Outcomes of adults and children with primary mediastinal B-cell lymphoma treated with dose-adjusted EPOCH-R

Lisa Giulino-Roth; Tara O'Donohue; Zhengming Chen; Nancy L. Bartlett; Ann LaCasce; William Martin-Doyle; Matthew J. Barth; Kimberly Davies; Kristie A. Blum; Beth Christian; Carla Casulo; Sonali M. Smith; James Godfrey; Amanda Termuhlen; Matthew J. Oberley; Sarah Alexander; Sheila Weitzman; Burton Appel; Benjamin Mizukawa; Jakub Svoboda; Zeinab Afify; Melinda Pauly; Hema Dave; Rebecca Gardner; Deborah M. Stephens; William A. Zeitler; Christopher Forlenza; Jennifer Levine; Michael E. Williams; Jody L. Sima; Catherine M. Bollard; John P. Leonard

doi:10.1111/bjh.14951

Outcomes of adults and children with primary mediastinal B-cell lymphoma treated with dose-adjusted EPOCH-R

Lisa Giulino-Roth
, Tara O'Donohue
, Zhengming Chen
, Nancy L. Bartlett
, Ann LaCasce
, William Martin-Doyle
, Matthew J. Barth
, Kimberly Davies
, Kristie A. Blum
, Beth Christian
, Carla Casulo
, Sonali M. Smith
, James Godfrey
, Amanda Termuhlen
, Matthew J. Oberley
, Sarah Alexander
, Sheila Weitzman
, Burton Appel
, Benjamin Mizukawa
, Jakub Svoboda

Zeinab Afify, Melinda Pauly, Hema Dave, Rebecca Gardner, Deborah M. Stephens, William A. Zeitler, Christopher Forlenza, Jennifer Levine, Michael E. Williams, Jody L. Sima, Catherine M. Bollard, John P. Leonard

University at Buffalo, Upstate Medical University

New York Presbyterian Hospital
Washington University St. Louis
Dana-Farber Cancer Institute
Brigham and Women’s Hospital
Boston Children's Hospital
Ohio State University
University of Rochester
The University of Chicago
University of Southern California
University of Toronto
Joseph M. Sanzari Children's Hospital
Cincinnati Children's Hospital Medical Center
University of Pennsylvania
University of Utah
Emory University
Children's Healthcare of Atlanta
George Washington University
University of Washington
University of Iowa
Memorial Sloan-Kettering Cancer Center
Columbia University
University of Virginia
SUNY Upstate Medical University
Roswell Park Cancer Institute
The University of Chicago
University of Toronto
Hackensack University Medical Center
University of Pennsylvania
University of Washington
University of Iowa
Columbia University

Research output: Contribution to journal › Article › peer-review

129 Scopus citations

Abstract

Treatment with dose-adjusted EPOCH (etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone) chemotherapy and rituximab (DA-EPOCH-R) has become the standard of care for primary mediastinal B-cell lymphoma (PMBCL) at many institutions despite limited data in the multi-centre setting. We report a large, multi-centre retrospective analysis of children and adults with PMBCL treated with DA-EPOCH-R to characterize outcomes and evaluate prognostic factors. We assessed 156 patients with PMBCL treated with DA-EPOCH-R across 24 academic centres, including 38 children and 118 adults. All patients received at least one cycle of DA-EPOCH-R. Radiation therapy was administered in 14·9% of patients. With median follow-up of 22·6 months, the estimated 3-year event-free survival (EFS) was 85·9% [95% confidence interval (CI) 80·3–91·5] and overall survival was 95·4% (95% CI 91·8–99·0). Outcomes were not statistically different between paediatric and adult patients. Thrombotic complications were reported in 28·2% of patients and were more common in paediatric patients (45·9% vs. 22·9%, P = 0·011). Seventy-five per cent of patients had a negative fluorodeoxyglucose positron emission tomography (FDG-PET) scan at the completion of DA-EPOCH-R, defined as Deauville score 1–3. Negative FDG-PET at end-of-therapy was associated with improved EFS (95·4% vs. 54·9%, P < 0·001). Our data support the use of DA-EPOCH-R for the treatment of PMBCL in children and adults. Patients with a positive end-of-therapy FDG-PET scan have an inferior outcome.

Original language	English
Pages (from-to)	739-747
Number of pages	9
Journal	British Journal of Haematology
Volume	179
Issue number	5
DOIs	https://doi.org/10.1111/bjh.14951
State	Published - Dec 2017

Keywords

DA-EPOCH-R
non-Hodgkin lymphoma
paediatric oncology
primary mediastinal B-cell lymphoma

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10.1111/bjh.14951

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Giulino-Roth, L., O'Donohue, T., Chen, Z., Bartlett, N. L., LaCasce, A., Martin-Doyle, W., Barth, M. J., Davies, K., Blum, K. A., Christian, B., Casulo, C., Smith, S. M., Godfrey, J., Termuhlen, A., Oberley, M. J., Alexander, S., Weitzman, S., Appel, B., Mizukawa, B., ... Leonard, J. P. (2017). Outcomes of adults and children with primary mediastinal B-cell lymphoma treated with dose-adjusted EPOCH-R. British Journal of Haematology, 179(5), 739-747. https://doi.org/10.1111/bjh.14951

@article{45a67ce26e614bf89aa4f8c9a1f3f91d,

title = "Outcomes of adults and children with primary mediastinal B-cell lymphoma treated with dose-adjusted EPOCH-R",

abstract = "Treatment with dose-adjusted EPOCH (etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone) chemotherapy and rituximab (DA-EPOCH-R) has become the standard of care for primary mediastinal B-cell lymphoma (PMBCL) at many institutions despite limited data in the multi-centre setting. We report a large, multi-centre retrospective analysis of children and adults with PMBCL treated with DA-EPOCH-R to characterize outcomes and evaluate prognostic factors. We assessed 156 patients with PMBCL treated with DA-EPOCH-R across 24 academic centres, including 38 children and 118 adults. All patients received at least one cycle of DA-EPOCH-R. Radiation therapy was administered in 14·9\% of patients. With median follow-up of 22·6 months, the estimated 3-year event-free survival (EFS) was 85·9\% [95\% confidence interval (CI) 80·3–91·5] and overall survival was 95·4\% (95\% CI 91·8–99·0). Outcomes were not statistically different between paediatric and adult patients. Thrombotic complications were reported in 28·2\% of patients and were more common in paediatric patients (45·9\% vs. 22·9\%, P = 0·011). Seventy-five per cent of patients had a negative fluorodeoxyglucose positron emission tomography (FDG-PET) scan at the completion of DA-EPOCH-R, defined as Deauville score 1–3. Negative FDG-PET at end-of-therapy was associated with improved EFS (95·4\% vs. 54·9\%, P < 0·001). Our data support the use of DA-EPOCH-R for the treatment of PMBCL in children and adults. Patients with a positive end-of-therapy FDG-PET scan have an inferior outcome.",

keywords = "DA-EPOCH-R, non-Hodgkin lymphoma, paediatric oncology, primary mediastinal B-cell lymphoma",

author = "Lisa Giulino-Roth and Tara O'Donohue and Zhengming Chen and Bartlett, \{Nancy L.\} and Ann LaCasce and William Martin-Doyle and Barth, \{Matthew J.\} and Kimberly Davies and Blum, \{Kristie A.\} and Beth Christian and Carla Casulo and Smith, \{Sonali M.\} and James Godfrey and Amanda Termuhlen and Oberley, \{Matthew J.\} and Sarah Alexander and Sheila Weitzman and Burton Appel and Benjamin Mizukawa and Jakub Svoboda and Zeinab Afify and Melinda Pauly and Hema Dave and Rebecca Gardner and Stephens, \{Deborah M.\} and Zeitler, \{William A.\} and Christopher Forlenza and Jennifer Levine and Williams, \{Michael E.\} and Sima, \{Jody L.\} and Bollard, \{Catherine M.\} and Leonard, \{John P.\}",

note = "Publisher Copyright: {\textcopyright} 2017 John Wiley \& Sons Ltd",

year = "2017",

month = dec,

doi = "10.1111/bjh.14951",

language = "English",

volume = "179",

pages = "739--747",

journal = "British Journal of Haematology",

issn = "0007-1048",

publisher = "John Wiley and Sons Inc.",

number = "5",

}

Giulino-Roth, L, O'Donohue, T, Chen, Z, Bartlett, NL, LaCasce, A, Martin-Doyle, W, Barth, MJ, Davies, K, Blum, KA, Christian, B, Casulo, C, Smith, SM, Godfrey, J, Termuhlen, A, Oberley, MJ, Alexander, S, Weitzman, S, Appel, B, Mizukawa, B, Svoboda, J, Afify, Z, Pauly, M, Dave, H, Gardner, R, Stephens, DM, Zeitler, WA, Forlenza, C, Levine, J, Williams, ME, Sima, JL, Bollard, CM & Leonard, JP 2017, 'Outcomes of adults and children with primary mediastinal B-cell lymphoma treated with dose-adjusted EPOCH-R', British Journal of Haematology, vol. 179, no. 5, pp. 739-747. https://doi.org/10.1111/bjh.14951

TY - JOUR

T1 - Outcomes of adults and children with primary mediastinal B-cell lymphoma treated with dose-adjusted EPOCH-R

AU - Giulino-Roth, Lisa

AU - O'Donohue, Tara

AU - Chen, Zhengming

AU - Bartlett, Nancy L.

AU - LaCasce, Ann

AU - Martin-Doyle, William

AU - Barth, Matthew J.

AU - Davies, Kimberly

AU - Blum, Kristie A.

AU - Christian, Beth

AU - Casulo, Carla

AU - Smith, Sonali M.

AU - Godfrey, James

AU - Termuhlen, Amanda

AU - Oberley, Matthew J.

AU - Alexander, Sarah

AU - Weitzman, Sheila

AU - Appel, Burton

AU - Mizukawa, Benjamin

AU - Svoboda, Jakub

AU - Afify, Zeinab

AU - Pauly, Melinda

AU - Dave, Hema

AU - Gardner, Rebecca

AU - Stephens, Deborah M.

AU - Zeitler, William A.

AU - Forlenza, Christopher

AU - Levine, Jennifer

AU - Williams, Michael E.

AU - Sima, Jody L.

AU - Bollard, Catherine M.

AU - Leonard, John P.

PY - 2017/12

Y1 - 2017/12

N2 - Treatment with dose-adjusted EPOCH (etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone) chemotherapy and rituximab (DA-EPOCH-R) has become the standard of care for primary mediastinal B-cell lymphoma (PMBCL) at many institutions despite limited data in the multi-centre setting. We report a large, multi-centre retrospective analysis of children and adults with PMBCL treated with DA-EPOCH-R to characterize outcomes and evaluate prognostic factors. We assessed 156 patients with PMBCL treated with DA-EPOCH-R across 24 academic centres, including 38 children and 118 adults. All patients received at least one cycle of DA-EPOCH-R. Radiation therapy was administered in 14·9% of patients. With median follow-up of 22·6 months, the estimated 3-year event-free survival (EFS) was 85·9% [95% confidence interval (CI) 80·3–91·5] and overall survival was 95·4% (95% CI 91·8–99·0). Outcomes were not statistically different between paediatric and adult patients. Thrombotic complications were reported in 28·2% of patients and were more common in paediatric patients (45·9% vs. 22·9%, P = 0·011). Seventy-five per cent of patients had a negative fluorodeoxyglucose positron emission tomography (FDG-PET) scan at the completion of DA-EPOCH-R, defined as Deauville score 1–3. Negative FDG-PET at end-of-therapy was associated with improved EFS (95·4% vs. 54·9%, P < 0·001). Our data support the use of DA-EPOCH-R for the treatment of PMBCL in children and adults. Patients with a positive end-of-therapy FDG-PET scan have an inferior outcome.

AB - Treatment with dose-adjusted EPOCH (etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone) chemotherapy and rituximab (DA-EPOCH-R) has become the standard of care for primary mediastinal B-cell lymphoma (PMBCL) at many institutions despite limited data in the multi-centre setting. We report a large, multi-centre retrospective analysis of children and adults with PMBCL treated with DA-EPOCH-R to characterize outcomes and evaluate prognostic factors. We assessed 156 patients with PMBCL treated with DA-EPOCH-R across 24 academic centres, including 38 children and 118 adults. All patients received at least one cycle of DA-EPOCH-R. Radiation therapy was administered in 14·9% of patients. With median follow-up of 22·6 months, the estimated 3-year event-free survival (EFS) was 85·9% [95% confidence interval (CI) 80·3–91·5] and overall survival was 95·4% (95% CI 91·8–99·0). Outcomes were not statistically different between paediatric and adult patients. Thrombotic complications were reported in 28·2% of patients and were more common in paediatric patients (45·9% vs. 22·9%, P = 0·011). Seventy-five per cent of patients had a negative fluorodeoxyglucose positron emission tomography (FDG-PET) scan at the completion of DA-EPOCH-R, defined as Deauville score 1–3. Negative FDG-PET at end-of-therapy was associated with improved EFS (95·4% vs. 54·9%, P < 0·001). Our data support the use of DA-EPOCH-R for the treatment of PMBCL in children and adults. Patients with a positive end-of-therapy FDG-PET scan have an inferior outcome.

KW - DA-EPOCH-R

KW - non-Hodgkin lymphoma

KW - paediatric oncology

KW - primary mediastinal B-cell lymphoma

UR - https://www.scopus.com/pages/publications/85032349219

U2 - 10.1111/bjh.14951

DO - 10.1111/bjh.14951

M3 - Article

C2 - 29082519

SN - 0007-1048

VL - 179

SP - 739

EP - 747

JO - British Journal of Haematology

JF - British Journal of Haematology

IS - 5

ER -

Outcomes of adults and children with primary mediastinal B-cell lymphoma treated with dose-adjusted EPOCH-R

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Keywords

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