R-EPOCH, R-HCVAD superior to R-CHOP for primary mediastinal large B-cell lymphoma

The R-EPOCH* and R-HCVAD** regimens yield better outcomes in patients with primary mediastinal large B-cell lymphoma (PMBCL) than R-CHOP***, a recent study has found.

The retrospective analysis included 166 PMBCL patients (median age, 33 years; 72 men) who were followed for a median of 58 months. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 79 percent and 70 percent, respectively. Those with more advanced disease and those who were older had worse survival outlook.

Most of the patients (n=89) were treated with R-CHOP as a first-line regimen, while 55 received four to seven cycles of R-EPOCH and 19 were given three to eight cycles of R-HCVAD. Objective response rates were higher in the two latter treatments (98 percent and 100 percent vs 91 percent, respectively), though the difference was not significant.

However, over the corresponding median follow-up lengths of 56.8, 126.2 and 54.8 months, R-EPOCH and R-HCVAD led to better OS and PFS rates than R-CHOP, respectively. Radiation therapy, administered in 85 patients, did not yield significant clinical benefit.

Thirty-one patients received stem cell transplants (25 autologous, six allogeneic), which seemed to improve OS in patients with relapsed or refractory PMBCL, especially in those who were initially partially responsive to treatment.

“In this large multicentric cohort analysis, we demonstrated that R-HCVAD and R-EPOCH provide superior clinical outcomes in PMBCL than R-CHOP as front-line immunochemotherapy that should be integrated into the clinical practice guidelines,” the researchers said.

“For relapsed or refractory PMBCL, autologous or allogenic stem cell transplantation after high-dose chemotherapy as the standard of care is an effective therapeutic strategy for PMBCL,” they added.

*etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab

**rituximab, cyclophosphamide, mesna, doxorubicin, vincristine, dexamethasone, methotrexate, and cytarabine

***cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab