Skip to main content

Advertisement

SpringerLink
Log in

Outcomes of Patients with Primary Mediastinal B-Cell Lymphoma Treated with Dose Adjusted R-EPOCH Regimen: A Single Centre Experience

  • Original Article
  • Published:
Indian Journal of Hematology and Blood Transfusion Aims and scope Submit manuscript

Abstract

Introduction

Primary Mediastinal B cell lymphoma (PMBCL) is a biologically and clinically distinct subset of diffuse large B cell lymphoma. We analysed the outcomes of our cohort of PMBCL patients treated with Dose adjusted (DA)-R-EPOCH regimen.

Patients and Methods

This is a retrospective analysis of consecutive PMBCL patients who received chemotherapy consisting of DA-R-EPOCH with filgrastim support. Survival analysis was done using Kaplan–Meier method. All calculations were performed using SPSS version 20 for windows.

Results

A total of 43 consecutive suspected PMBCL patients were reviewed for this study, 6 patients were excluded as diagnosis of PMBCL could not be established. All patients except one (97.3%) received 6 cycles of R-DA-EPOCH regimen. Median age of the patients was 27 years (range 15–58). Bulky disease (> 7 cm) was present in 97% patients and 54% patients had extranodal disease. With a median follow up of 40 months, 3-year overall survival was 80.6% (95% CI: 74.0–87.2). The 3-year event free survival was 78.4% (95% CI: 71.6–85.2). There were 6 (16.2%) relapses, 1 (2.7%) primary progression and 7 (23%) deaths. Mediastinal radiotherapy was administered to 17 (45.9%) patients. All the deaths were due to disease progression. Grade III/IV toxicities were seen in 28 (75.7%) patients, febrile neutropenia being the most common one.

Conclusions

DA-R-EPOCH regimen is an effective and tolerable regimen in PMBCL patients even with adverse features.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Savage K (2006) Primary mediastinal large B cell lymphoma. Oncologist 11:488–495

    Article  CAS  Google Scholar 

  2. Wilson WH, Sin-Ho J, Pitcher BN, Hsi ED, Friedberg J, Cheson B et al (2016) Phase III randomized study of R-CHOP versus DA-EPOCH-R and molecular analysis of untreated diffuse large B-cell lymphoma: CALGB/Alliance 50303. Blood 128:469–469

    Article  Google Scholar 

  3. Vassilakopoulos TP, Pangalis GA, Katsigiannis A, Papageorgiou SG, Constantinou N, Terpos E et al (2012) Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone with or without radiotherapy in primary mediastinal large B-cell lymphoma: The emerging standard of care. Oncologist 17:239–249

    Article  CAS  Google Scholar 

  4. Xu LM, Fang H, Wang WH, Jin J, Wang SL, Liu YP et al (2013) Prognostic significance of rituximab and radiotherapy for patients with primary mediastinal large B-cell lymphoma receiving doxorubicin-containing chemotherapy. Leuk Lymphoma 54:1684–1690

    Article  CAS  Google Scholar 

  5. Zinzani PL, Stefoni V, Finolezzi E, Brusamolino E, Cabrasd MG, Chiappella A et al (2009) Rituximab combined with MACOP-B or VACOP-B and radiation therapy in primary mediastinal large B-cell lymphoma: A retrospective study. Clin Lymphoma Myeloma 9:381–385

    Article  CAS  Google Scholar 

  6. Dunleavy K, Pittaluga S, Maeda LS, Advani R, Chen CC, Hessler J et al (2013) Dose-adjusted EPOCH-rituximab therapy in primary mediastinal B-cell lymphoma. N Engl J Med 368(15):1408–1416

    Article  CAS  Google Scholar 

  7. Giulino-Roth L, O’Donohue T, Chen Z, Bartlett NL, LaCasce A, Martin-Doyle W et al (2017) Outcomes of adults and children with primary mediastinal B-cell lymphoma treated with dose-adjusted EPOCH-R. Br J Haematol 179:739–747

    Article  CAS  Google Scholar 

  8. Wilson WH, Grossbard ML, Pittaluga S, Cole D, Pearson D, Drbohlave N et al (2002) Dose-adjusted EPOCH chemotherapy for untreated large B-cell lymphomas:a pharmacodynamic approach with high efficacy. Blood 99:2685–2693

    Article  CAS  Google Scholar 

  9. Wilson WH, Jung SH, Porcu P, Hurd D, Johnson J, Martin SE et al (2012) A Cancer and Leukemia Group B multi-center study of DA-EPOCH-rituximab in untreated diffuse large B-cell lymphoma with analysis of outcome by molecular subtype. Haematologica 97:758–765

    Article  CAS  Google Scholar 

  10. Wilson WH, Dunleavy K, Pittaluga S, Hegde U, Grant N, Steinberge SM et al (2008) Phase II study of dose-adjusted EPOCH and rituximab in untreated diffuse large B-cell lymphoma with analysis of germinal center and post-germinal center biomarkers. J Clin Oncol 26:2717–2724

    Article  CAS  Google Scholar 

  11. Mazzarotto R, Boso C, Vianello F, Aversa MS, Chiarion-Sileni V, Trentin L et al (2007) Primary mediastinal large B-cell lymphoma: results of intensive chemotherapy regimens (MACOP-B/VACOP-B) plus involved field radiotherapy on 53 patients: A single institution experience. Int J Radiat Oncol Biol Phys 68(3):823–829

    Article  CAS  Google Scholar 

  12. Savage KJ, Al-Rajhi N, Voss N, Paltiel C, Klasa R, Gascoyne RD et al (2006) Favourable outcome of primary mediastinal large B-cell lymphoma in a single institution: the British Columbia experience. Ann Oncol 17:123–130

    Article  CAS  Google Scholar 

  13. Chan EHL, Koh LP, Lee J, De Mel S, Jeyasekharan A, Liu X et al (2019) Real world experience of R-CHOP with or without consolidative radiotherapy vs DA-EPOCH-R in the first-line treatment of primary mediastinal B-cell lymphoma. Cancer Med 8(10):4626–4632

    Article  Google Scholar 

  14. Malenda A, Kołkowska-Leśniak A, Puła B, Długosz-Danecka M, Chełstowska M, Końska A et al (2020) Outcomes of treatment with dose-adjusted EPOCH-R or R-CHOP in primary mediastinal large B-cell lymphoma. Eur J Haematol 104(1):59–66

    Article  CAS  Google Scholar 

  15. Gogia A, Kumar S, Chellapurum SK, Biswas A, Mallick S (2020) Primary mediastinal B cell lymphoma: A limited institutional experience with uniform DAEPOCH-R protocol. Indian J Hematol Blood Transfus. https://doi.org/10.1007/s12288-020-01301-z

    Article  PubMed  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National University, E. Borges Marg, Parel, Mumbai, Maharashtra, 400012, India

    Hasmukh Jain, Akhil Kapoor, Manju Sengar, Raajit Chanana, Bhausaheb Bagal & Jayashree Thorat

  2. Medical Oncologist, Cytecare hospital, Bengaluru, India

    Hari Menon

  3. Department of Pathology, Tata Memorial Hospital, Mumbai, India

    Epari Sridhar, Tanuja Shet & Sumeet Gujral

  4. Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India

    Siddhartha Laskar, Jayant Shastri & Nehal Khanna

  5. Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, India

    Archi Agarwal & Venkatesh Rangarajan

Authors
  1. Hasmukh Jain
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Akhil Kapoor
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Manju Sengar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Raajit Chanana
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hari Menon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Epari Sridhar
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Siddhartha Laskar
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Archi Agarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jayant Shastri
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Nehal Khanna
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Venkatesh Rangarajan
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Bhausaheb Bagal
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Jayashree Thorat
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Tanuja Shet
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Sumeet Gujral
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All the authors made substantial contributions in the design, conduct, and analysis part of the research. The article was drafted and approved by all the authors for publication.

Corresponding author

Correspondence to Hasmukh Jain.

Ethics declarations

Conflict of interest

The authors declare no competing interests related to the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jain, H., Kapoor, A., Sengar, M. et al. Outcomes of Patients with Primary Mediastinal B-Cell Lymphoma Treated with Dose Adjusted R-EPOCH Regimen: A Single Centre Experience. Indian J Hematol Blood Transfus 37, 379–385 (2021). https://doi.org/10.1007/s12288-020-01372-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12288-020-01372-y

Keywords

Search

Navigation