Clinical Analysis Of49Patients With Primary Mediastinal Large B Cell Lymphoma

Objective:To investigate clinical characteristic prognostic factors and optimal treatment and of primary mediastinal large B-cell lymphoma (PMLBCL). Aimed at raising understanding to the disease and to establish the most effective and optimal treatment.Methods:forty-nine patients with PMLBCL were studied retrospectively from May2005to May2011. All these patients were treated in Department of Medical Oncology, the second xiangya hospital, central-south University, Hunan province and the Oncology hospital of Hunan province. To explore the relationship between treatment and prognosis.Results:Of the49patients,27were men and22were women, the ratio was1.22:1. Aged from12to61, the median age was36.5. The majority of patients were in stage Ⅰ/Ⅱ (27cases,55.1%), others were in stage Ⅲ/Ⅳ (22cases,44.9%).15(30%)patientshad superior vena cava syndrome at diagnosis.21(42%) patients had adjacent organs infiltration. High LDH levels are observed in23(46%) patients, international prognostic index,IPI<233case,(67%), IPI>216case,(33%)。The complete response (CR) in7(14%) and partial remission (PR) stable disease(SD)in32,the overall response rates was79.5%(39/49).At median follow-up,The5-year overall survival rates were67.3%. In univariate analysis, these factors which include stage Ⅲ/Ⅳ (p=0.01),without radiotherapy (p=0.007),LDH≥ULN (upper limit of normal)(p=0.000),disease progression (p=0.0.001) international prognostic index(IPI)≥2(p=0.000) predicted poor outcome. The addition of rituximab to chemotherapy can improve the survival. In multivariate analysis, The addition of radiotherapy to chemotherapy (p=0.021) and LDH (p=0.003) appear to influence prognosis.CONCLUSION:PMLBCL affects young adults,.most cases are stage Ⅰ-Ⅱ, with unique clinicopathologic features. Comprehensive treatment of patients after5-year overall survival rate is about67percent.The addition of rituximab to chemotherapy improved the survival trend, The addition of radiotherapy to chemotherapy may lead to favourable outcome. LDH is an independent prognostic factor.