Intermediate Results of Treatment of Primary Mediastinal Large В-Cell Lymphoma with Da-Epoch-R Regimen

Abstract

ABSTRACT Aim: To estimate efficacy and toxicity of R-DA-EPOCH regimen in patients with primary mediastinal (thymic) large B-cell lymphoma (PMBL). Methods: The studied group included 22 patients with newly diagnosed PMBL. Median age was 34 years, 16 were females (72,8%) and 6 were mails (27,2%). Primary and post treatment assessment of disease included PET/CT or CT of neck, chest, abdomen and pelvic. In 61,5% of patient was early stage (І-ІІ) of disease, 93,3% of patients had greatest size of the tumor mass in mediastinum more than 10 cm. The tumor pleurisy, pericarditis and lungs lesions were revealed in 46,5%, 52% and 30,7%, respectively. All patients received 6 cycles of R-DA-EPOCH regimen. Patients who achieved complete metabolic response received mediastinal radiation therapy (30 Gy) or were under observation. Results: Response assessment performed after the completion of 6th cycles of chemotherapy. 19 patients have already completed treatment plan. 2 patients were exclude from study due to diseases progression (one of them had CNS lesion after 3rd cycle of chemotherapy, second patient had rapid increase of mediastinal mass after 6 cycle). Overall response rate was 89,4%. Complete response was achieved in 14 patients (73,6%). PET/CT was performed in 16 patients. Complete morphologic regression but with residual metabolic activity of residual mass was revealed in 5 patients (31,3%). Treatment was associated with moderate hematological toxicity: anemia grade 4 observed in one case (5,2%), febrile neutropenia requiring hospitalization in 2 patients (10,5%), and one of them had infection associated with venous port. Thrombocytopenia grade 3-4 was not observed. All detected cases of non-hematological toxicity were grade 1 or 2. Diarrhea, nausea, stomatitis, neuropathy were observed in 5,2%, 10,5%, 36,8% and in 31,6% of cases, respectively. Conclusions: Our results indicate that R-DA-EPOCH has a high cure rate in patients with PMBL, which allows to achieve good response in 89,4% cases. Such treatment associated with moderate hematological and non-hematological toxicity. Further continuation of study is needed to estimate and analyze long-term results of therapy. Disclosure: All authors have declared no conflicts of interest.