Treatment and clinical management of primary mediastinal large B-cell lymphoma with sclerosis: MACOP-B regimen and mediastinal radiotherapy monitored by 67Gallium scan in 50 patients

Pier Luigi Zinzani, Maurizio Martelli, Massimo Magagnoli, Edoardo Pescarmona, Laura Scaramucci, Francesca Palombi, Maurizio Bendandi, Maria Paola Martelli, Stefano Ascani, Giulio Fraternali Orcioni, Stefano A. Pileri, Franco Mandelli, Sante Tura

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Abstract

To evaluate the efficacy of a combined modality treatment (MACOP-B plus mediastinal radiotherapy) and the advantages of Gallium-67-citrate single- photon emission (67Ga-SPECT) over computed tomography (CT) for restaging in patients with primary mediastinal large B-cell lymphoma (PMLBCL) with sclerosis. Between 1989 and 1998, 50 previously untreated patients with PMLBCL with sclerosis (70% with bulky mass) were treated with MACOP-B regimen plus mediastinal radiotherapy. The radiologic clinical stage with evaluation of tumor size included CT and 67GaSPECT at diagnosis, after chemotherapy, and after radiotherapy. Forty-three patients (86%) achieved a complete response and 7 were nonresponders to treatment. For the imaging evaluation, only 47 patients were evaluable because 3 had disease progression during chemotherapy. After treatment, 3/5 (60%) patients with positive 67GaSPECT and negative CT scan relapsed, as against 0/21 (0%) with negative 67GaSPECT and CT scan. Twenty-one patients had a positive CT scan: of these, the 4 with positive 67GaSPECT all progressed, whereas there were no relapses among the 17 with negative 67GaSPECT. After radiotherapy, there was a decrease of positive CT (from 33 to 21 cases) and of positive 67GaSPECT (from 31 to 9 cases). Relapse-free survival rate was 93% at 96 months (median 39 months). In patients with PMLBCL with sclerosis, MACOP-B plus radiation therapy is a very useful first-line treatment and radiation therapy may play an important role. As regards restaging, 67GaSPECT should be considered the imaging technique of choice at least in patients who show CT positivity.

Original languageEnglish
Pages (from-to)3289-3293
Number of pages5
JournalBlood
Volume94
Issue number10
Publication statusPublished - Nov 15 1999

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ASJC Scopus subject areas

  • Hematology

Cite this

Zinzani, P. L., Martelli, M., Magagnoli, M., Pescarmona, E., Scaramucci, L., Palombi, F., Bendandi, M., Martelli, M. P., Ascani, S., Orcioni, G. F., Pileri, S. A., Mandelli, F., & Tura, S. (1999). Treatment and clinical management of primary mediastinal large B-cell lymphoma with sclerosis: MACOP-B regimen and mediastinal radiotherapy monitored by 67Gallium scan in 50 patients. Blood, 94(10), 3289-3293.