Prognostic significance of pleural or pericardial effusion and the implication of optimal treatment in primary mediastinal large B-cell lymphoma: A multicenter retrospective study in Japan

Tomohiro Aoki, Koji Izutsu, Ritsuro Suzuki, Chiaki Nakaseko, Hiroshi Arima, Kazuyuki Shimada, Akihiro Tomita, Makoto Sasaki, Jun Takizawa, Kinuko Mitani, Tadahiko Igarashi, Yoshinobu Maeda, Noriko Fukuhara, Fumihiro Ishida, Nozomi Niitsu, Ken Ohmachi, Hirotaka Takasaki, Naoya Nakamura, Tomohiro Kinoshita, Shigeo NakamuraMichinori Ogura

Research output: Contribution to journalArticle

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Abstract

The prognosis of patients with primary mediastinal large B-cell lymphoma has improved over recent years. However, the optimal treatment strategy including the role of radiotherapy remains unknown. We retrospectively analyzed the clinical outcomes of 345 patients with newly diagnosed primary mediastinal large B-cell lymphoma in Japan. With a median follow up of 48 months, the overall survival at four years for patients treated with RCHOP (n=187), CHOP (n=44), DA-EPOCH-R (n=9), 2nd- or 3rd-generation regimens, and chemotherapy followed by autologous stem cell transplantation were 90%, 67%, 100%, 91% and 92%, respectively. Focusing on patients treated with R-CHOP, a higher International Prognostic Index score and the presence of pleural or pericardial effusion were identified as adverse prognostic factors for overall survival in patients treated with R-CHOP without consolidative radiotherapy (IPI: hazard ratio 4.23, 95% confidence interval 1.48-12.13, P=0.007; effusion: hazard ratio 4.93, 95% confidence interval 1.37-17.69, P=0.015). Combined with the International Prognostic Index score and the presence of pleural or pericardial effusion for the stratification of patients treated with R-CHOP without radiotherapy, patients with lower International Prognostic Index score and the absence of effusion comprised approximately one-half of these patients and could be identified as curable patients (95% overall survival at 4 years). The DA-EPOCH-R regimen might overcome the effect of these adverse prognostic factors. Our simple indicators of International Prognostic Index score and the presence of pleural or pericardial effusion could stratify patients with primary mediastinal large B-cell lymphoma and help guide selection of treatment.

Original languageEnglish
Pages (from-to)1817-1825
Number of pages9
JournalHaematologica
Volume99
Issue number12
DOIs
Publication statusPublished - 01-12-2014
Externally publishedYes

Fingerprint

Pericardial Effusion
B-Cell Lymphoma
Pleural Effusion
Multicenter Studies
Japan
Retrospective Studies
Therapeutics
Radiotherapy
Survival
Confidence Intervals
Stem Cell Transplantation
Drug Therapy

All Science Journal Classification (ASJC) codes

  • Hematology

Cite this

Aoki, Tomohiro ; Izutsu, Koji ; Suzuki, Ritsuro ; Nakaseko, Chiaki ; Arima, Hiroshi ; Shimada, Kazuyuki ; Tomita, Akihiro ; Sasaki, Makoto ; Takizawa, Jun ; Mitani, Kinuko ; Igarashi, Tadahiko ; Maeda, Yoshinobu ; Fukuhara, Noriko ; Ishida, Fumihiro ; Niitsu, Nozomi ; Ohmachi, Ken ; Takasaki, Hirotaka ; Nakamura, Naoya ; Kinoshita, Tomohiro ; Nakamura, Shigeo ; Ogura, Michinori. / Prognostic significance of pleural or pericardial effusion and the implication of optimal treatment in primary mediastinal large B-cell lymphoma : A multicenter retrospective study in Japan. In: Haematologica. 2014 ; Vol. 99, No. 12. pp. 1817-1825.
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abstract = "The prognosis of patients with primary mediastinal large B-cell lymphoma has improved over recent years. However, the optimal treatment strategy including the role of radiotherapy remains unknown. We retrospectively analyzed the clinical outcomes of 345 patients with newly diagnosed primary mediastinal large B-cell lymphoma in Japan. With a median follow up of 48 months, the overall survival at four years for patients treated with RCHOP (n=187), CHOP (n=44), DA-EPOCH-R (n=9), 2nd- or 3rd-generation regimens, and chemotherapy followed by autologous stem cell transplantation were 90{\%}, 67{\%}, 100{\%}, 91{\%} and 92{\%}, respectively. Focusing on patients treated with R-CHOP, a higher International Prognostic Index score and the presence of pleural or pericardial effusion were identified as adverse prognostic factors for overall survival in patients treated with R-CHOP without consolidative radiotherapy (IPI: hazard ratio 4.23, 95{\%} confidence interval 1.48-12.13, P=0.007; effusion: hazard ratio 4.93, 95{\%} confidence interval 1.37-17.69, P=0.015). Combined with the International Prognostic Index score and the presence of pleural or pericardial effusion for the stratification of patients treated with R-CHOP without radiotherapy, patients with lower International Prognostic Index score and the absence of effusion comprised approximately one-half of these patients and could be identified as curable patients (95{\%} overall survival at 4 years). The DA-EPOCH-R regimen might overcome the effect of these adverse prognostic factors. Our simple indicators of International Prognostic Index score and the presence of pleural or pericardial effusion could stratify patients with primary mediastinal large B-cell lymphoma and help guide selection of treatment.",
author = "Tomohiro Aoki and Koji Izutsu and Ritsuro Suzuki and Chiaki Nakaseko and Hiroshi Arima and Kazuyuki Shimada and Akihiro Tomita and Makoto Sasaki and Jun Takizawa and Kinuko Mitani and Tadahiko Igarashi and Yoshinobu Maeda and Noriko Fukuhara and Fumihiro Ishida and Nozomi Niitsu and Ken Ohmachi and Hirotaka Takasaki and Naoya Nakamura and Tomohiro Kinoshita and Shigeo Nakamura and Michinori Ogura",
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Aoki, T, Izutsu, K, Suzuki, R, Nakaseko, C, Arima, H, Shimada, K, Tomita, A, Sasaki, M, Takizawa, J, Mitani, K, Igarashi, T, Maeda, Y, Fukuhara, N, Ishida, F, Niitsu, N, Ohmachi, K, Takasaki, H, Nakamura, N, Kinoshita, T, Nakamura, S & Ogura, M 2014, 'Prognostic significance of pleural or pericardial effusion and the implication of optimal treatment in primary mediastinal large B-cell lymphoma: A multicenter retrospective study in Japan', Haematologica, vol. 99, no. 12, pp. 1817-1825. https://doi.org/10.3324/haematol.2014.111203

Prognostic significance of pleural or pericardial effusion and the implication of optimal treatment in primary mediastinal large B-cell lymphoma : A multicenter retrospective study in Japan. / Aoki, Tomohiro; Izutsu, Koji; Suzuki, Ritsuro; Nakaseko, Chiaki; Arima, Hiroshi; Shimada, Kazuyuki; Tomita, Akihiro; Sasaki, Makoto; Takizawa, Jun; Mitani, Kinuko; Igarashi, Tadahiko; Maeda, Yoshinobu; Fukuhara, Noriko; Ishida, Fumihiro; Niitsu, Nozomi; Ohmachi, Ken; Takasaki, Hirotaka; Nakamura, Naoya; Kinoshita, Tomohiro; Nakamura, Shigeo; Ogura, Michinori.

In: Haematologica, Vol. 99, No. 12, 01.12.2014, p. 1817-1825.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Prognostic significance of pleural or pericardial effusion and the implication of optimal treatment in primary mediastinal large B-cell lymphoma

T2 - A multicenter retrospective study in Japan

AU - Aoki, Tomohiro

AU - Izutsu, Koji

AU - Suzuki, Ritsuro

AU - Nakaseko, Chiaki

AU - Arima, Hiroshi

AU - Shimada, Kazuyuki

AU - Tomita, Akihiro

AU - Sasaki, Makoto

AU - Takizawa, Jun

AU - Mitani, Kinuko

AU - Igarashi, Tadahiko

AU - Maeda, Yoshinobu

AU - Fukuhara, Noriko

AU - Ishida, Fumihiro

AU - Niitsu, Nozomi

AU - Ohmachi, Ken

AU - Takasaki, Hirotaka

AU - Nakamura, Naoya

AU - Kinoshita, Tomohiro

AU - Nakamura, Shigeo

AU - Ogura, Michinori

PY - 2014/12/1

Y1 - 2014/12/1

N2 - The prognosis of patients with primary mediastinal large B-cell lymphoma has improved over recent years. However, the optimal treatment strategy including the role of radiotherapy remains unknown. We retrospectively analyzed the clinical outcomes of 345 patients with newly diagnosed primary mediastinal large B-cell lymphoma in Japan. With a median follow up of 48 months, the overall survival at four years for patients treated with RCHOP (n=187), CHOP (n=44), DA-EPOCH-R (n=9), 2nd- or 3rd-generation regimens, and chemotherapy followed by autologous stem cell transplantation were 90%, 67%, 100%, 91% and 92%, respectively. Focusing on patients treated with R-CHOP, a higher International Prognostic Index score and the presence of pleural or pericardial effusion were identified as adverse prognostic factors for overall survival in patients treated with R-CHOP without consolidative radiotherapy (IPI: hazard ratio 4.23, 95% confidence interval 1.48-12.13, P=0.007; effusion: hazard ratio 4.93, 95% confidence interval 1.37-17.69, P=0.015). Combined with the International Prognostic Index score and the presence of pleural or pericardial effusion for the stratification of patients treated with R-CHOP without radiotherapy, patients with lower International Prognostic Index score and the absence of effusion comprised approximately one-half of these patients and could be identified as curable patients (95% overall survival at 4 years). The DA-EPOCH-R regimen might overcome the effect of these adverse prognostic factors. Our simple indicators of International Prognostic Index score and the presence of pleural or pericardial effusion could stratify patients with primary mediastinal large B-cell lymphoma and help guide selection of treatment.

AB - The prognosis of patients with primary mediastinal large B-cell lymphoma has improved over recent years. However, the optimal treatment strategy including the role of radiotherapy remains unknown. We retrospectively analyzed the clinical outcomes of 345 patients with newly diagnosed primary mediastinal large B-cell lymphoma in Japan. With a median follow up of 48 months, the overall survival at four years for patients treated with RCHOP (n=187), CHOP (n=44), DA-EPOCH-R (n=9), 2nd- or 3rd-generation regimens, and chemotherapy followed by autologous stem cell transplantation were 90%, 67%, 100%, 91% and 92%, respectively. Focusing on patients treated with R-CHOP, a higher International Prognostic Index score and the presence of pleural or pericardial effusion were identified as adverse prognostic factors for overall survival in patients treated with R-CHOP without consolidative radiotherapy (IPI: hazard ratio 4.23, 95% confidence interval 1.48-12.13, P=0.007; effusion: hazard ratio 4.93, 95% confidence interval 1.37-17.69, P=0.015). Combined with the International Prognostic Index score and the presence of pleural or pericardial effusion for the stratification of patients treated with R-CHOP without radiotherapy, patients with lower International Prognostic Index score and the absence of effusion comprised approximately one-half of these patients and could be identified as curable patients (95% overall survival at 4 years). The DA-EPOCH-R regimen might overcome the effect of these adverse prognostic factors. Our simple indicators of International Prognostic Index score and the presence of pleural or pericardial effusion could stratify patients with primary mediastinal large B-cell lymphoma and help guide selection of treatment.

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