Todeschini G, Secchi S, Morra E, Vitolo U, Orlandi E, Pasini F, Gallo E, Ambrosetti A, Tecchio C, Tarella C, Gabbas A, Gallamini A, Gargantini L, Pizzuti M, Fioritoni G, Gottin L, Rossi G, Lazzarino M, Menestrina F, Paulli M, Palestro M, Cabras M G, Di Vito F, Pizzolo G
Department of Hematology, Verona University, Italy.
Br J Cancer. 2004 Jan 26;90(2):372-6. doi: 10.1038/sj.bjc.6601460.
The optimal treatment of primary mediastinal large B-cell lymphoma (PMLBCL) is still undefined. In the absence of randomised studies, we retrospectively analysed: (a) the effectiveness of two chemotherapy regimens (CHOP vs MACOP-B/VACOP-B) in complete remission (CR) achievement and event-free survival (EFS) and (b) the role of mediastinal involved-field radiotherapy (IF-RT) as consolidation. From 1982 to 1999, 138 consecutive patients affected by PMLBCL were treated in 13 Italian institutions with CHOP (43) or MACOP-B/VACOP-B (95). The two groups of patients were similar as regard to age, gender, presence of bulky mediastinal mass, pleural effusion, stage and international prognostic indexes category of risk. Overall, 75.5% of patients in CR received IF-RT as consolidation. Complete remission was 51.1% in the CHOP group and 80% in MACOP-B/VACOP-B (P<0.001). Relapse occurred in 22.7% of CHOP- and in 9.2% of MACOP-B/VACOP-B-treated patients (n.s.). Event-free patients were 39.5% in CHOP and 75.7% in the MACOP-B/VACOP-B group (P<0.001). The addition of IF-RT as consolidation improved the outcome, irrespectively of the type of chemotherapy (P=0.04). At a multivariate analysis, achievement of CR (P<0.0001) and type of CT (MACOP-B/VACOP-B) retained the significance for OS (P=0.008) and EFS (P=0.03). In our experience, MACOP-B/VACOP-B appears to positively influence OS and EFS in patients affected by PMLBCL, as compared to CHOP. Consolidation IF-RT on mediastinum further improves the outcome of CR patients.
原发性纵隔大B细胞淋巴瘤（PMLBCL）的最佳治疗方案仍未明确。在缺乏随机研究的情况下，我们进行了回顾性分析：（a）两种化疗方案（CHOP与MACOP-B/VACOP-B）在实现完全缓解（CR）和无事件生存（EFS）方面的有效性，以及（b）纵隔累及野放疗（IF-RT）作为巩固治疗的作用。1982年至1999年，138例连续的PMLBCL患者在13家意大利机构接受了CHOP方案（43例）或MACOP-B/VACOP-B方案（95例）治疗。两组患者在年龄、性别、巨大纵隔肿块的存在、胸腔积液、分期和国际预后指数风险类别方面相似。总体而言，75.5%达到CR的患者接受了IF-RT作为巩固治疗。CHOP组的完全缓解率为51.1%，MACOP-B/VACOP-B组为80%（P<0.001）。CHOP治疗的患者中有22.7%复发，MACOP-B/VACOP-B治疗的患者中有9.2%复发（无统计学差异）。CHOP组的无事件患者为39.5%，MACOP-B/VACOP-B组为75.7%（P<0.001）。无论化疗类型如何，添加IF-RT作为巩固治疗均可改善预后（P=0.04）。在多变量分析中，达到CR（P<0.0001）和CT类型（MACOP-B/VACOP-B）对总生存期（OS，P=0.008）和无事件生存期（EFS，P=0.03）仍具有显著意义。根据我们的经验，与CHOP相比，MACOP-B/VACOP-B似乎对PMLBCL患者的OS和EFS有积极影响。纵隔的巩固性IF-RT可进一步改善CR患者的预后。
