Impact of immunochemotherapy regimens on outcomes of patients with primary mediastinal B-cell lymphoma in the IELSG37 trial

The IELSG37 trial enrolled 545 patients with primary mediastinal B-cell lymphoma (PMBCL) and demonstrated that consolidation radiotherapy (RT) can be omitted in patients with complete metabolic response, defined by the Lugano classification as Deauville score (DS) 1 to 3. This report evaluates outcomes after different frontline rituximab- and doxorubicin-based immunochemotherapy regimens chosen according to local practice. Patients treated with R-CHOP21 (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone, administered every 21 days) showed a significantly higher percentage of DS 5 than those on other regimens (23.8% vs 8.2% average; P < .001) and a trend toward additional unplanned treatments (53.2% vs 46.9%; P = .30). The increased risk of poor response was confirmed in a multinomial logistic regression analysis adjusted for age, sex, international prognostic index score, and performance status. R-CHOP21 was also associated with smaller reductions in metabolic tumor volume and less pronounced decreases in maximum standardized uptake value. Patients with DS 5 more often received additional treatment (RT and/or salvage chemotherapy with or without autologous consolidation) after induction immunochemotherapy (96% vs 41%; P < .001) and experienced significantly poorer outcomes. Although differences in progression-free and overall survival between R-CHOP21 and more aggressive regimens were not statistically significant, R-CHOP21 may increase the risk of additional treatments and may be inadvisable as frontline therapy for PMBCL. This trial was registered at www.clinicaltrials.gov as #NCT01599559.

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Journal
Blood
Published
2025-09-12
DOI
https://doi.org/10.1182/blood.2025028823
Citations
2
Primary Topic
Lymphoma Diagnosis and Treatment
Type
article
Field-Weighted Citation Impact
2.94
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article

Impact of immunochemotherapy regimens on outcomes of patients with primary mediastinal B-cell lymphoma in the IELSG37 trial

C Ionescu, Kelly Cozens, Elsa Pennese, Peter Johnson et al.
2 citations
Blood
Lymphoma Diagnosis and Treatment
2.94
article

Impact of immunochemotherapy regimens on outcomes of patients with primary mediastinal B-cell lymphoma in the IELSG37 trial

C Ionescu, Kelly Cozens, Elsa Pennese, Peter Johnson, David Hodgson, Nicoletta Ielmini, Luca Arcaini, Kate Cwynarski, Elisa Lucchini, Luca Ceriani, Iryna Kriachok, Monica Balzarotti, Maria Cristina Pirosa, Iolanda De Martino, Maurizio Martelli, Mats Jerkeman, Andrea Janíková, Claudia Cellini, Vittorio Ruggero Zilioli, Giovannino Ciccone, Anastasios Stathis, Franco Cavalli, Carla Minoia, N. George Mikhaeel, Sara Veronica Usai, Alexander Fosså, Jan Walewski, Umberto Ricardi, Alice Di Rocco, Francesco Merli, Andrew John Davies, Weili Zhao, Barbara Botto, Anna Dąbrowska‐Iwanicka, Alessandra Tucci, Michele Spina, Andrés J.M. Ferreri, Marek Trněný, Luigi Rigacci, Emanuele Zucca
article en
2 citations

Abstract

The IELSG37 trial enrolled 545 patients with primary mediastinal B-cell lymphoma (PMBCL) and demonstrated that consolidation radiotherapy (RT) can be omitted in patients with complete metabolic response, defined by the Lugano classification as Deauville score (DS) 1 to 3. This report evaluates outcomes after different frontline rituximab- and doxorubicin-based immunochemotherapy regimens chosen according to local practice. Patients treated with R-CHOP21 (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone, administered every 21 days) showed a significantly higher percentage of DS 5 than those on other regimens (23.8% vs 8.2% average; P < .001) and a trend toward additional unplanned treatments (53.2% vs 46.9%; P = .30). The increased risk of poor response was confirmed in a multinomial logistic regression analysis adjusted for age, sex, international prognostic index score, and performance status. R-CHOP21 was also associated with smaller reductions in metabolic tumor volume and less pronounced decreases in maximum standardized uptake value. Patients with DS 5 more often received additional treatment (RT and/or salvage chemotherapy with or without autologous consolidation) after induction immunochemotherapy (96% vs 41%; P < .001) and experienced significantly poorer outcomes. Although differences in progression-free and overall survival between R-CHOP21 and more aggressive regimens were not statistically significant, R-CHOP21 may increase the risk of additional treatments and may be inadvisable as frontline therapy for PMBCL. This trial was registered at www.clinicaltrials.gov as #NCT01599559.

BloodVol. 146(23)
University of Bern (CH), Oslo University Hospital (NO), Humanitas University (IT), University College London Hospitals NHS Foundation Trust (GB), Vita-Salute San Raffaele University (IT), University of Oslo (NO), Lund University (SE), Guy's and St Thomas' NHS Foundation Trust (GB), Charles University (CZ), University of Pavia (IT), University Hospital of Bern (CH), Ruijin Hospital (CN), Princess Margaret Cancer Centre (CA), San Raffaele University of Rome (IT), Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT), Azienda Sanitaria Unità Locale di Reggio Emilia (IT), Ospedale "Santa Maria delle Croci" di Ravenna (IT), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT), Ente Ospedaliero Cantonale (CH), Institute of Oncology Research (CH), University Hospital Brno (CZ), Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (IT), Azienda Ospedaliero-Universitaria Careggi (IT), National Institute of Oncology (HU), Presidio Ospedaliero (IT), National Cancer Institute (UA), Ospedale Santa Maria della Misericordia di Udine (IT), Ospedale di Circolo di Busto Arsizio (IT), Azienda Socio Sanitaria Territoriale Lariana (IT), Fondazione Intergruppo Italiano Linfomi Onlus (IT), Torino e-district (IT), Department of Medical Sciences (BY), Centro di Riferimento Oncologico (IT), Istituto Tumori Bari (IT), IRCCS Ospedale San Raffaele (IT), National Cancer Institute (MY), Cancer Research UK Clinical Trials Unit (GB), Skåne University Hospital (SE), Campus Bio Medico University Hospital (IT), Azienda USL di Pescara (IT), Shanghai Institute of Hematology (CN), The Maria Sklodowska-Curie National Research Institute of Oncology (PL), Piedmont Reference Center for Epidemiology and Cancer Prevention (IT), Policlinico San Matteo Fondazione (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Gruppo Italiano per il Trapianto di Midollo Osseo (IT), General University Hospital in Prague (CZ), IRCCS Humanitas Research Hospital (IT), Azienda Ospedaliera G. Brotzu (IT), University of Southampton (GB), Istituto Imaging della Svizzera Italiana, University College London (GB), University of Turin (IT), Università della Svizzera italiana (CH), Sapienza University of Rome (IT)
Openalex Percentile: Top 8%
Lymphoma Diagnosis and Treatment
2.94
DOISourceOpenAlex
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