Publication Only: Aggressive non-Hodgkin lymphoma - Clinical
There is no consensus on the most optimal program for primary mediastinal lymphoma (PML) treatment. Recently a phase II study of R-DA-EPOCH regimen (Dunleavy K. et al) demonstrated high cure rate. But there were no randomized trials and according to different authors, about 10-30% of patients (pts) develop relapse/progression within 2 years from diagnose. We have previously demonstrated the high efficacy of the modified R-m-NHL-BFM-90 program for treating patients with aggressive lymphomas, including PML, but high toxicity of this protocol restricts it application. Positron emission tomography (PET/CT) is one of the most significant predictor of outcome in pts with aggressive lymphomas. Therefore, we have developed a hybrid PET/CT-guided protocol with intensive induction (blocks A and B) of R-m-NHL-BFM-90/4R-EPOCH (without escalation).
To assess the efficacy and safety of R-m-NHL-BFM-90/R-EPOCH regimen for pts with untreated PML.
A total 15 pts were enrolled in prospective study between 2015 and 2019 years. The median age was 34 (range 19-50); M:F = 3:12; Ann Arbor stage >I in 15 (100%); adverse factors (bulky mediastinal disease>10 cm in 10 pts, soft tissues involvement in 7 pts, breast in 4 pts, pleural effusion in 6 pts, elevated lactate dehydrogenase level in 7 pts). All pts underwent PET/CT before the start of therapy, after 2 courses of induction (available in 12 pts) and after the end of therapy.
Following 2 courses of induction 6 pts (40%) were in CR (D1-3) and 9 pts (60%) in PR (D4). All pts eventually received 1-4 courses R-EPOCH. After the end of therapy 14 pts (93%) were in CR (D1-3). (tab.1). Only 1 patient response was assessed as D4. She received autologous transplantation of hematopoietic stem cells and achieved CR (D3). With a median follow-up of 12 months (range 1-36) all pts (100%) are alive in complete remission.
R-m-NHL-BFM-90/R-EPOCH protocol associated with high efficacy and favorable safety.