Top Line: Is it safe to omit consolidative radiation in patients with primary mediastinal b-cell lymphoma who have a complete response to induction chemotherapy?
The Study: Primary mediastinal B-cell lymphoma is a less common, but aggressive B-cell lymphoma that can often affect younger women. While radiation plays a role in the management of PMBCL due to its aggressive nature, mediastinal radiation, especially in younger women, may have negative long-term effects. In the IELSG37 trial, 530 patients (62% women, median age 35) received induction immunochemotherapy with an anthracycline and rituximab-based regimen. On PET/CT after induction therapy, 50.6% had a complete metabolic response. Those patients were randomized to observation or 30 Gy consolidative radiation. Patients who didn’t have a complete metabolic response received radiation. Among complete responders, the rate of PFS at 30 months was 98.5% with RT and 96.2% with observation. Overall survival was 99% in both arms of complete responders at 5 years.
TBL: In IELSG37, half of patients with PMBCL had a complete response to induction chemoimmunotherapy and those patients had excellent early survival outcomes with the omission of consolidative mediastinal radiation. | Zucca, ASCO 2023
The Study: Primary mediastinal B-cell lymphoma is a less common, but aggressive B-cell lymphoma that can often affect younger women. While radiation plays a role in the management of PMBCL due to its aggressive nature, mediastinal radiation, especially in younger women, may have negative long-term effects. In the IELSG37 trial, 530 patients (62% women, median age 35) received induction immunochemotherapy with an anthracycline and rituximab-based regimen. On PET/CT after induction therapy, 50.6% had a complete metabolic response. Those patients were randomized to observation or 30 Gy consolidative radiation. Patients who didn’t have a complete metabolic response received radiation. Among complete responders, the rate of PFS at 30 months was 98.5% with RT and 96.2% with observation. Overall survival was 99% in both arms of complete responders at 5 years.
TBL: In IELSG37, half of patients with PMBCL had a complete response to induction chemoimmunotherapy and those patients had excellent early survival outcomes with the omission of consolidative mediastinal radiation. | Zucca, ASCO 2023