High-dose chemotherapy for relapsed and refractory diffuse large B-cell lymphoma: mediastinal localization predicts for a favorable outcome.

Popat, Uday; Przepiork, D; Champlin, Richard E.; Pugh, William; Amin, Kamal Adel; Mehra, Rakesh; Rodríguez, José A.; Giralt, Sergío; Romaguera, Jorge; Rodriguez, A; Preti, A.; Andersson, B.; Khouri, Issa F.; Claxton, DF; Lima, Marcos de; Donato, M.; Anderlini, Paolo; Gajewski, J.; Cabanillas, Fernando; Besien, Koen van

doi:10.1200/jco.1998.16.1.63

Cited by 56 publications

(25 citation statements)

References 33 publications

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“…Involvedfield radiotherapy was ineffective in controlling the disease progression too. These findings are in agreement with the majority of reports (Moller et al, 1987;Jacobson et al, 1988;Cazals-Hatem et al, 1996;Zinzani et al, 2001), but contrast with the relatively good results described by other authors (Popat et al, 1998;Sehn et al, 1998) in small groups of refractory/relapsed patients treated with stem cell rescue.…”

Section: Discussioncontrasting

confidence: 52%

Primary mediastinal large B-cell lymphoma (PMLBCL): long-term results from a retrospective multicentre Italian experience in 138 patients treated with CHOP or MACOP-B/VACOP-B

et al. 2004

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Section: Discussioncontrasting

confidence: 52%

Primary mediastinal large B-cell lymphoma (PMLBCL): long-term results from a retrospective multicentre Italian experience in 138 patients treated with CHOP or MACOP-B/VACOP-B

et al. 2004

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“…Considering the young age of these patients and the pattern of relapse which spares the bone marrow, highdose chemotherapy supported by autologous stem cell transplantation has been tested in 2 observational outcome studies (grade of evidence 3) as rescue therapy. 65,66 With this strategy, relapsed mediastinal lymphomas seem to have a better prognosis with respect to the other diffuse large cell lymphoma, with a 5-year disease-free survival of 55% and 35% respectively. In contrast, patients treated with a conventional second-line chemotherapy or with radiation therapy on the mediastinum (for patients who did not undergo radiation therapy after the front-line chemotherapy regimen) have a median survival after relapse of a few months.…”

Section: Recurrent Diseasementioning

confidence: 99%

“…The data do not prove superiority of high-dose chemotherapy over conventional chemotherapy. [64][65][66] The use of high-dose chemotherapy supported by stem cell transplantation to consolidate the initial response in high-risk patients resulted inconclusive.…”

Section: Chemotherapymentioning

confidence: 99%

Practice guidelines for the management of extranodal non-Hodgkin's lymphomas of adult non-immunodeficient patients. Part I: primary lung and mediastinal lymphomas. A project of the Italian Society of Hematology, the Italian Society of Experimental Hematology and the Italian Group for Bone Marrow Transplantation

Zinzani¹,

Martelli²,

Poletti³

et al. 2008

Haematologica

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Extranodal non-Hodgkin's lymphomas constitute 20-25% of overall non-Hodgkin's lymphomas cases and can be managed with very different therapeutic strategies. Therefore, the Italian Society of Hematology and the two affiliate societies (the Italian Society of Experimental Hematology and the Italian Group of Bone Marrow Transplantation) appointed a panel of experts to produce clinical practice-guidelines for the management of these conditions. Primary lung and mediastinal lymphomas were the objective of this part of the project. The panel of experts produced the following key recommendations that were graded according to the strength of evidence and clinical judgement. The first-line therapy for non-MALT primary lung non-Hodgkin's lymphomas should include anthracycline-based chemotherapy with CHOP or CHOP-like, MACOP-B or MACOP-B-like regimens (grade D). Rituximab association with chemotherapy needs to be evaluated within approved clinical trials. Second-line therapy with high-dose chemotherapy and autologous stem cell transplantation is recommended (grade B). In patients with MALT primary lung non-Hodgkin's lymphomas, the recommended first-line therapy should include chlorambucil, CHOP, CHOP-like or fludarabine-containing regimens (grade B). Radiotherapy is to be reserved for patients with a unique, small lesion in a poorly mobile site and with contraindication to surgery (grade D). Rituximab should be administered only within approved clinical trials. For treatment of primary mediastinal large B-cell lymphomas, the recommended first-line therapy is a chemotherapy and radiotherapy association (grade B). An anthracycline-based chemotherapy with CHOP, MACOP-B or VACOP-B is recommended (grade B). Rituximab combination with chemotherapy is highly suggested but only for patients enrolled into approved clinical trials. Patients with an inadequate early response should be candidates for early intensification with high-dose chemotherapy (grade C). Patients with refractory or relapsed disease should undergo rescue programs including intensive, non-cross-resistant debulking treatment followed, in chemosensitive patients, by high-dose chemotherapy and autologous stem cell transplantation (grade B).

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“…Among 30 patients from the MD Anderson Cancer Center who showed chemosensitivity at the time of relapse, OS of 72% at a median follow-up of 8½ years is reported. 77 …”

Section: Treatment At the Time Of Recurrencementioning

confidence: 99%

Primary mediastinal B‐cell lymphoma

Boleti

Johnson

2007

Hematological Oncology

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Primary mediastinal B-cell lymphoma is a discrete clinicopathologic entity. Molecular analysis reveals it to be distinct from other types of large B-cell lymphoma, and retrospective analysis suggests that it may respond better to multi-agent chemotherapy regimens than to the more commonly used CHOP. The addition of rituximab may mitigate such differences, and may also diminish the role of consolidation radiotherapy, which is often used to treat residual mediastinal masses. For the future the role of FDG-PET scanning requires prospective examination, and it is hoped that this may allow the de-escalation of treatment if it can be shown to yield reliable prognostic information. The relative rarity of this type of lymphoma necessitates international collaboration in clinical trials, with a prospective clinicopathologic study, IELSG 26, already underway.

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High-dose chemotherapy for relapsed and refractory diffuse large B-cell lymphoma: mediastinal localization predicts for a favorable outcome.

Abstract: Our results indicate that patients with PML may display an increased susceptibility to high-dose chemotherapy compared with other types of B-cell large-cell lymphoma. These findings, if confirmed, may have implications for the initial management of patients with PML.

Cited by 56 publications

References 33 publications

Primary mediastinal large B-cell lymphoma (PMLBCL): long-term results from a retrospective multicentre Italian experience in 138 patients treated with CHOP or MACOP-B/VACOP-B

Primary mediastinal large B-cell lymphoma (PMLBCL): long-term results from a retrospective multicentre Italian experience in 138 patients treated with CHOP or MACOP-B/VACOP-B

Primary mediastinal B‐cell lymphoma

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