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

Primary mediastinal large-B cell lymphoma (PMLCL) are considered to be a di stinct clinicopathologic entity among the diffuse large B-cell lymphomas. T his study evaluated the prognostic factors and therapeutic outcome of PMLCL in a single-institution series. Twenty seven patients were reviewed. Ninet een of the 27 had Stage I-II and 8 had Stage III-IV disease. B-symptoms wer e found in 11 (41%) and bulky disease in 10 (37%) patients. All were initia lly given combination chemotherapy (CT): doxorubicin-containing regimens to 23 patients (11 patients had CHOP, 12 received more intensive third-genera tion regimens) and 4 elderly (>70 years) patients received CVP. Eleven resp onders were consolidated with irradiation (RT) as parr 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 t heir initial therapy, Forty-four percent of patients remained progression-f ree and 59% are alive at 3 years. The actuarial 10-year time to progression (TTP) and overall survival (OS) were 44% and 50%, respectively. Age >60 ye ars, performance status >1 and IPI intermediate-high to high risk were sign ificantly associated with poorer OS and TTP by univariate analysis (log-ran k test). A better outcome was associated with the use of more aggressive ch emotherapy regimens or with the inclusion of RT in the first-line treatment . Our analyses suggest that the application of radiotherapy in combination regimens and the use of more aggressive chemotherapy in the treatment of th is particular type of lymphoma should now be evaluated in prospective rando mized trials.