ISSN (print) 1997-6933     ISSN (online) 2500-2139
Vol. 18 No. 1 (2025), LYMPHOID TUMORS
Vol. 18 No. 1 (2025)
LYMPHOID TUMORS

Treatment of Patients with Relapsed/Refractory Primary Mediastinal (Thymic) Large B-Cell Lymphoma: Own Data and Literature Review

Published 01.01.2025
Arman Vachakanovich Arakelyan
NN Blokhin National Medical Cancer Research Center, 23 Kashirskoye sh., Moscow, Russian Federation, 115522; IM Sechenov First Moscow State Medical University, 2 korp. 4 Bolshaya Pirogovskaya ul., Moscow, Russian Federation, 119435
https://orcid.org/0000-0003-4911-0959
G.S. Tumyan
NN Blokhin National Medical Cancer Research Center, 23 Kashirskoye sh., Moscow, Russian Federation, 115522
https://orcid.org/0000-0002-5771-4413
A.A. Semenova
NN Blokhin National Medical Cancer Research Center, 23 Kashirskoye sh., Moscow, Russian Federation, 115522
https://orcid.org/0000-0003-4951-3053
M.Yu. Kichigina
NN Blokhin National Medical Cancer Research Center, 23 Kashirskoye sh., Moscow, Russian Federation, 115522
https://orcid.org/0000-0002-2715-2528
I.Z. Zavodnova
NN Blokhin National Medical Cancer Research Center, 23 Kashirskoye sh., Moscow, Russian Federation, 115522
https://orcid.org/0000-0001-6674-8634
D.N. Tupitsyna
NN Blokhin National Medical Cancer Research Center, 23 Kashirskoye sh., Moscow, Russian Federation, 115522
https://orcid.org/0009-0003-4830-1160
E.V. Paramonova
NN Blokhin National Medical Cancer Research Center, 23 Kashirskoye sh., Moscow, Russian Federation, 115522
https://orcid.org/0009-0008-7886-7671
A.S. Antipova
NN Blokhin National Medical Cancer Research Center, 23 Kashirskoye sh., Moscow, Russian Federation, 115522
https://orcid.org/0000-0002-1731-8336
V.O. Shpirko
NN Blokhin National Medical Cancer Research Center, 23 Kashirskoye sh., Moscow, Russian Federation, 115522
https://orcid.org/0000-0002-2300-0332
Yu.I. Klyuchagina
NN Blokhin National Medical Cancer Research Center, 23 Kashirskoye sh., Moscow, Russian Federation, 115522; IM Sechenov First Moscow State Medical University, 2 korp. 4 Bolshaya Pirogovskaya ul., Moscow, Russian Federation, 119435
https://orcid.org/0000-0003-2748-9208
S.F. Ramazanova
NN Blokhin National Medical Cancer Research Center, 23 Kashirskoye sh., Moscow, Russian Federation, 115522
https://orcid.org/0009-0008-7084-0060
U.G. Koshkina
NN Blokhin National Medical Cancer Research Center, 23 Kashirskoye sh., Moscow, Russian Federation, 115522
https://orcid.org/0009-0000-1023-5426
I.S. Monin
NN Blokhin National Medical Cancer Research Center, 23 Kashirskoye sh., Moscow, Russian Federation, 115522
https://orcid.org/0000-0001-7297-6932
N.M. Zolotaikina
NN Blokhin National Medical Cancer Research Center, 23 Kashirskoye sh., Moscow, Russian Federation, 115522
https://orcid.org/0000-0002-1227-5605
G.D. Petrova
NN Blokhin National Medical Cancer Research Center, 23 Kashirskoye sh., Moscow, Russian Federation, 115522
https://orcid.org/0000-0003-4207-2822
O.P. Trofimova
NN Blokhin National Medical Cancer Research Center, 23 Kashirskoye sh., Moscow, Russian Federation, 115522
https://orcid.org/0000-0002-7204-370X
A.S. Subbotin
NN Blokhin National Medical Cancer Research Center, 23 Kashirskoye sh., Moscow, Russian Federation, 115522
https://orcid.org/0000-0002-4648-2362
M.A. Senchenko
NN Blokhin National Medical Cancer Research Center, 23 Kashirskoye sh., Moscow, Russian Federation, 115522
https://orcid.org/0000-0002-9921-5620
V.Yu. Kirsanov
IM Sechenov First Moscow State Medical University, 2 korp. 4 Bolshaya Pirogovskaya ul., Moscow, Russian Federation, 119435
https://orcid.org/0000-0003-1034-4432
2025-1
PDF_2025-18-1-38-50 (Russian)

Keywords

primary mediastinal (thymic) large B-cell lymphoma
relapse
refractoriness
immunochemotherapy
radiotherapy
auto-HSCT

How to Cite

Arakelyan A.V., Tumyan G.S., Semenova A.A., Kichigina M.Y., Zavodnova I.Z., Tupitsyna D.N., Paramonova E.V., Antipova A.S., Shpirko V.O., Klyuchagina Y.I., Ramazanova S.F., Koshkina U.G., Monin I.S., Zolotaikina N.M., Petrova G.D., Trofimova O.P., Subbotin A.S., Senchenko M.A., Kirsanov V.Y. Treatment of Patients with Relapsed/Refractory Primary Mediastinal (Thymic) Large B-Cell Lymphoma: Own Data and Literature Review. Clinical Oncohematology. 2025;(1):38–50. doi:10.21320/2500-2139-2025-18-1-38-50.
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Abstract

AIM. To determine the optimal strategy of chemotherapy for patients with relapsed/refractory (r/r) primary mediastinal (thymic) large B-cell lymphoma (PMBCL).

MATERIALS & METHODS. The study is based on the clinical data from 26 patients with r/r PMBCL treated at the NN Blokhin National Medical Cancer Research Center from 2010 to 2024. The patients were 20–48 years of age (median 33 years); there were 21 (81 %) women. All patients had a bulky mediastinal tumor mass (> 10 cm in maximum dimension).

RESULTS. All calculations were performed in the combined group (n = 26) which included patients with both primary refractory PMBCL (n = 21) and tumor relapses (n = 5). Refractoriness was confirmed by PMBCL progressing within less than 6 months from the completion of the first therapy program. Relapses developed during 2 years after the first-line therapy. The treatment of r/r PMBCL included the R-DHAP, R-ICE, R-BeGeV, and R-B protocols. In 24 out of 26 patients, the second- or subsequent-line salvage therapy programs included immune checkpoint inhibitor (CPI; nivolumab or pembrolizumab) and immunoconjugate (brentuximab vedotin, BV) boosts. CPIs were received by 11 (42 %) patients, and CPI + BV were administered to 13 (50 %) patients. With the follow-up median of 28 months in the total group of r/r PMBCL patients (n = 26), the 3-year progression-free survival (PFS) was 41.7 % (median 14 months), whereas the 3-year overall survival (OS) was 73.7 % (median not reached). Radiotherapy (RT) was administered to 11 (42 %) patients. The RT recipients showed the 3-year PFS of 72.7 % and OS of 100 % as compared to non-recipients with 20.3 % and 56.3 %, respectively. Autologous hematopoietic stem cell transplantation (auto-HSCT) was performed in 12 (46 %) patients. Auto-HSCT recipients showed the 3-year OS of 100 % as compared to non-recipients with 51 %.

CONCLUSION. This study demonstrated that new drugs, in particular CPI ± BV, added to the second- and subsequent-line salvage therapy protocols in r/r PMBCL can be used to overcome the primary tumor refractoriness and neutralize this extremely unfavorable factor. High-dose chemotherapy (conditioning) with subsequent auto-HSCT is clearly associated with the best long-term survival rates. By the time of drafting this paper, 12 followed-up auto-HSCT recipients remained tumor-free. In cases of RT infeasibility at the initial stage, it was mediastinal radiation in the therapy for r/r PMBCL which showed its crucial prognostically favorable value and led to considerable improvement of PFS and OS rates. In general, the capacity of chemotherapy for patients with r/r PMBCL includes CPI ± BV-boosted salvage therapy protocols as well as added auto-HSCT and RT.

PDF_2025-18-1-38-50 (Russian)

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