Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone with or Without Radiotherapy in Primary Mediastinal Large B-Cell Lymphoma: The Emerging Standard of Care
Autor: | Marina P. Siakantaris, Stella I. Kokoris, Theodoros P. Vassilakopoulos, Evangelos Terpos, John Meletis, Nikos Constantinou, Photis Beris, Christos Poziopoulos, Gerassimos A. Pangalis, John Dervenoulas, Andreas Katsigiannis, Meletios A. Dimopoulos, Effimia Vrakidou, Paraskevi Roussou, Christina Kalpadakis, Evagelia M. Dimitriadou, Zacharoula Galani, Sotirios G. Papageorgiou, Marie-Christine Kyrtsonis, Maria N. Dimopoulou, Panayiotis Panayiotidis, Sotirios Sachanas, Maria K. Angelopoulou, Alexandra Zorbala, Panagiotis Repoussis |
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Rok vydání: | 2012 |
Předmět: |
Adult
Male Cancer Research Vincristine medicine.medical_specialty genetic structures Lymphoma Prednisolone CHOP Multimodal Imaging Gastroenterology Antibodies Monoclonal Murine-Derived Autologous stem-cell transplantation immune system diseases Prednisone hemic and lymphatic diseases Internal medicine Antineoplastic Combined Chemotherapy Protocols polycyclic compounds medicine Humans Cyclophosphamide Aged business.industry Chemoradiotherapy Middle Aged medicine.disease eye diseases Surgery Oncology Doxorubicin Positron-Emission Tomography Female Rituximab Lymphoma Large B-Cell Diffuse Primary mediastinal B-cell lymphoma Tomography X-Ray Computed business medicine.drug |
Zdroj: | The Oncologist. 17:239-249 |
ISSN: | 1549-490X 1083-7159 |
Popis: | Learning Objectives After completing this course, the reader will be able to: Describe the effect of the addition of rituximab to standard CHOP chemotherapy on the outcome of patients with primary mediastinal large B-cell lymphoma.Explain potential changes in the use of radiotherapy and aggressive chemotherapy in the rituximab era. This article is available for continuing medical education credit at CME.TheOncologist.com More aggressive treatment approaches (methotrexate, cytarabine, cyclophosphamide, vincristine, prednisone, and bleomycin [the MACOP-B regimen] or consolidation with high-dose therapy and autologous stem cell transplantation) have been considered to be superior to cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) in patients with primary mediastinal large B-cell lymphoma (PMLBCL). Rituximab-CHOP (R-CHOP) is the standard of care for diffuse large B-cell lymphoma, whereas efficacy in PMLBCL has not been adequately confirmed. Patient and Methods. Seventy-six consecutive PMLBCL patients who received R-CHOP with or without radiotherapy (RT) were compared with 45 consecutive historical controls treated with CHOP with or without RT. Baseline characteristics of the two groups were balanced. Results. The rate of early treatment failure was much lower with R-CHOP with or without RT (9% versus 30%; p = .004). The 5-year freedom from progression rate after R-CHOP with or without RT was 81%, versus 48% for CHOP with or without RT (p < .0001). The 5-year event-free survival rates were 80% and 47% (p < .0001) and the 5-year overall and lymphoma-specific survival rates were 89% and 69% (p = .003) and 91% and 69% (p = .001), respectively, with only seven of 76 lymphoma-related deaths. Among R-CHOP responders, 52 of 68 received RT. Conclusions. Based on these results, most patients with PMLBCL appear to be cured by R-CHOP in 21-day cycles with or without RT, which could be the current standard of care. Therefore, the need for more aggressive treatment strategies is questionable unless high-risk patients are adequately defined. Further studies are required to establish the precise role of RT. |
Databáze: | OpenAIRE |
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