Primary mediastinal B-cell lymphoma: upfront high-dose chemotherapy with autologous stem cell transplantation results in favorable long-term outcome and may spare radiotherapy

The optimal therapeutic approach for primary mediastinal B-cell lymphoma remains unknown and varies in clinical practice. Dose-adjusted EPOCH-R or R-CHOP-based immuno-chemotherapy with mediastinal radiotherapy are acceptable treatment options. We report a retrospective analysis of PMBL patients treated with high-dose chemotherapy (HDCT) and autologous stem cell transplantation (ASCT) consolidation or dose-dense immuno-chemotherapy alone. A comparison of the two consolidation strategies showed no significant difference in 5-year PFS (95.5% vs. 82.4%, HR 0.22 95% CI 0.03-1.69, p = 0.13) or OS (100% vs. 87.1%, HR 0.1 95% CI 0.006-1.69, p = 0.11), with a trend toward better survival in the preplanned HDCT/ASCT group. Notably, 35.3% of patients received additional HDCT/ASCT after an inadequate response to dose-dense immuno-chemotherapy. When comparing all patients, with or without first-line HDCT/ASCT consolidation, regardless of the initial consolidation strategy, we found a significant difference in 5-year PFS (96.2% vs. 75%, HR 0.09 95% CI 0.01-0.83, p = 0.03) and OS (100% vs. 80.1%, HR 0.03 95% CI 0.002-0.7, p = 0.03) for patients treated with HDCT/ASCT. In addition, mediastinal radiotherapy was administered significantly less frequently in patients treated with HDCT/ASCT. In conclusion, high-dose chemotherapy and autologous stem cell transplantation may be a valid strategy to induce a favorable long-term outcome and spare radiotherapy in patients with PMBL.