start Page: 739
End Page: 747
Language: English
DOI: 10.1111/bjh.14951
PUBMED: 29082519
PROVIDER: scopus
Notes: Article -- Export Date: 2 January 2018 -- Source: Scopus
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