Identification of Very Low-Risk Subgroups of Patients with Primary Mediastinal Large B-Cell Lymphoma Treated with R-CHOP.

Autor:	Vassilakopoulos TP; Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece., Michail M; Department of Hematology, Nicosia General Hospital, Nicosia, Cyprus., Papageorgiou S; Second Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece., Kourti G; Third Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece.; Department of Hematology and Lymphoma, Evangelismos General Hospital, Athens, Greece., Angelopoulou MK; Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece., Panitsas F; Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece., Sachanas S; Department of Hematology, Athens Medical Center, Psychikon Branch, Athens, Greece., Kalpadakis C; Department of Hematology, University of Crete, Iraklion, Crete, Greece., Katodritou E; Department of Hematology, Theagenion Anticancer General Hospital, Thessaloniki, Greece., Leonidopoulou T; Department of Hematology, Sismanoglion General Hospital, Athens, Greece., Kotsianidis I; Department of Hematology, Democritus University of Thrace, Alexandroupolis, Greece., Hatzimichael E; Department of Hematology, University of Ioannina, Ioannina, Greece., Kotsopoulou M; Department of Hematology, Metaxa Anticancer Hospital, Piraeus, Greece., Dimou M; First Propedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece., Variamis E; First Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece., Boutsis D; Department of Hematology, Athens Navy Hospital, Athens, Greece., Terpos E; Department of Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece., Dimopoulou MN; Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece., Karakatsanis S; Third Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece., Michalis E; Department of Clinical Hematology, 'G.Gennimatas' Athens General Hospital, Athens, Greece., Karianakis G; Department of Hematology, HYGEIA Hospital, Athens, Greece., Tsirkinidis P; Department of Hematology, 401 Army Hospital, Athens, Greece., Vadikolia C; Department of Hematology, 424 Army Hospital, Thessaloniki, Greece., Poziopoulos C; Department of Hematology, Metropolitan Hospital, N. Faliron, Athens, Greece., Pigaditou A; Department of Hematology, Athens Medical Center, Amaroussion Branch, Athens, Greece., Vrakidou E; Department of Hematology, HYGEIA Hospital, Athens, Greece., Economopoulos T; Department of Hematology, Athens Medical Center, Amaroussion Branch, Athens, Greece., Kyriazopoulou L; Department of Hematology, University of Ioannina, Ioannina, Greece., Siakantaris MP; Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece., Kyrtsonis MC; First Propedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece., Symeonidis A; Hematology Division, Dept of Internal Medicine, University of Patras, Patras, Greece., Anargyrou K; Department of Hematology, 251 Air Force Hospital, Athens, Greece., Papaioannou M; Hematology Unit, 1st Dept of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece., Hatjiharissi E; Department of Hematology, Theagenion Anticancer General Hospital, Thessaloniki, Greece.; Hematology Unit, 1st Dept of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece., Vervessou E; Department of Hematology, Henry Dynant Hospital, Athens, Greece., Tsirogianni M; Department of Hematology, Aghios Savvas Anticancer Hospital, Athens, Greece., Palassopoulou M; Department of Hematology, University of Thessalia Hospital, Larissa, Greece., Gainaru G; Department of Hematology, HYGEIA Hospital, Athens, Greece., Stefanoudaki E; Department of Hematology, Amalia Fleming Hospital, Athens, Greece., Zikos P; Hematology Division, Aghios Andreas Hospital, Patras, Greece., Tsirigotis P; Second Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece., Tsourouflis G; Second Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece., Assimakopoulou T; Department of Hematology, Sismanoglion General Hospital, Athens, Greece., Konstantinidou P; Department of Hematology, Theagenion Anticancer General Hospital, Thessaloniki, Greece., A Papadaki H; Department of Hematology, University of Crete, Iraklion, Crete, Greece., Megalakaki K; Department of Hematology, Metaxa Anticancer Hospital, Piraeus, Greece., Dimopoulos MA; Department of Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece., Pappa V; Second Propaedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece., Karmiris T; Department of Hematology and Lymphoma, Evangelismos General Hospital, Athens, Greece., Roussou P; Third Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece., Panayiotidis P; First Propedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece., Konstantopoulos K; Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece., Pangalis GA; Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.; Department of Hematology, Athens Medical Center, Psychikon Branch, Athens, Greece.
Jazyk:	angličtina
Zdroj:	The oncologist [Oncologist] 2021 Jul; Vol. 26 (7), pp. 597-609. Date of Electronic Publication: 2021 Jun 17.
DOI:	10.1002/onco.13789
Abstrakt:	Background: R-CHOP can cure approximately 75% of patients with primary mediastinal large B-cell lymphoma (PMLBCL), but prognostic factors have not been sufficiently evaluated yet. R-da- EPOCH is potentially more effective but also more toxic than R-CHOP. Reliable prognostic classification is needed to guide treatment decisions. Materials and Methods: We analyzed the impact of clinical prognostic factors on the outcome of 332 PMLBCL patients ≤65 years treated with R-CHOP ± radiotherapy in a multicenter setting in Greece and Cyprus. Results: With a median follow-up of 69 months, 5-year freedom from progression (FFP) was 78% and 5-year lymphoma specific survival (LSS) was 89%. On multivariate analysis, extranodal involvement (E/IV) and lactate dehydrogenase (LDH) ≥2 times upper limit of normal (model A) were significantly associated with FFP; E/IV and bulky disease (model B) were associated with LSS. Both models performed better than the International Prognostic Index (IPI) and the age-adjusted IPI by Harrel's C rank parameter and Akaike information criterion. Both models A and B defined high-risk subgroups (13%-27% of patients [pts]) with approximately 19%-23% lymphoma-related mortality. They also defined subgroups composing approximately one-fourth or one-half of the patients, with 11% risk of failure and only 1% or 4% 5-year lymphoma-related mortality. Conclusion: The combination of E/IV with either bulky disease or LDH ≥2 times upper limit of normal defined high-risk but not very-high-risk subgroups. More importantly, their absence defined subgroups comprising approximately one-fourth or one-half of the pts, with 11% risk of failure and minimal lymphoma-related mortality, who may not need more intensive treatment such as R-da-EPOCH. Implications for Practice: By analyzing the impact of baseline clinical characteristics on outcomes of a large cohort of patients with primary mediastinal large B-cell lymphoma homogeneously treated with R-CHOP with or without radiotherapy, we developed novel prognostic indices which can aid in deciding which patients can be adequately treated with R-CHOP and do not need more intensive regimens such as R-da-EPOCH. The new indices consist of objectively determined characteristics (extranodal disease or stage IV, bulky disease, and markedly elevated serum lactate dehydrogenase), which are readily available from standard initial staging procedures and offer better discrimination compared with established risk scores (International Prognostic Index [IPI] and age-adjusted IPI). (© 2021 AlphaMed Press.)
Databáze:	MEDLINE
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