Outcomes after first-line immunochemotherapy for primary mediastinal B cell lymphoma patients: a LYSA study.
Fiche publication
Date publication
août 2021
Journal
Blood advances
Auteurs
Membres identifiés du Cancéropôle Est :
Dr ROSSI Cédric
Tous les auteurs :
Camus V, Rossi C, Sesques P, Lequesne J, Tonnelet D, Haioun C, Durot E, Willaume A, Gauthier M, Moles-Moreau MP, Antier C, Lazarovici J, Monjanel H, Bernard S, Tardy MP, Besson C, Lebras L, Choquet S, Le Dû K, Bonnet C, Bailly S, Damaj G, Laribi K, Maisonneuve HG, Houot R, Chauchet A, Jardin F, Traverse-Glehen A, Decazes P, Becker S, Berriolo-Riedinger A, Tilly H
Lien Pubmed
Résumé
Primary mediastinal B-cell lymphoma (PMBL) is a rare type of aggressive lymphoma typically affecting young female patients. The first-line standard of care remains debated. We performed a large multicenter retrospective study in 25 centers in France and Belgium to describe PMBL patient outcomes after first-line treatment in real-life settings. Three hundred thirteen patients were enrolled and received rituximab (R) plus ACVBP (n=180) or CHOP delivered every 14 (R-CHOP14, n=76) or 21 days (R-CHOP21, n=57) and consolidation strategies in modalities that varied according to time and institution, mainly guided by positron emission tomography. Consolidation autologous stem cell transplantation was performed for 46 (25.6%), 24 (31.6%) and one (1.8%) patients in the R-ACVBP, R-CHOP14 and R-CHOP21 groups, respectively (p<0.001); only 17 (5.4%) patients received mediastinal radiotherapy. The end-of-treatment complete metabolic response rates were 86.3%, 86.8% and 76.6% (p=0.23) in the R-ACVBP, R-CHOP14 and R-CHOP21 groups, respectively. The median follow-up was 44 months, and the R-ACVBP, R-CHOP14 and R-CHOP21 3-year progression-free survival (PFS) probabilities were 89.4% [95% confidence interval: 84.8-94.2%], 89.4% [82.7-96.6%] and 74.7% [64-87.1%] (p=0.018), respectively. A baseline total metabolic tumor volume (TMTV) ≥360 cm3 was associated with a lower PFS (hazard ratio=2.18 [1.05-4.53]). Excess febrile neutropenia (24.4% vs 5.3% vs 5.3%, p<0.001) and mucositis (22.8% vs 3.9% vs 1.8%, p<0.001) were observed with R-ACVBP compared to R-CHOP regimens. PMBL patients treated with dose-dense immunochemotherapy without radiotherapy have excellent outcomes. R-ACVBP acute toxicity was higher than that of R-CHOP14. Our data confirmed the prognostic importance of baseline TMTV.
Référence
Blood Adv. 2021 Aug 30;: