Primary mediastinal large B-cell lymphoma medical therapy
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Template:Primary mediastinal large B-cell lymphoma medical therapy Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Badria Munir M.B.B.S.[2]
Overview
Patients with primary mediastinal large B-cell lymphoma are treated with chemotherapy followed by radiotherapy, relapsed disease is then treated with autologous stem cell transplant.
Medical Therapy
| Therapy | Description |
|---|---|
| Chemotherapy |
|
| Biological therapy |
|
| Radiation therapy |
|
| Stem cell transplant |
|
- The choice of initial treatment depends on stage of disease at the time of presentation. Following are different treatment regimens that are recommended for various stages:
Induction Chemotherapy:
- R-CHOP chemotherapy which includes rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone is preferred regimen for limited disease but it is not suggested alone, follow up with radiotherapy is highly recommended to prevent relapse of disease.
- Dose adjusted da-EPOCH-Retoposide, doxorubicin, cyclophosphamide, vincristine, prednisone, and rituximab.
- This is best for the patients who wish to avoid radiotherapy, such as young patients (<30 yrs) or women who have concerns with irradiation of breast tissue.
- However investigators from Europe have suggested that MACOP-B(methotrexate with leucovorin rescue, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin) may be superior to CHOP in the management of primary mdiastinal large B-cell lymphoma.
Radiotherapy:
- Radiotherapy is usually indicated to prevent relapse and recurrence of disease after chemotherapy induction especially after following R-CHOP regimen.[2]
- In aggressive disease, radiation therapy has been proven to be beneficial in patients with good-prognosis stage I and nonbulky stage II disease.[3]
High-Dose Chemotherapy and Autologous Stem Cell Transplantation:
- The use of high-dose chemotherapy and autologous stem cell transplantation in patients with aggressive disease proves to be beneficial in some cases.[4]
Relapsed disease:
- Patients with relapsed disease often have systemic involvement and many also have extranodal diseas, in the parenchymal organs, including kidneys, liver, and CNS.[5]
- These patients are recommended to undergo salvage systemic chemotherapy followed by stem cell transplantation.[6]
Salvage therapy:
- rituximab, ifosfamide, carboplatin, and etoposide (RICE) serves as a salvage approach.
- Patients who demonstrate improvement on PET scan are recommended for transplantation.
- Patients who have refractory disease should be offered clinical trials, although some can be considered for allogeneic bone marrow transplantation.
References
- ↑ Primary mediastinal large B-cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/primary-mediastinal-large-b-cell-lymphoma/?region=nb. Accessed on March 7, 2016
- ↑ Martelli M, Ceriani L, Zucca E, Zinzani PL, Ferreri AJ, Vitolo U, Stelitano C, Brusamolino E, Cabras MG, Rigacci L, Balzarotti M, Salvi F, Montoto S, Lopez-Guillermo A, Finolezzi E, Pileri SA, Davies A, Cavalli F, Giovanella L, Johnson PW (June 2014). "[18F]fluorodeoxyglucose positron emission tomography predicts survival after chemoimmunotherapy for primary mediastinal large B-cell lymphoma: results of the International Extranodal Lymphoma Study Group IELSG-26 Study". J. Clin. Oncol. 32 (17): 1769–75. doi:10.1200/JCO.2013.51.7524. PMID 24799481.
- ↑ Miller TP, Dahlberg S, Cassady JR, Adelstein DJ, Spier CM, Grogan TM, LeBlanc M, Carlin S, Chase E, Fisher RI (July 1998). "Chemotherapy alone compared with chemotherapy plus radiotherapy for localized intermediate- and high-grade non-Hodgkin's lymphoma". N. Engl. J. Med. 339 (1): 21–6. doi:10.1056/NEJM199807023390104. PMID 9647875.
- ↑ Haioun C, Lepage E, Gisselbrecht C, Bastion Y, Coiffier B, Brice P, Bosly A, Dupriez B, Nouvel C, Tilly H, Lederlin P, Biron P, Brière J, Gaulard P, Reyes F (March 1997). "Benefit of autologous bone marrow transplantation over sequential chemotherapy in poor-risk aggressive non-Hodgkin's lymphoma: updated results of the prospective study LNH87-2. Groupe d'Etude des Lymphomes de l'Adulte". J. Clin. Oncol. 15 (3): 1131–7. doi:10.1200/JCO.1997.15.3.1131. PMID 9060555.
- ↑ Cheson BD, Horning SJ, Coiffier B, Shipp MA, Fisher RI, Connors JM, Lister TA, Vose J, Grillo-López A, Hagenbeek A, Cabanillas F, Klippensten D, Hiddemann W, Castellino R, Harris NL, Armitage JO, Carter W, Hoppe R, Canellos GP (April 1999). "Report of an international workshop to standardize response criteria for non-Hodgkin's lymphomas. NCI Sponsored International Working Group". J. Clin. Oncol. 17 (4): 1244. doi:10.1200/JCO.1999.17.4.1244. PMID 10561185.
- ↑ Popat U, Przepiork D, Champlin R, Pugh W, Amin K, Mehra R, Rodriguez J, Giralt S, Romaguera J, Rodriguez A, Preti A, Andersson B, Khouri I, Claxton D, de Lima M, Donato M, Anderlini P, Gajewski J, Cabanillas F, van Besien K (January 1998). "High-dose chemotherapy for relapsed and refractory diffuse large B-cell lymphoma: mediastinal localization predicts for a favorable outcome". J. Clin. Oncol. 16 (1): 63–9. doi:10.1200/JCO.1998.16.1.63. PMID 9440724.