Ma'koseh Mohammad, Yaseen Abeer, Abed Nebras Abu, Shahin Omar, Abufara Alaa, Halahleh Khalid, Al-Rwashdeh Mohammad, Rahman Zaid Abdel, Muqbel Ro'a, Farfoura Heba, Al-Ibraheem Akram, Al-Rabi Kamal, Abdel-Razeq Hikmat
Department of Medicine, King Hussein Cancer Center, Amman, Jordan.
College of Medicine, University of Jordan, Amman, Jordan.
Hematology. 2025 Dec;30(1):2515337. doi: 10.1080/16078454.2025.2515337. Epub 2025 Jun 18.
Primary Mediastinal Large B Cell Lymphoma (PMLBCL) is a rare but aggressive B-cell lymphoma. This study compares the outcomes and toxicities of DA-EPOCH-R (Dose-adjusted etoposide, prednisolone, vincristine, cyclophosphamide, and doxorubicin in combination with rituximab) and RCHOP-21 (rituximab, cyclophosphamide, doxorubicin, and vincristine, every 21 days) in the treatment of newly diagnosed PMLBCL.
We retrospectively reviewed the medical records of adults (>18 years) diagnosed with PMLBCL and treated at our center from 2010 to 2023. Baseline characteristics were compared using chi-square and Mann Whitney U-tests. Survival outcomes were analysed using Kaplan Meier and log-rank tests.
Eighty-seven patients were included, with a median age of 30 years (range: 18-55), 48 patients (55.2%) received RCHOP-21, and 39 patients (44.8%) received DA-EPOCH-R. Radiotherapy was more frequent in the RCHOP-21 group (66.6% vs 15%, < 0.001). DA-EPOCH-R achieved a higher complete metabolic response (CMR) (92% vs 69%, = 0.007). After a median follow-up of 47.4 months, patients treated with DA-EPOCH-R had superior overall survival (OS) and progression free survival (PFS); 3-year OS rates were 94.4% vs 69.8% ( = 0.01) and the 3-year PFS rates were 86.7% vs 62.2% ( = 0.016), particularly in patients with aa-IPI >1. Post-chemotherapy delta SUV max <0.75, and <0.7 correlated with relapse and mortality, respectively. Grade III-IV anemia and non-hematological toxicities were more frequent in the DA-EPOCH-R, but no therapy-related deaths occurred.
DA-EPOCH-R improves CMR, PFS, and OS compared to R-CHOP-21 with radiotherapy in PMLBCL, particularly in high-risk patients. Longer follow-up is needed to assess long-term toxicities.
原发性纵隔大B细胞淋巴瘤（PMLBCL）是一种罕见但侵袭性的B细胞淋巴瘤。本研究比较了剂量调整的依托泊苷、泼尼松龙、长春新碱、环磷酰胺和多柔比星联合利妥昔单抗（DA-EPOCH-R）与利妥昔单抗、环磷酰胺、多柔比星和长春新碱，每21天一次（RCHOP-21）在新诊断的PMLBCL治疗中的疗效和毒性。
我们回顾性分析了2010年至2023年在本中心诊断并接受治疗的成年（>18岁）PMLBCL患者的病历。使用卡方检验和曼-惠特尼U检验比较基线特征。使用Kaplan Meier法和对数秩检验分析生存结果。
纳入87例患者，中位年龄30岁（范围：18 - 55岁），48例（55.2%）接受RCHOP-21治疗，39例（44.8%）接受DA-EPOCH-R治疗。RCHOP-21组放疗更频繁（66.6%对15%，<0.001）。DA-EPOCH-R实现了更高的完全代谢缓解（CMR）（92%对69%，=0.007）。中位随访47.4个月后，接受DA-EPOCH-R治疗的患者总生存期（OS）和无进展生存期（PFS）更佳；3年OS率分别为94.4%对69.8%（=0.01），3年PFS率分别为86.7%对62.2%（=0.016），尤其是在aa-IPI>1的患者中。化疗后SUV最大值变化<0.75和<0.7分别与复发和死亡率相关。DA-EPOCH-R组III-IV级贫血和非血液学毒性更常见，但未发生治疗相关死亡。
与R-CHOP-21联合放疗相比，DA-EPOCH-R在PMLBCL治疗中改善了CMR、PFS和OS，尤其是在高危患者中。需要更长时间的随访来评估长期毒性。
