Abstract

BARCKGROUND: Primary mediastinal B cell lymphoma(PMBCL) is a highly curable subtype of non-Hodgkin lymphoma that is predominantly diagnosed in adolescents and young adults. Consequently, long-term treatment-related morbidity is critical to consider when devising treatment strategies that include different chemoimmunotherapy strategies with or without radiotherapy. Furthermore, adaptive approaches using the end-of-chemotherapy (EOC)positron emission tomography (PET)/computed tomography (CT) scanning may help determine which patients may benefit from additional therapies. We aimed to develop evidence-based guidelines for treating these patients.METHODS: We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA) guideline using PubMed database. The ARS expert committee made up of radiation oncologists, hematoligists, and pediatric oncologists developed consensus guidelines using the modifited DELPHI framework.RESULTS: Nine studies were identified that met the full criteria for inclusion based on reporting outcomes on patients with primary mediastinal B cell lymphoma with EOC PET/CT response scored with the 5 point Deauville scale. These studies formed the evidence for these guidelines in managing patients with PMBCL according to the EOC PET response, including after a 5PDS of 1-3, 4, 5, and for patients with relapsed and refractory disease. The expert group also developed guidance on radiation simulation, treatment planning, and plan evaluation based on expert opinion.CONCLUSIONS: Various treatment approaches exist in the management of PMBCL, including different chemoimmunotherapy regimens, the use of consolidative radiotherapy, and adaptive approaches based on EOC PET/CT response. These guidelines can be used by practitioners to provide appropriate treatment according to different disease scenarios.

View details for DOI 10.1016/j.ijrobp.2021.03.035

View details for PubMedID 33774076