Prognostic significance of pleural or pericardial effusion and the implication of optimal treatment in primary mediastinal large B-cell lymphoma: A multicenter retrospective study in Japan

Tomohiro Aoki, Koji Izutsu, Ritsuro Suzuki, Chiaki Nakaseko, Hiroshi Arima, Kazuyuki Shimada, Akihiro Tomita, Makoto Sasaki, Jun Takizawa, Kinuko Mitani, Tadahiko Igarashi, Yoshinobu Maeda, Noriko Fukuhara, Fumihiro Ishida, Nozomi Niitsu, Ken Ohmachi, Hirotaka Takasaki, Naoya Nakamura, Tomohiro Kinoshita, Shigeo NakamuraMichinori Ogura

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

The prognosis of patients with primary mediastinal large B-cell lymphoma has improved over recent years. However, the optimal treatment strategy including the role of radiotherapy remains unknown. We retrospectively analyzed the clinical outcomes of 345 patients with newly diagnosed primary mediastinal large B-cell lymphoma in Japan. With a median follow up of 48 months, the overall survival at four years for patients treated with RCHOP (n=187), CHOP (n=44), DA-EPOCH-R (n=9), 2nd- or 3rd-generation regimens, and chemotherapy followed by autologous stem cell transplantation were 90%, 67%, 100%, 91% and 92%, respectively. Focusing on patients treated with R-CHOP, a higher International Prognostic Index score and the presence of pleural or pericardial effusion were identified as adverse prognostic factors for overall survival in patients treated with R-CHOP without consolidative radiotherapy (IPI: hazard ratio 4.23, 95% confidence interval 1.48-12.13, P=0.007; effusion: hazard ratio 4.93, 95% confidence interval 1.37-17.69, P=0.015). Combined with the International Prognostic Index score and the presence of pleural or pericardial effusion for the stratification of patients treated with R-CHOP without radiotherapy, patients with lower International Prognostic Index score and the absence of effusion comprised approximately one-half of these patients and could be identified as curable patients (95% overall survival at 4 years). The DA-EPOCH-R regimen might overcome the effect of these adverse prognostic factors. Our simple indicators of International Prognostic Index score and the presence of pleural or pericardial effusion could stratify patients with primary mediastinal large B-cell lymphoma and help guide selection of treatment.

Original languageEnglish
Pages (from-to)1817-1825
Number of pages9
JournalHaematologica
Volume99
Issue number12
DOIs
Publication statusPublished - 2014 Dec 1

ASJC Scopus subject areas

  • Hematology

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