ArticleAnnals of hematology2026
Primary mediastinal B-cell lymphoma: upfront high-dose chemotherapy with autologous stem cell transplantation results in favorable long-term outcome and may spare radiotherapy.
Article in Annals of hematology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
The optimal therapeutic approach for primary mediastinal B-cell lymphoma remains unknown and varies in clinical practice. Dose-adjusted EPOCH-R or R-CHOP-based immuno-chemotherapy with mediastinal radiotherapy are acceptable treatment options. We report a retrospective analysis of PMBL patients treated with high-dose chemotherapy (HDCT) and autologous stem cell transplantation (ASCT) consolidation or dose-dense immuno-chemotherapy alone. A comparison of the two consolidation strategies showed no significant difference in 5-year PFS (95.5% vs. 82.4%, HR 0.22 95% CI 0.03-1.69, p = 0.13) or OS (100% vs. 87.1%, HR 0.1 95% CI 0.006-1.69, p = 0.11), with a trend toward better survival in the preplanned HDCT/ASCT group. Notably, 35.3% of patients received additional HDCT/ASCT after an inadequate response to dose-dense immuno-chemotherapy. When comparing all patients, with or without first-line HDCT/ASCT consolidation, regardless of the initial consolidation strategy, we found a significant difference in 5-year PFS (96.2% vs. 75%, HR 0.09 95% CI 0.01-0.83, p = 0.03) and OS (100% vs. 80.1%, HR 0.03 95% CI 0.002-0.7, p = 0.03) for patients treated with HDCT/ASCT. In addition, mediastinal radiotherapy was administered significantly less frequently in patients treated with HDCT/ASCT. In conclusion, high-dose chemotherapy and autologous stem cell transplantation may be a valid strategy to induce a favorable long-term outcome and spare radiotherapy in patients with PMBL.
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