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PET/CT in primary mediastinal large B-cell lymphoma responding to rituximab-CHOP: An analysis of 106 patients regarding prognostic significance and implications for subsequent radiotherapy

Leukemia volume 30, pages 238–242 (2016)Cite this article

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Primary mediastinal large B-cell lymphoma (PMLBCL) is a unique clinicopathologic entity, usually presenting with bulky anterior mediastinal masses with or without local symptoms, including the superior vena cava syndrome. Post-treatment residual masses are very common because of initial disease bulk and fibrosis, a prominent histologic feature of PMLBCL. Thus, response evaluation by conventional computed tomography (CT) is not accurate enough. Positron emission tomography combined with CT (PET/CT) can effectively discriminate between fibrotic or necrotic tissue and residual masses containing viable tumor in various lymphoma subtypes. Despite widespread clinical experience gained in final response assessment of Hodgkin lymphoma and diffuse large B-cell lymphomas, PET/CT is used rather empirically in PMLBCL; in fact, its use is based on the projection of data derived from Hodgkin lymphoma and diffuse large B-cell lymphoma.

The optimal treatment of PMBCL has not been firmly established yet. Rituximab-cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP), usually followed by radiotherapy, is the most widely used regimen, but 20–25% of patients still relapse or progress.1, 2, 3, 4 Even better results have been reported with the combination of rituximab and dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin,5 or, possibly, methotrexate (or etoposide), doxorubicin, cyclophosphamide, vincristine, prednisone, bleomycin6, 7 and German protocols designed for Burkitt lymphoma,8 but no direct comparison with R-CHOP has been performed. PET/CT is currently used for final response assessment in PMLBCL; however, it is not known whether the prognostic significance of post-immunochemotherapy PET/CT remains the same if different regimens of variable intensity (and possibly efficacy) are used.

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Figure 1

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Acknowledgements

This study was not supported, either partly or entirely, by any grant, fund, organization or corporation. The following individuals contributed by providing data for this study: Dimou M, Masouridis S (Department of Haematology and First Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece), Korkolopoulou P, Rassidakis GZ, Patsouris E (Department of Pathology, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece), Michail P (First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece), Tomos P (Second Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece), Hatjiharissi E (Hematology Clinic, Theagenion Cancer Hospital, Thessaloniki, Greece).

Author Contributions

Vassilakopoulos TP: Designed research, performed research, collected data, analyzed and interpreted data, performed statistical analysis, and wrote the manuscript. Pangalis GA: Designed research, performed research, collected data, interpreted data and critically reviewed the manuscript. Chatziioannou S: Performed research, collected data, interpreted data and critically reviewed the manuscript. Papageorgiou S: Performed research, collected data, interpreted data and critically reviewed the manuscript. Angelopoulou MK: Performed research, collected data, interpreted data and critically reviewed the manuscript. Galani Z: Performed research, collected data, interpreted data and critically reviewed the manuscript. Kourti G: Performed research, collected data and interpreted data. Prassopoulos V: Performed research, collected data, interpreted data and critically reviewed the manuscript. Leonidopoulou T: Performed research, collected data, interpreted data and critically reviewed the manuscript. Terpos E: Performed research, collected data, interpreted data and critically reviewed the manuscript. Dimopoulou M: Performed research, collected data and interpreted data. Sachanas S: Performed research, collected data and interpreted data. Kalpadakis C: Performed research, collected data and interpreted data. Konstantinidou P: Performed research, collected data, interpreted data and critically reviewed the manuscript. Boutsis D: Performed research, collected data and interpreted data. Stefanoudaki E: Performed research, collected data, interpreted data and critically reviewed the manuscript. Kyriazopoulou L: Performed research, collected data, interpreted data and critically reviewed the manuscript. Siakantaris MP: Performed research, collected data andinterpreted data. Kyrtsonis M-C: Performed research, collected data, interpreted data. Variami E: Performed research, collected data, interpreted data. Kotsianidis I: Performed research, collected data, interpreted data and critically reviewed the manuscript. Symeonidis A: Performed research, collected data, interpreted data, critically reviewed the manuscript. Michali E: Performed research, collected data, interpreted data. Katodritou E: Performed research, collected data, interpreted data and critically reviewed the manuscript. Kokkini G: Performed research, interpreted data and critically reviewed the manuscript. Tsatalas C: Performed research, interpreted data and critically reviewed the manuscript. Dimopoulos MA: Performed research, interpreted data and critically reviewed the manuscript. Sotiropoulos V: Performed research, collected data, interpreted data and critically reviewed the manuscript. Pappa V: Performed research, interpreted data and critically reviewed the manuscript. Karmiris T: Performed research, interpreted data and critically reviewed the manuscript. Meletis J: Performed research, interpreted data and critically reviewed the manuscript. Apostolidis J: Performed research, interpreted data and critically reviewed the manuscript. Konstantopoulos K: Performed research, interpreted data and critically reviewed the manuscript. Datseris I: Performed research, interpreted data and critically reviewed the manuscript. Panayiotidis P: Performed research, interpreted data and critically reviewed the manuscript. Roussou P: Performed research, interpreted data and critically reviewed the manuscript. Rondogianni Ph: Performed research, collected data, interpreted data and critically reviewed the manuscript.

Author information

Authors and Affiliations

  1. Department of Haematology, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece

    T P Vassilakopoulos, M K Angelopoulou, M N Dimopoulou, J Meletis & K Konstantopoulos

  2. Department of Haematology, Athens Medical Center, Psychikon Branch, Athens, Greece

    G A Pangalis & S Sachanas

  3. Department of Nuclear Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece

    S Chatziioannou

  4. Second Propedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece

    S Papageorgiou & V Pappa

  5. Third Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece

    Z Galani & P Roussou

  6. Department of Haematology and Lymphoma, Evangelismos General Hospital, Athens, Greece

    G Kourti, T Karmiris & J Apostolidis

  7. Department of Nuclear Medicine, HYGEIA Hospital, Athens, Greece

    V Prassopoulos

  8. Department of Haematology, Sismanoglion General Hospital, Athens, Greece

    T Leonidopoulou & G Kokkini

  9. Department of Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece

    E Terpos & M-A Dimopoulos

  10. Department of Haematology, University of Crete, Iraklion, Greece

    C Kalpadakis & H Papadaki

  11. Department of Haematology, Theagenion Anticancer General Hospital, Thessaloniki, Greece

    P Konstantinidou & E Katodritou

  12. Department of Haematology, Athens Navy Hospital, Athens, Greece

    D Boutsis

  13. Department of Haematology, Amalia Fleming Hospital, Athens, Greece

    E Stefanoudaki

  14. Department of Haematology, University of Ioannina, Ioannina, Greece

    L Kyriazopoulou

  15. First Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece

    M P Siakantaris & E Variami

  16. First Propedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece

    M-C Kyrtsonis & P Panayiotidis

  17. Department of Haematology, Democritus University of Thrace, Alexandroupolis, Greece

    I Kotsianidis & C Tsatalas

  18. Hematology Division, Department of Internal Medicine, University of Patras, Patras, Greece

    A Symeonidis

  19. Department of Clinical Haematology, “G.Gennimatas” Athens General Hospital, Athens, Greece

    E Michali

  20. Department of Nuclear Medicine and PET/CT, Athens Medical Center, Athens, Greece

    V Sotiropoulos

  21. Department of Nuclear Medicine and PET/CT, Evangelismos General Hospital, Athens, Greece

    I Datseris & P Rondogianni

Authors
  1. T P Vassilakopoulos
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  2. G A Pangalis
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  37. P Roussou
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Corresponding author

Correspondence to T P Vassilakopoulos.

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Vassilakopoulos, T., Pangalis, G., Chatziioannou, S. et al. PET/CT in primary mediastinal large B-cell lymphoma responding to rituximab-CHOP: An analysis of 106 patients regarding prognostic significance and implications for subsequent radiotherapy. Leukemia 30, 238–242 (2016). https://doi.org/10.1038/leu.2015.120

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