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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

© The Korean Society of Hematology

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

Heui June Ahn1,3,#, Dok-Hyun Yoon1,#, Shin Kim1, Kyoungmin Lee1, EunHee Kang1, Jooryung Huh2, Chan-Sik Park2, and Cheolwon Suh1*

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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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

Copyright © The Korean Society of Hematology.

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

Heui June Ahn1,3,#, Dok-Hyun Yoon1,#, Shin Kim1, Kyoungmin Lee1, EunHee Kang1, Jooryung Huh2, Chan-Sik Park2, and Cheolwon Suh1*

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

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

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..
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