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Blood, Vol. 94 No. 10 (November 15), 1999:
pp. 3289-3293
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, and
Sante Tura
From the Institute of Hematology and Medical Oncology
"Seràgnoli," University of Bologna, Bologna, Italy;
Department of Cellular Biotechnology and Hematology, University "La
Sapienza," Rome, Italy; Department of Experimental Medicine and
Pathology, University "La Sapienza," Rome, Italy; and Service of
Pathologic Anatomy and Unit of Hematopathology, University of Bologna,
Bologna, Italy.
To evaluate the efficacy of a combined modality treatment (MACOP-B
plus mediastinal radiotherapy) and the advantages of Gallium-67-citrate single-photon emission (67GaSPECT) 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.
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