Broccoli Alessandro, Casadei Beatrice, Stefoni Vittorio, Pellegrini Cinzia, Quirini Federica, Tonialini Lorenzo, Morigi Alice, Marangon Miriam, Argnani Lisa, Zinzani Pier Luigi
Institute of Haematology "L. e A. Seràgnoli", University of Bologna, Via Massarenti, 9 - 40138, Bologna, Italy.
BMC Cancer. 2017 Apr 17;17(1):276. doi: 10.1186/s12885-017-3269-6.
The purpose of this study is to investigate the most suitable first-line approach and the best combination treatment for primary mediastinal large B-cell lymphoma (PMLBCL) as they have been matter of debate for at least two decades.
Our single centre experience in the treatment of 98 de novo PMLBCL patients over the last 20 years is reviewed. All patients received MACOP-B chemotherapy. Thirty-seven received both rituximab and mediastinal radiotherapy; 30 were irradiated after chemotherapy, although not receiving rituximab and 20 received rituximab without radiotherapy consolidation. Eleven patients received chemotherapy only.
Sixty-one (62.2%) patients achieved a complete response after MACOP-B (with or without rituximab); among the 27 (27.6%) partial responders, 21 obtained a complete response after radiotherapy. At the end of their scheduled treatment, 82 patients (83.7%) had a complete and 6 a partial response (6.1%). Eleven patients relapsed within the first 2 years of follow-up. The 17-year overall survival is 72.0% (15 patients died); progression-free and disease-free survival are 67.6% and 88.4%, respectively. A statistically significant difference in overall and progression-free survival was noted among treatment groups, although no disease-free survival difference was documented.
Our data indicate that a third-generation regimen like MACOP-B could be considered a suitable first-line treatment. Mediastinal consolidation radiotherapy impacts on survival and complete response rates and remains a good strategy to convert partial into complete responses. Data suggest that radiotherapy may be avoided in patients obtaining a complete response after (immuno)chemotherapy, but this requires confirmation with further ad hoc studies.
本研究旨在探讨原发性纵隔大B细胞淋巴瘤(PMLBCL)最合适的一线治疗方法及最佳联合治疗方案,至少二十年来这些一直是争论的焦点。
回顾了我们单中心在过去20年中治疗98例初治PMLBCL患者的经验。所有患者均接受MACOP-B化疗。37例患者同时接受了利妥昔单抗和纵隔放疗;30例患者在化疗后接受了放疗,但未接受利妥昔单抗治疗,20例患者接受了利妥昔单抗治疗但未进行放疗巩固。11例患者仅接受了化疗。
61例(62.2%)患者在接受MACOP-B化疗(无论是否联合利妥昔单抗)后达到完全缓解;在27例(27.6%)部分缓解的患者中,21例在放疗后获得完全缓解。在预定治疗结束时,82例患者(83.7%)获得完全缓解,6例患者部分缓解(6.1%)。11例患者在随访的前2年内复发。17年总生存率为72.0%(15例患者死亡);无进展生存率和无病生存率分别为67.6%和88.4%。各治疗组之间在总生存率和无进展生存率方面存在统计学显著差异,尽管未记录到无病生存率差异。
我们的数据表明,像MACOP-B这样的第三代方案可被视为合适的一线治疗方法。纵隔巩固放疗对生存率和完全缓解率有影响,仍然是将部分缓解转化为完全缓解的良好策略。数据表明,在(免疫)化疗后获得完全缓解的患者中可能避免放疗,但这需要进一步的专门研究予以证实。