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<p>Primary mediastinal B-cell lymphoma (PMBCL) is a rare and distinct subtype of non-Hodgkin lymphoma. No consensus exists on optimal frontline treatment, and the use of R-CHOP ± radiotherapy (RT) and DA-EPOCH-R ± RT remains common, yet comparative real-world data are limited. In our multicenter retrospective study, we analyzed PMBCL patients, stratified by the first-line therapy (R-CHOP-21 ± RT or DA-EPOCH-R ± RT). Primary outcomes were complete response (CR) rate, progression-free survival (PFS), and overall survival (OS), alongside assessment of treatment-related toxicities and prognostic factors for PFS and OS. We included 157 patients [R-CHOP ± RT group (<i>n</i> = 80) and DA-EPOCH-R ± RT group (<i>n</i> = 77)] with a median age of 31&#xa0;years, of whom 68.2% were female. CR rates were similar for R-CHOP ± RT (75%) and DA-EPOCH-R ± RT (76.6%). RT use was higher in the R-CHOP group (41.2% vs. 19.5%, <i>p</i> = 0.002). DA-EPOCH-R had significantly higher toxicity (29.9% vs. 16.2%, <i>p</i> = 0.033). The median follow-up of the entire cohort was 29&#xa0;months with 2-year PFS and OS rates of 73.9% and 83.6%, respectively. Also, PFS and OS did not differ between regimens. In patients achieving CR with R-CHOP, RT omission did not impact survival. Multivariate analysis identified older age, poor performance status, superior vena cava syndrome and splenic involvement as independent OS predictors, while pericardial effusion, splenic involvement and hemoglobin &lt; 10.5&#xa0;g/dL were linked to inferior PFS. R-CHOP-21 ± RT and DA-EPOCH-R ± RT provide comparable efficacy in PMBCL. Due to the higher toxicity of DA-EPOCH-R, for those achieving CR following R-CHOP, selective RT omission may be a reasonable alternative. Established and disease-specific prognostic factors should guide individualized treatment strategies.</p>

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Real-world outcomes and prognostic factors in primary mediastinal B-cell lymphoma: a multicenter study of 157 patients

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年9月1日

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  • Selin Küçükyurt,
  • Oguzhan Koca,
  • Esra Terzi Demirsoy,
  • Serkan Akın,
  • Ali Doğan,
  • Deniz Gören,
  • Ahmet Yiğitbaşı,
  • Osman Şahin,
  • Yıldız İpek,
  • Rafiye Çiftçiler,
  • Fahri Şahin,
  • Meral Uluköylü Mengüç,
  • Işıl Erdoğan Özünal,
  • Özge Soyer Kösemehmetoğlu,
  • Yasemin Özgür,
  • Figen Atalay,
  • Hacer Berna Afacan Öztürk,
  • Merve Yüksel,
  • Nesibe Taşer Kanat,
  • Ayşe Uysal,
  • Utku İltar,
  • Abdulkerim Yıldız,
  • Fatma Keklik Karadağ,
  • Mehmet Baysal,
  • Mehmet Can Uğur,
  • Serkan Güven,
  • İbrahim Ethem Pınar,
  • Özgür Mehtap,
  • İbrahim Barışta,
  • Ahmet Muzaffer Demir,
  • Mahmut Yeral,
  • Cem Selim,
  • Güray Saydam,
  • Işık Kaygusuz Atagündüz,
  • Pınar Tığlıoğlu,
  • İmdat Dilek,
  • Mesut Ayer,
  • Ahmet Kürşad Güneş,
  • Meltem Kurt Yüksel,
  • Ali Ünal,
  • Ozan Salim,
  • Nur Soyer,
  • Elif Birtaş Ateşoğlu,
  • Ahmet Emre Eşkazan

摘要

Primary mediastinal B-cell lymphoma (PMBCL) is a rare and distinct subtype of non-Hodgkin lymphoma. No consensus exists on optimal frontline treatment, and the use of R-CHOP ± radiotherapy (RT) and DA-EPOCH-R ± RT remains common, yet comparative real-world data are limited. In our multicenter retrospective study, we analyzed PMBCL patients, stratified by the first-line therapy (R-CHOP-21 ± RT or DA-EPOCH-R ± RT). Primary outcomes were complete response (CR) rate, progression-free survival (PFS), and overall survival (OS), alongside assessment of treatment-related toxicities and prognostic factors for PFS and OS. We included 157 patients [R-CHOP ± RT group (n = 80) and DA-EPOCH-R ± RT group (n = 77)] with a median age of 31 years, of whom 68.2% were female. CR rates were similar for R-CHOP ± RT (75%) and DA-EPOCH-R ± RT (76.6%). RT use was higher in the R-CHOP group (41.2% vs. 19.5%, p = 0.002). DA-EPOCH-R had significantly higher toxicity (29.9% vs. 16.2%, p = 0.033). The median follow-up of the entire cohort was 29 months with 2-year PFS and OS rates of 73.9% and 83.6%, respectively. Also, PFS and OS did not differ between regimens. In patients achieving CR with R-CHOP, RT omission did not impact survival. Multivariate analysis identified older age, poor performance status, superior vena cava syndrome and splenic involvement as independent OS predictors, while pericardial effusion, splenic involvement and hemoglobin < 10.5 g/dL were linked to inferior PFS. R-CHOP-21 ± RT and DA-EPOCH-R ± RT provide comparable efficacy in PMBCL. Due to the higher toxicity of DA-EPOCH-R, for those achieving CR following R-CHOP, selective RT omission may be a reasonable alternative. Established and disease-specific prognostic factors should guide individualized treatment strategies.