R‐CHOP versus dose‐adjusted R‐EPOCH in frontline management of primary mediastinal B‐cell lymphoma: a multi‐centre analysis |
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| Authors: | Nirav N Shah Aniko Szabo Scott F Huntington Narendranath Epperla Nishitha Reddy Siddhartha Ganguly Julie Vose Cynthia Obiozor Fahad Faruqi Alexandra E Kovach Luciano J Costa Ana C Xavier Ryan Okal Abraham S Kanate Nilanjan Ghosh Mohamed A Kharfan‐Dabaja Lauren Strelec Mehdi Hamadani Timothy S Fenske Oscar Calzada Jonathon B Cohen Julio Chavez Jakub Svoboda |
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| Institution: | 1. Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, WI, USA;2. Correspondence: Nirav N. Shah, Division of Hematology and Oncology, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI 53226, USA.;3. E‐mail:;4. Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA;5. Yale University, New Haven, CT, USA;6. Vanderbilt University Ingram Cancer Center, Nashville, TN, USA;7. Kansas University Medical Center, Kansas City, USA;8. University of Nebraska Medical Center, Omaha, NE, USA;9. University of Alabama at Birmingham, Birmingham, AL, USA;10. Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA;11. West Virginia University, Morgantown, WV, USA;12. Levine Cancer Institute/Carolinas HealthCare System, Charlotte, North Carolina, USA;13. H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA;14. University of Pennsylvania, Philadelphia, PA, USA;15. Center of International Bone Marrow Transplant Research (CIBMTR), Milwaukee, WI, USA;16. Emory University‐Winship Cancer Institute, Atlanta, GA, USA |
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| Abstract: | Primary mediastinal (thymic) large B‐cell lymphoma (PMBCL) is an uncommon subtype of non‐Hodgkin lymphoma (NHL) that presents with a mediastinal mass and has unique clinicopathological features. Historically, patients with PMBCL were treated with R‐CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy ± involved field radiation. Since a phase II trial, published in April 2013, demonstrated excellent results using dose‐adjusted (DA) R‐EPOCH (rituximab, etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin), this treatment has gained popularity. We performed a retrospective, multicentre analysis of patients aged ≥18 years with PMBCL since January 2011. Patients were stratified by frontline regimen, R‐CHOP versus DA‐R‐EPOCH. 132 patients were identified from 11 contributing centres (56 R‐CHOP and 76 DA‐R‐EPOCH). The primary outcome was overall survival. Secondary outcomes included progression‐free survival, complete response (CR) rate, and rates of treatment‐related complications. Demographic characteristics were similar in both groups. DA‐R‐EPOCH use increased after April 2013 (79% vs. 45%, P < 0·001), and there was less radiation use after DA‐R‐EPOCH (13% vs. 59%, P < 0·001). While CR rates were higher with DA‐R‐EPOCH (84% vs. 70%, P = 0·046), these patients were more likely to experience treatment‐related toxicities. At 2 years, 89% of R‐CHOP patients and 91% of DA‐R‐EPOCH patients were alive. To our knowledge, this represents the largest series comparing outcomes of R‐CHOP to DA‐R‐EPOCH for PMBCL. |
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| Keywords: |
PMBCL
chemotherapy non‐Hodgkin lymphoma |
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