29 Scopus citations

Abstract

The management of primary mediastinal large B-cell lymphoma (PMBCL) requires a balance between optimizing chances of cure and reducing risk of long-term toxicities. The combination of rituximab to cyclophosphamide, doxorubicin, vincristine and prednisone (RCHOP) followed by mediastinal radiation results in a plateau in progression-free survival after first few years of follow-up. In rituximab era, a negative positron emission tomography (PET) scan performed after the completion of immunochemotherapy has a high predictive value for durable remission. Consequently, end-of-therapy PET may be utilizable to avoid radiation without compromising survival. Additionally, intensified chemotherapy alone has shown excellent survival. PMBCL is frequently associated with amplification of programmed death ligand (PDL) 1/2 and constitutive activation of JAK-STAT and NFKB pathways; these may serve as promising therapeutic targets. Clinical trials that integrate novel therapies into upfront immunochemotherapy and utilize end-of-therapy PET scan to guide mediastinal radiation have potential to further enhance survival and prevent long-term toxicities.

Original languageEnglish (US)
Pages (from-to)476-485
Number of pages10
JournalCancer Treatment Reviews
Volume41
Issue number6
DOIs
StatePublished - Jun 1 2015

Keywords

  • Chemotherapy
  • Mediastinal radiation
  • Positron emission tomography
  • Primary mediastinal large B-cell lymphoma
  • Rituximab

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

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