Dr. Dunleavy Discusses Treatment Options for PMBL

Kieron Dunleavy, MD
Published: Monday, Apr 16, 2012

Kieron Dunleavy, MD, a staff clinician with the National Cancer Institute in Bethesda, MD, explains that the molecular subtype of diffuse large B cell lymphoma (DLBCL), known as primary mediastinal B cell lymphoma (PMBL), has a molecular profile that is more similar to Hodgkin lymphoma than other subtypes of DLBCL, which makes it difficult to treat.

Overall, the standard treatment for DLBCL is R-CHOP (rituximab–cyclophosphamide, doxorubicin, vincristine, and prednisone), however, this regimen has not been effective at treating patients with PMBL. This subtype remains an area that requires novel approaches and dose intensity modifications.

Dunleavy explains that one approach being researched involves adjusting the dose intensity of the regimen EPOCH (etoposide, prednisone, vincristine [Oncovin] and doxorubicin hydrochloride [hydroxydaunorubicin hycrochloride]) in combination with rituximab (EPOCH-R). This approach was tested in 46 patients and resulted in mediastinal radiation being obviated in approximately 95% of the cases, making it an ideal treatment for PMBL.

Kieron Dunleavy, MD, a staff clinician with the National Cancer Institute in Bethesda, MD, explains that the molecular subtype of diffuse large B cell lymphoma (DLBCL), known as primary mediastinal B cell lymphoma (PMBL), has a molecular profile that is more similar to Hodgkin lymphoma than other subtypes of DLBCL, which makes it difficult to treat.

Overall, the standard treatment for DLBCL is R-CHOP (rituximab–cyclophosphamide, doxorubicin, vincristine, and prednisone), however, this regimen has not been effective at treating patients with PMBL. This subtype remains an area that requires novel approaches and dose intensity modifications.

Dunleavy explains that one approach being researched involves adjusting the dose intensity of the regimen EPOCH (etoposide, prednisone, vincristine [Oncovin] and doxorubicin hydrochloride [hydroxydaunorubicin hycrochloride]) in combination with rituximab (EPOCH-R). This approach was tested in 46 patients and resulted in mediastinal radiation being obviated in approximately 95% of the cases, making it an ideal treatment for PMBL.


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