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On 14th January 2017, Ferreri and Martelli published a review article on Primary Mediastinal Large B-Cell Lymphoma (PMBCL) in Critical Reviews in Oncology and Hematology.1
First-line treatment is crucial in managing patients with PMBCL. Current salvage regimens are inefficient and so it is of utmost importance that first-line treatment results in cure, while minimizing the risk of long-term morbidity for patients.
Ferreri and Martelli state that it can be difficult comparing the advantages of different treatment protocols, and to explain differences achieved in CR and survival rates using similar protocols for phase 2 trials. The authors of the review also highlight that the results of the two retrospective studies in the pre-rituximab era indicate that third-generation chemotherapy regimens are superior to first generation regimens. The authors of the review also conclude that superior results are achieved when rituximab is added to chemotherapy. They hypothesize that rituximab removes the distinction between chemotherapy regimens. Lastly, the Ferreri and Martelli state that the encouraging results of DA-EPOCH-R without RT require validation in larger multicentric trials.
Primary mediastinal large B-cell lymphoma (PMLBCL) is a distinct clinical and biological disease from other types of DLBCL. It is more frequent in young female and constitutes 6%-10% of all DLBCL. PMLBCL is characterized by a diffuse proliferation of medium to large B-cells associated with sclerosis. Molecular analysis shows it to be a distinct entity from other DLBCL. Rituximab CHOP/MACOP-B-like regimens followed by with mediastinal radiotherapy (RT) were associated with a 5-years PFS of 75%-85%. More intensive regimens, as DA-EPOCH-R without mediastinal RT, have shown very promising results, but this therapeutic advance needs to be confirmed in further prospective trials. The role of consolidative mediastinal RT should be still better assess in prospective comparative studies. PET-CT scan is a powerful tool to define the real quality of response and it is hoped that future prospective trials may allow its role in the de-escalation of mediastinal RT.
References
Your opinion matters
Which of the following would most increase your confidence in referring patients with R/R large B-cell lymphoma for CAR T-cell therapy?