Primary mediastinal large B-cell lymphoma (PMLCL): The need for prospective controlled clinical trials

Primary mediastinal large-B cell lymphomas (PMLCL) are considered to be a d istinct clinicopathologic entity among the diffuse large B-cell lymphomas. This study evaluated the prognostic factors and therapeutic outcome of PMLC L in a single-institution series. Twenty seven patients were reviewed. Nine teen of the 27 had Stage I-II and 8 had Stage III-IV disease. B-symptoms we re found in 11 (41%) patients and bulky disease in 10 (37%). All patients w ere initially given combination chemotherapy (CT): doxorubicin-containing r egimens to 23 patients (11 patients had CHOP, 12 more intensive third-gener ation regimens) and 4 elderly (>70 years) patients received CVP Eleven resp onders were consolidated with irradiation (RT) as part of their initial tre atment, with a median total dose of 39 Gy, Nineteen patients (70%) achieved clinical remission (15 CR and 4 PR) with their initial therapy. Forty-four percent of patients remained progression-free and 59% are alive at 3 years . The actuarial 10-year TTP and OS were 44% and 50%, respectively. Age >60 years, performance status >1 and IPI intermediate-high to high risk were si gnificantly associated with poorer OS and TTP by univariate analysis (log-r ank test). A better outcome was associated with the use of more aggressive chemotherapy regimens or with the inclusion of RT in the first-line treatme nt, In conclusion our analyses suggest that the application of radiotherapy in combination regimens and the use of more aggressive chemotherapy in the treatment of this particular lymphoma entity should be evaluated in prospe ctive randomized trials.