Outcomes of Relapsed and Refractory Primary Mediastinal (Thymic) Large B Cell Lymphoma Treated with Second-Line Therapy and Intent to Transplant

Santosha Vardhana, Paul A. Hamlin, Joanna Yang, Andrew Zelenetz, Craig S. Sauter, Matthew J. Matasar, Andy Ni, Joachim Yahalom, Craig Moskowitz

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Primary mediastinal (thymic) large B cell lymphoma is a subtype of diffuse large B cell lymphoma with distinct clinical, molecular, and genetic features, many of which overlap with Hodgkin lymphoma. Increasingly, initial therapy for these patients has used dose-dense chemotherapy with or without radiation with excellent results. In patients with relapsed and primary refractory disease, outcomes of second-line therapy followed by consolidation with high-dose therapy and autologous stem cell transplantation remains largely undefined. We reviewed the outcomes of 60 transplant-eligible patients with relapsed or refractory primary mediastinal (thymic) large B cell lymphoma enrolled on sequential protocols with uniform second-line therapy with intent to consolidate with autologous stem cell transplant. The estimated 3-year overall and event-free survivals for all patients were 61% and 57%, respectively, and 68% and 65%, respectively, for patients proceeding to stem cell transplant. Multivariable analysis of risk factors before transplant revealed that an incomplete response to initial therapy, advanced Ann Arbor stage at disease progression, and failure to achieve a partial remission or better to second-line therapy to be independently associated with inferior event-free and overall survival. A risk score based on these variables was able to identify patients who are unlikely to respond to conventional second-line strategies. These results suggest that salvage chemoradiotherapy with intent of subsequent high-dose therapy and autologous stem cell transplant is successful in most patients with relapsed and refractory primary mediastinal (thymic) large B cell lymphoma. Alternative strategies are warranted for a significant subset of patients with high-risk disease who are unlikely to be cured with this strategy.

Original languageEnglish (US)
Pages (from-to)2133-2138
Number of pages6
JournalBiology of Blood and Marrow Transplantation
Volume24
Issue number10
DOIs
StatePublished - Oct 1 2018
Externally publishedYes

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B-Cell Lymphoma
Transplants
Stem Cells
Therapeutics
Disease-Free Survival
Lymphoma, Large B-Cell, Diffuse
Stem Cell Transplantation
Chemoradiotherapy
Hodgkin Disease
Disease Progression
Molecular Biology
Radiation
Drug Therapy

Keywords

  • Chemotherapy
  • DLBCL
  • Lymphoma
  • PMBCL
  • Radiation
  • Transplant

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Outcomes of Relapsed and Refractory Primary Mediastinal (Thymic) Large B Cell Lymphoma Treated with Second-Line Therapy and Intent to Transplant. / Vardhana, Santosha; Hamlin, Paul A.; Yang, Joanna; Zelenetz, Andrew; Sauter, Craig S.; Matasar, Matthew J.; Ni, Andy; Yahalom, Joachim; Moskowitz, Craig.

In: Biology of Blood and Marrow Transplantation, Vol. 24, No. 10, 01.10.2018, p. 2133-2138.

Research output: Contribution to journalArticle

Vardhana, Santosha ; Hamlin, Paul A. ; Yang, Joanna ; Zelenetz, Andrew ; Sauter, Craig S. ; Matasar, Matthew J. ; Ni, Andy ; Yahalom, Joachim ; Moskowitz, Craig. / Outcomes of Relapsed and Refractory Primary Mediastinal (Thymic) Large B Cell Lymphoma Treated with Second-Line Therapy and Intent to Transplant. In: Biology of Blood and Marrow Transplantation. 2018 ; Vol. 24, No. 10. pp. 2133-2138.
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AU - Hamlin, Paul A.

AU - Yang, Joanna

AU - Zelenetz, Andrew

AU - Sauter, Craig S.

AU - Matasar, Matthew J.

AU - Ni, Andy

AU - Yahalom, Joachim

AU - Moskowitz, Craig

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AB - Primary mediastinal (thymic) large B cell lymphoma is a subtype of diffuse large B cell lymphoma with distinct clinical, molecular, and genetic features, many of which overlap with Hodgkin lymphoma. Increasingly, initial therapy for these patients has used dose-dense chemotherapy with or without radiation with excellent results. In patients with relapsed and primary refractory disease, outcomes of second-line therapy followed by consolidation with high-dose therapy and autologous stem cell transplantation remains largely undefined. We reviewed the outcomes of 60 transplant-eligible patients with relapsed or refractory primary mediastinal (thymic) large B cell lymphoma enrolled on sequential protocols with uniform second-line therapy with intent to consolidate with autologous stem cell transplant. The estimated 3-year overall and event-free survivals for all patients were 61% and 57%, respectively, and 68% and 65%, respectively, for patients proceeding to stem cell transplant. Multivariable analysis of risk factors before transplant revealed that an incomplete response to initial therapy, advanced Ann Arbor stage at disease progression, and failure to achieve a partial remission or better to second-line therapy to be independently associated with inferior event-free and overall survival. A risk score based on these variables was able to identify patients who are unlikely to respond to conventional second-line strategies. These results suggest that salvage chemoradiotherapy with intent of subsequent high-dose therapy and autologous stem cell transplant is successful in most patients with relapsed and refractory primary mediastinal (thymic) large B cell lymphoma. Alternative strategies are warranted for a significant subset of patients with high-risk disease who are unlikely to be cured with this strategy.

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