Primary mediastinal B-cell lymphoma treated with CHOP-like chemotherapy with or without rituximab

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BlankPrimary mediastinal B-cell lymphoma treated with CHOP-like chemotherapy

with or without rituximab: results of the Mabthera International Trial Group

study

1.. M. Rieger1,*,

2.. A. Österborg2,

3.. R. Pettengell3,

4.. D. White4,

5.. D. Gill5,

6.. J. Walewski6,

7.. E. Kuhnt7,

8.. M. Loeffler8,

9.. M. Pfreundschuh9,

10.. A. D. Ho1 and

11.. for the MabThera International Trial (MInT) Group

+ Author Affiliations

1.. 1Department of Internal Medicine V, University of Heidelberg, Heidelberg,

Germany

2.. 2Departments of Oncology, Haematology, Karolinska University Hospital,

Stockholm, Sweden

3.. 3St ’s University of London, UK

4.. 4Dalhousie University, Halifax, Nova Scotia for the NCIC Clinical Trials

Group, Kingston, Ontario, Canada

5.. 5Department of Haematology, Princess andra Hospital, Queensland,

Australia

6.. 6Department of Lymphoma, Sklodowska-Curie Institute and Oncology

Centre, Warszawa, Poland

7.. 7Clinical Trial Centre Leipzig, University of Leipzig, Leipzig

8.. 8Institute of Medical Informatics, Statistics and Epidemiology, University

of Leipzig, Leipzig

9.. 9Saarland University Medical School, Homburg, Germany

1.. *Correspondence to: Dr M. Rieger, Department of Internal Medicine V,

University of Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany.

Tel: +49-6221-56 8001; Fax: +49-6221-56 4920; E-mail:

michael.rieger@...

Background: The aim of this subgroup analysis of the Mabthera International

Trial Group study was to evaluate the impact of chemotherapy and rituximab in

primary mediastinal B-cell lymphoma (PMBCL) in comparison to other diffuse large

B-cell lymphoma (DLBCL).

Methods: Patients were randomly assigned to six cycles of CHOP-like regimens

with or without rituximab.

Results: Of 824 patients enrolled, 87 had PMBCL and 627 other types of DLBCL.

Rituximab increased the rates of complete remission (unconfirmed) in both PMBCL

(from 54% to 80%, P = 0.015) and DLBCL (from 72% to 87%, P < 0.001). In PMBCL,

rituximab virtually eliminated progressive disease (PD) (2.5% versus 24%, P <

0.001), whereas without rituximab, PD was more frequent in PMBCL than in DLBCL

(24% versus 10%, P = 0.010). With a median observation time of 34 months, 3-year

event-free survival (EFS) was improved by rituximab for PMBCL (78% versus 52%, P

= 0.012) and for DLBCL (81% versus 61%, P < 0.001). Overall survival benefit was

similar for DLBCL (93% versus 85%, P < 0.001) and PMBCL (89% versus 78%, P =

0.158).

Conclusion: In young patients with PMBCL (age-adjusted International Prognostic

Index 0–1), rituximab added to six cycles of CHOP-like chemotherapy increases

response rate and EFS to the same extent as other DLBCL. The combination of

rituximab with CHOP chemotherapy is an effective treatment in PMBCL with good

prognosis features.