Impact of immunochemotherapy regimens on outcomes of patients with primary mediastinal B-cell lymphoma in the IELSG37 trial
Abstract
Abstract The IELSG37 trial enrolled 545 patients with primary mediastinal B-cell lymphoma (PMBCL) and demonstrated that consolidation radiotherapy (RT) can be omitted in patients with complete metabolic response, defined by the Lugano classification as Deauville score (DS) 1 to 3. This report evaluates outcomes after different frontline rituximab- and doxorubicin-based immunochemotherapy regimens chosen according to local practice. Patients treated with R-CHOP21 (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone, administered every 21 days) showed a significantly higher percentage of DS 5 than those on other regimens (23.8% vs 8.2% average; P < .001) and a trend toward additional unplanned treatments (53.2% vs 46.9%; P = .30). The increased risk of poor response was confirmed in a multinomial logistic regression analysis adjusted for age, sex, international prognostic index score, and performance status. R-CHOP21 was also associated with smaller reductions in metabolic tumor volume and less pronounced decreases in maximum standardized uptake value. Patients with DS 5 more often received additional treatment (RT and/or salvage chemotherapy with or without autologous consolidation) after induction immunochemotherapy (96% vs 41%; P < .001) and experienced significantly poorer outcomes. Although differences in progression-free and overall survival between R-CHOP21 and more aggressive regimens were not statistically significant, R-CHOP21 may increase the risk of additional treatments and may be inadvisable as frontline therapy for PMBCL. This trial was registered at www.clinicaltrials.gov as #NCT01599559.
Article Details
Authors (40)
Emanuele Zucca
Institute of Oncology Research, Bellinzona, Switzerland
Luca Ceriani
2Institute of Oncology Research, Bellinzona, Switzerland
Giovannino Ciccone
5Clinical Epidemiology Unit, Oncology Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino and Centro di Riferimento Regionale per l’Epidemiologia e la Prevenzione Oncologia Piemonte Piemonte, Turin, Italy
Alice Di Rocco
6Division of Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
Maria Cristina Pirosa
1Clinic of Hematology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
Iryna Kriachok
7Onco-Hematology Department, National Cancer Institute, Kyiv, Ukraine
Barbara Botto
8Department of Hematology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
Monica Balzarotti
9Department of Medical Oncology and Hematology, IRCCS Humanitas Research Hospital, Milan, Italy
Alessandra Tucci
10Department of Haematology, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
Sara Veronica Usai
11Unità Operativa Ematologia e Centro Trapianto di Midollo Osseo, Ospedale Oncologico Businco, Azienda Ospedaliera Brotzu, Cagliari, Italy
Vittorio Ruggero Zilioli
12Division of Hematology, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
Elsa Pennese
13Unità Operativa Semplice Dipartimentale Centro Diagnosi e Terapia Linfomi, Presidio Ospedaliero Pescara, Pescara, Italy
Luca Arcaini
Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
Anna Dabrowska-Iwanicka
16Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
Andrés J. M. Ferreri
IRCCS San Raffaele Scientific Institute
Francesco Merli
19Department of Hematology, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico di Reggio Emilia, Reggio Emilia, Italy
Weili Zhao
Luigi Rigacci
21Department of Hematology, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
Claudia Cellini
22Department of Hematology, Ospedale Santa Maria delle Croci, Ravenna, Italy
David Hodgson
Codruta Ionescu
24Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Carla Minoia
25Department of Hematology, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Tumori Giovanni Paolo II, Bari, Italy
Elisa Lucchini
26Unit of Hematology, Dipartimento di Medicina Specialistica, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
Michele Spina
Centro di Riferimento Oncologico IRCCS, Aviano, Italy
Alexander Fosså
Andrea Janíková
26Department of Internal Medicine, Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
Kate Cwynarski
15Department of Haematology, University College London, London, United Kingdom
N. George Mikhaeel
32Clinical Oncology Department, Guy’s Cancer Center, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
Mats Jerkeman
Anastasios Stathis
Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzoona, Switzerland
Kelly Cozens
34Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
Nicoletta Ielmini
2Institute of Oncology Research, Bellinzona, Switzerland
Iolanda De Martino
35Fondazione Italiana Linfomi Onlus, Alessandria, Italy
Jan Walewski
16Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
Marek Trneny
Franco Cavalli
2Institute of Oncology Research, Bellinzona, Switzerland
Umberto Ricardi
Peter W. M. Johnson
38Clinical Trials Unit, School of Cancer Sciences, University of Southampton, Southampton, United Kingdom
Andrew Davies
Maurizio Martelli
12Hematology Department of Translational and Precision Medicine, Sapienza University, Rome, Italy