MACOP-B AND INVOLVED FIELD RADIATION-THERAPY IS AN EFFECTIVE THERAPY FOR PRIMARY MEDIASTINAL LARGE B-CELL LYMPHOMA WITH SCLEROSIS

Purpose: To evaluate the clinical features of presentation and the res ponse to two different third-generation regimens (F-MACHOP and MACOP-B ) of primary mediastinal large B-cell lymphoma (MLBCL), a recently def ined distinct clinicopathological entity of non-Hodgkin's lymphoma (NH L). Patients and methods: Thirty-seven consecutive patients with MLBCL , eight male and 29 female (F/M ratio 1 :3.5) with a median age of 35 years, were enrolled in the present study. Thirty-five (94.5%) patient s presented disease confined to thorax,with chest symptoms of a rapidl y enlarging mass in the mediastinum in 70% and superior vena cava synd rome (SCVS) in 43% of these patients. The first 10 patients received F -MACHOP and the succeeding 27 patients MACOP-B chemotherapy, associate d in 24 (88.8%) with involved field radiation therapy (IFRT). (67)Gall ium scan was routinely performed pre- and post-IFRT in Is patients. Re sults: All 37 patients were assessable for response: 10 of 10 (100%) i n the F-MACHOP and 26 of 27 (96.3%) in the MACOP-B group achieved over all responses (CR+PR). Three of 24 (12.5%) patients in PR after chemot herapy obtained CR after IFRT. Persistent Gallium avidity was observed in 16 patients after chemotherapy and in only four patients after IFR T. Thus far, four of the 10 F-MACHOP and two of the 26 MACOP-B respond ers have presented disease progression. The probability of progression -free survival (PFS) was 91% and 60% (P < 0.02) while overall survival (OS) was 93% and 70% (P = n.s.) at a mean follow-up of 27 and 52 mont hs in the MACOP-B+IFRT and F-MACHOP groups, respectively Conclusion: M ACOP-B+IFRT has proved to be a highly effective and less toxic therape utic approach for primary MLBCL and appears to be superior to other th ird-generation chemotherapy regimens.