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Treatment of primary mediastinal large B cell lymphoma with an alternating chemotherapy regimen based on high-dose methotrexate

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Abstract

Primary mediastinal large B cell lymphomas (MLCL) differ from other diffuse large cell lymphomas, leading to a description as a separate entity in the current World Health Organization classification. Dose intensification improves long-term results, but no standard therapy has been established so far. We investigated the use of a high-dose methotrexate-based alternating chemotherapy regimen (B-ALL protocol of the German ALL study group) followed by consolidative mediastinal radiotherapy first as a single-center trial, then later as a prospective multicenter trial in 44 patients with a median age of 33 years. Response rates exceeded 90% with an overall survival rate of 80% in the single-center group (8.6 years median follow-up) and 82% in the multicenter group (2.5 years follow-up).Short-term toxicity was manageable, but required hospitalization: the rates of grade 3 or 4 toxicity were 20% (for mucositis), 42% (for neutropenia), 29% (for thrombocytopenia), and 9% (for neutropenic fever). No relapse occurred more than 2 years after diagnosis and initiation of treatment, but unfortunately, no patient with overt progression or relapse within these 2 years could be salvaged. Future directions in the treatment of MLCL will not focus on further dose intensification, but rather on the incorporation of (radio)immunotherapy as a therapeutic tool and gene expression profiling as well as positron emission tomography–computed tomography as stratifying tools.

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Author notes

  1. W. U. Knauf

    Present address: Oncology Bethanien, Frankfurt am Main, Germany

Authors and Affiliations

  1. Department of Medicine III (Hematology, Oncology and Transfusion Medicine), Charité—Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany

    T. Fietz, W. U. Knauf & E. Thiel

  2. Internal Medicine III, Klinikum Chemnitz, Chemnitz, Germany

    M. Hänel

  3. Hematology and Oncology, University of Magdeburg, Magdeburg, Germany

    A. Franke

  4. Hematology and Oncology, University of Rostock, Rostock, Germany

    M. Freund

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for the East German Study Group on Hematology and Oncology—OSHO

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Fietz, T., Knauf, W.U., Hänel, M. et al. Treatment of primary mediastinal large B cell lymphoma with an alternating chemotherapy regimen based on high-dose methotrexate. Ann Hematol 88, 433–439 (2009). https://doi.org/10.1007/s00277-008-0625-2

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  • DOI: https://doi.org/10.1007/s00277-008-0625-2

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