Outcomes of relapsed and refractory primary mediastinal (thymic) large B cell lymphoma treated with second-line therapy and intent to transplant Journal Article


Authors: Vardhana, S.; Hamlin, P. A.; Yang, J.; Zelenetz, A.; Sauter, C. S.; Matasar, M. J.; Ni, A.; Yahalom, J.; Moskowitz, C. H.
Article Title: Outcomes of relapsed and refractory primary mediastinal (thymic) large B cell lymphoma treated with second-line therapy and intent to transplant
Abstract: Primary mediastinal (thymic) large B cell lymphoma is a subtype of diffuse large B cell lymphoma with distinct clinical, molecular, and genetic features, many of which overlap with Hodgkin lymphoma. Increasingly, initial therapy for these patients has used dose-dense chemotherapy with or without radiation with excellent results. In patients with relapsed and primary refractory disease, outcomes of second-line therapy followed by consolidation with high-dose therapy and autologous stem cell transplantation remains largely undefined. We reviewed the outcomes of 60 transplant-eligible patients with relapsed or refractory primary mediastinal (thymic) large B cell lymphoma enrolled on sequential protocols with uniform second-line therapy with intent to consolidate with autologous stem cell transplant. The estimated 3-year overall and event-free survivals for all patients were 61% and 57%, respectively, and 68% and 65%, respectively, for patients proceeding to stem cell transplant. Multivariable analysis of risk factors before transplant revealed that an incomplete response to initial therapy, advanced Ann Arbor stage at disease progression, and failure to achieve a partial remission or better to second-line therapy to be independently associated with inferior event-free and overall survival. A risk score based on these variables was able to identify patients who are unlikely to respond to conventional second-line strategies. These results suggest that salvage chemoradiotherapy with intent of subsequent high-dose therapy and autologous stem cell transplant is successful in most patients with relapsed and refractory primary mediastinal (thymic) large B cell lymphoma. Alternative strategies are warranted for a significant subset of patients with high-risk disease who are unlikely to be cured with this strategy. Ā© 2018
Keywords: adult; cancer chemotherapy; cancer survival; event free survival; treatment response; aged; survival rate; major clinical study; overall survival; cisplatin; cancer combination chemotherapy; cancer radiotherapy; chemotherapy; cytarabine; methotrexate; rituximab; cancer staging; drug megadose; antineoplastic agent; carboplatin; radiation; etoposide; dexamethasone; autologous stem cell transplantation; ifosfamide; survival time; cancer regression; lymphoma; dlbcl; transplant; mediastinum cancer; clinical outcome; ofatumumab; diffuse large b cell lymphoma; thymus lymphoma; human; article; pmbcl; primary mediastinal thymic large b cell lymphoma
Journal Title: Biology of Blood and Marrow Transplantation
Volume: 24
Issue: 10
ISSN: 1083-8791
Publisher: Elsevier Inc.  
Date Published: 2018-10-01
Start Page: 2133
End Page: 2138
Language: English
DOI: 10.1016/j.bbmt.2018.06.009
PUBMED: 29909154
PROVIDER: scopus
DOI/URL:
Notes: Article -- Export Date: 3 December 2018 -- Source: Scopus
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MSK Authors
  1. Joachim Yahalom
    382 Yahalom
  2. Craig Moskowitz
    366 Moskowitz
  3. Craig Steven Sauter
    150 Sauter
  4. Andrew D Zelenetz
    538 Zelenetz
  5. Paul Hamlin
    167 Hamlin
  6. Matthew J Matasar
    116 Matasar
  7. Joanna C Yang
    30 Yang
  8. Ai   Ni
    44 Ni