Impact of immunochemotherapy regimens on outcomes of patients with primary mediastinal B-cell lymphoma in the IELSG37 trial

作者：Emanuele Zucca, Luca Ceriani, Giovannino Ciccone, Alice Di Rocco, Maria Cristina Pirosa, Iryna Kriachok, Barbara Botto, Monica Balzarotti, Alessandra Tucci, Sara Veronica Usai, Vittorio Ruggero Zilioli, Elsa Pennese, Luca Arcaini, Anna Dąbrowska‐Iwanicka, Andrés J.M. Ferreri, Francesco Merli, Weili Zhao, Luigi Rigacci, Claudia Cellini, David Hodgson, C Ionescu, Carla Minoia, Elisa Lucchini, Michele Spina, Alexander Fosså, Andrea Janíková, Kate Cwynarski, N. George Mikhaeel, Mats Jerkeman, Anastasios Stathis, Kelly Cozens, Nicoletta Ielmini, Iolanda De Martino, Jan Walewski, Marek Trněný, Franco Cavalli, Umberto Ricardi, Peter Johnson, Andrew Davies, Maurizio Martelli · 发表于：Blood · 年份：2025 · DOI：10.1182/blood.2025028823 · 被引用次数：3 · 研究领域：Lymphoma Diagnosis and Treatment、Cardiac tumors and thrombi、Sarcoma Diagnosis and Treatment

ABSTRACT: The IELSG37 trial enrolled 545 patients with primary mediastinal B-cell lymphoma (PMBCL) and demonstrated that consolidation radiotherapy (RT) can be omitted in patients with complete metabolic response, defined by the Lugano classification as Deauville score (DS) 1 to 3. This report evaluates outcomes after different frontline rituximab- and doxorubicin-based immunochemotherapy regimens chosen according to local practice. Patients treated with R-CHOP21 (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone, administered every 21 days) showed a significantly higher percentage of DS 5 than those on other regimens (23.8% vs 8.2% average; P < .001) and a trend toward additional unplanned treatments (53.2% vs 46.9%; P = .30). The increased risk of poor response was confirmed in a multinomial logistic regression analysis adjusted for age, sex, international prognostic index score, and performance status. R-CHOP21 was also associated with smaller reductions in metabolic tumor volume and less pronounced decreases in maximum standardized uptake value. Patients with DS 5 more often received additional treatment (RT and/or salvage chemotherapy with or without autologous consolidation) after induction immunochemotherapy (96% vs 41%; P < .001) and experienced significantly poorer outcomes. Although differences in progression-free and overall survival between R-CHOP21 and more aggressive regimens were not statistically significant, R-CHOP21 may increase the risk of...