Primary mediastinal large B-cell lymphoma: a single-center experience in Korea

Heui June Ahn; Dok-Hyun Yoon; Shin Kim; Kyoungmin Lee; EunHee Kang; Jooryung Huh; Chan-Sik Park; Cheolwon Suh

doi:10.5045/br.2014.49.1.36

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Original Article

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Blood Res 2014; 49(1):

Published online March 31, 2014

https://doi.org/10.5045/br.2014.49.1.36

Primary mediastinal large B-cell lymphoma: a single-center experience in Korea

Heui June Ahn^1,3,#, Dok-Hyun Yoon^1,#, Shin Kim¹, Kyoungmin Lee¹, EunHee Kang¹, Jooryung Huh², Chan-Sik Park², and Cheolwon Suh^1*

Author Info. +

¹Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

²Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

³Department of Internal Medicine, Gangneung Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Correspondence to : Correspondence to Cheolwon Suh, M.D., Ph.D. Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea. Tel: +82-2-3010-3209, Fax: +82-2-3010-6961, csuh@amc.seoul.kr

Received: December 23, 2013; Revised: January 18, 2014; Accepted: March 4, 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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Abstract

Background

Primary mediastinal large B-cell lymphoma (PMBL) is a distinct subtype of non-Hodgkin lymphoma, which has no consensus for its ideal treatment or prognosis.

Methods

We reviewed the clinicopathologic features and clinical outcomes of 25 PMBL cases diagnosed at a single institution between 1993 and 2009 and compared them with 588 cases of non-mediastinal, diffuse large B-cell lymphoma (DLBCL, control group) diagnosed during the same period.

Results

Thirteen (52.0%) PMBL patients had Ann Arbor stage III or IV disease, and 10 (40.0%) had B symptoms. Thirteen (52%) PMBL patients were classified as high-intermediate/high-risk according to the International Prognostic Index. There was a significant prevalence of young (median: 31 years; range, 15-78 years; P<0.001), female (68%; P=0.014) patients in the PMBL group compared to the control group (median: 56 years; range, 15-85 years; 43.2% female). Bulky disease and elevated levels of lactate dehydrogenase (LDH) were more frequent in the PMBL group (P<0.001 and P=0.003, respectively). Nineteen (76%) PBML patients achieved complete remission, and 18 were alive at the last follow-up (median: 43 months; range, 1-92 months). There was no difference in the 3-year, overall survival rate (72%, 95% confidence interval [CI]: 54.0-83.0 versus 70.1%, 95% CI, 109.0-126.0; P=0.686) between PMBL and control patients, respectively.

Conclusion

Compared to patients with non-mediastinal DLBCL, Korean patients with PMBL are predominantly young women with bulky disease and high LDH levels but with no significant difference in survival.

Keywords Lymphoma, B cell, PMBL, Prognosis, Treatment

Article

Original Article

Blood Res 2014; 49(1): 36-41

Published online March 31, 2014 https://doi.org/10.5045/br.2014.49.1.36

Primary mediastinal large B-cell lymphoma: a single-center experience in Korea

Heui June Ahn^1,3,#, Dok-Hyun Yoon^1,#, Shin Kim¹, Kyoungmin Lee¹, EunHee Kang¹, Jooryung Huh², Chan-Sik Park², and Cheolwon Suh^1*

¹Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

²Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

³Department of Internal Medicine, Gangneung Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Correspondence to: Correspondence to Cheolwon Suh, M.D., Ph.D. Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea. Tel: +82-2-3010-3209, Fax: +82-2-3010-6961, csuh@amc.seoul.kr

Received: December 23, 2013; Revised: January 18, 2014; Accepted: March 4, 2014

Abstract

Background

Primary mediastinal large B-cell lymphoma (PMBL) is a distinct subtype of non-Hodgkin lymphoma, which has no consensus for its ideal treatment or prognosis.

Methods

Results

Conclusion

Compared to patients with non-mediastinal DLBCL, Korean patients with PMBL are predominantly young women with bulky disease and high LDH levels but with no significant difference in survival.

Keywords: Lymphoma, B cell, PMBL, Prognosis, Treatment

Abstract

Fig 1.

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Figure 1.

Kaplan-Meier curves showing progression-free survival (A) and overall survival (B) of patients with PMBL and non-mediastinal DLBCL, respectively. DLBCL, diffuse large B-cell lymphoma; PMBL, primary mediastinal large B-cell lymphoma.

Blood Research 2014; 49: 36-41https://doi.org/10.5045/br.2014.49.1.36

Table 1 . Clinical characteristics and initial treatment regimens of 588 patients with DLBCL and 25 patients with PMBL..

Abbreviations: DLBCL, diffuse large B-cell lymphoma; PMBL, primary mediastinal large B-cell lymphoma; PS, performance status; LDH, lactate dehydrogenase; IPI, International Prognostic Index; CHOP, cyclophosphamide, doxorubicin, vincristine, and prednisolone; R-CHOP, CHOP plus rituximab..

Table 2 . Clinical courses of the 25 PMBL patients..

^a)One patient received consolidation RT followed by ASCT..

Abbreviations: PMBL, primary mediastinal large B-cell lymphoma; CR, complete response; RT, radiotherapy; ASCT, autologous stem cell transplantation; CHOP, cyclophosphamide, doxorubicin, vincristine, and prednisolone; R-CHOP, CHOP plus rituximab; Vanderbilt, cyclophosphamide, etoposide, vincristine, bleomycin, methotrexate, doxorubicin, and prednisolone; ESHAP, etoposide, methylprednisolone, cytarabine, and cisplatin..

Table 3 . Univariate analysis for progression-free survival and overall survival in patients with PMBL..

Abbreviations: PMBL, primary mediastinal large B-cell lymphoma; PFS, progression-free survival; OS, overall survival; PS, performance status; LDH, lactate dehydrogenase; IPI, International Prognostic Index; SVC, superior vena cava..