Outcome of Primary Mediastinal Large B Cell Lymphoma Treated with RCHOP

Figures & data

Table 1 Patients Characteristics and Treatment

Characteristic	Number (%)
Gender
Male	27 (55%)
Female	22 (45%)
Median age (range)	29 (18–56) years
ECOG performance status
0–1	48 (98%)
2 or more	1 (2%)
B symptoms
Yes	29 (59%)
No	20 (41%)
Bulky disease (7 or more centimeters)	45 (92%)
Bulky disease (10 or more centimeters)	31 (63.3%)
Stage
I	6 (12.2%)
II	29 (59.2%)
III	3 (6.1%)
IV	11 (22.4%)
Number of extranodal sites
0	37 (75.5%)
1	3 (6.1%)
2 or more	9 (18.4%)
High LDH	36 (37.5%)
B2 microglobulin (2.5 mg/dl or more)	11 (22.4%)
ESR (50 mL/hour or more)	15 (30.6%)
IPI
0–1	35 (71.4%)
More than 1	14 (18.6%)
Number of RCHOP cycles
6	39 (79.6%)
7 or 8	10 (20.4%)
Radiotherapy consolidation	32 (65.3%)
First line salvage treatment	19 (38.8%)
DHAP	10 (52.6%)
GDP	4 (21%)
ICE	3 (15.8%)
High dose methotrexate	2 (10.5%)
Second line salvage treatment	15 (30.6%)
ICE	10 (66.6%)
GDP	2 (13.3%)
DHAP	1 (6.6%)
R-Gem-Ox	1 (6.6%)
Mini-BEAM	1 (6.6%)
Third line salvage treatment	9 (18.4%)
Pembrolizumab	2 (22.2%)
Mini-BEAM	3 (33.3%)
ICE	1 (11.1%)
GDP	1 (11.1%)
DHAP	1 (11.1%)
Hyper-CVAD	1 (11.1%)

Abbreviations: ESR, Erythrocyte sedimentation rate; LDH, Lactate dehydrogenase; IPI, international prognostic index; DHAP, cisplatin, cytarabine and dexamethasone; GDP, cisplatin, gemcitabine and dexamethasone; ICE, Ifosfamide, carboplatin and etoposide; R-Gem-Ox, rituximab, gemcitabine and oxaliplatin; Mini-BEAM, carmustine, etoposide, cytarabine and melphalan; Hyper-CVAD, cyclophosphamide, vincristine, dexamethasone alternating with cytarabine and methotrexate.

Table 2 Response to Frontline and Salvage Treatments

Response to frontline chemotherapy
Complete response	30 (61.2%)
Partial response	9 (18.4%)
Disease progression	10 (20.4%)
End of treatment response
Complete response	32 (65.3%)
Partial response	8 (16.3%)
Disease progression	9 (18.4%)
Response to first line salvage chemotherapy (n=19)
Complete response	1 (5.2%)
Partial response	1 (5.2%)
Disease progression	17 (89.6%)
Response to second line salvage chemotherapy (n=15)
Partial response	2 (13.3%)
Disease progression or death	13 (86.7%)
Response to third line salvage chemotherapy (n=9)
Complete response	2(22.2%)
Disease progression or death	7 (77.8)
ASCT	5 (10.2%)
Relapse post ASCT
Yes	1 (20%)
No	4 (80%)
Status on last encounter
Alive	35 (71.4%)
Dead	14 (28.6%)

Abbreviation: ASCT: autologous stem cell transplant.

Figure 1 Progression free survival in all patients.

Figure 2 Overall survival in all patients.

Table 3 Univariate Analysis for Progression Free Survival and Overall Survival

Variable	4-year PFS %	P value	4-year OS%	P-value
Gender
Male	51.9%	0.196	65.3%	0.69
Female	69.7%		72.%
Stage I–II	76%	<0.001	84.1%	<0.001
Stage III–IV	21.4%		33.3%
Bulky disease ≥7cm	59.8%	0.13	65.8%	0.197
No bulky disease	100%		100%
Bulky disease ≥10 cm	53.1%	0.193	64.4%	0.533
No bulky disease	70.5%		77%
B-symptoms	53.3%	0.294	62.5%	0.257
No B symptoms	68.9%		78.2%
<2 extranodal sites	71.4%	<0.001	80.7%	<0.001
			20.2%
2 or more extranodal sites	11.1%
ESR <50	66.3%	0.267	70.6%	0.335
ESR ≥50	64.7%		58.3%
B-2 microglobulin <2.5	75%	0.034	78.1%	0.021
B2 microglobulin ≥2.5	45.5%		43.6%
Normal LDH	83.3%	0.273	83.3%	0.489
High LDH	55.6%		65.7%
IPI: 0–1	76%	<0.001	84.1%	<0.001
IPI >1	21.4%		33.3%
Response to chemotherapy
Complete response	93.1%	<0.001	92%	<0.001
Partial response	22.2%		55.6%
Disease progression	0%		15%
End of treatment response
Complete response	93.1%	<0.001	92.6%	<0.001
No complete response	0%		26.9%

Abbreviations: ESR, Erythrocyte sedimentation rate; LDH, Lactate dehydrogenase; IPI, international prognostic index.

Table 4 Multivariate Analysis

Progression Free Survival
Variable	P value	HR	95% CI
			Lower	Upper
B2 microglobulin	0.307	1.861	0.565	6.133
IPI	0.005	6.294	1.765	22.447
Overall survival
B2 microglobulin	0.189	2.314	0.662	8.084
IPI	0.019	4.755	1.295	17.459

Abbreviation: IPI, international prognostic index.

Figure 3 Progression free survival according to international prognostic index (IPI).

Figure 4 Overall survival according to international prognostic index (IPI).

Table 5 Correlation Between Different Pre-Treatment Variables and End-of Treatment Response

Variable	CR (%)	No CR (%)	P-value
Gender
Male	50%	64.7%	0.378
Female	50%	35.3%
Stage I–II	84.4%	47.1%	0.009
Stage III–IV	15.6%	52.9%
Bulky disease ≥10 cm	59.4%	70.6%	0.541
No bulky disease	40.6%	29.4%
B-symptoms	56.3%	42.9%	0.761
No B symptoms	43.7%	35.3%
<2 extranodal sites	93.7%	58.8%	0.005
2 or more extranodal sites	6.3%	41.2%
ESR <50	68.2%	42.9%	0.175
ESR ≥50	31.8%	47.1%
B-2 microglobulin <2.5	78.7%	50%	0.13
B2 microglobulin ≥2.5	21.3%	50%
Normal LDH	18.5%	6.7%	0.395
High LDH	81.5%	93.3%
IPI: 0–1	84.4%	47.9%	0.009
IPI >1	15.6%	52.1%

Abbreviations: ESR, Erythrocyte sedimentation rate; LDH, Lactate dehydrogenase; IPI, international prognostic index.

Figure 5 Overall survival according to end of treatment response.

Abbreviation: CR, complete response.