[Eight-year experience in treating aggressive mediastinal large B-cell lymphomas].

Area of Science:

• Hematology
• Oncology
• Pathology

Context:

• Mediastinal lymph node involvement in large B-cell lymphoma (LBCL) presents diagnostic challenges.
• Distinguishing between diffuse large B-cell lymphoma (DLBCL) and primary mediastinal large B-cell lymphoma (PMLBCL) is crucial for treatment stratification.

Purpose:

• To establish differential diagnostic criteria for DLBCL with primary mediastinal LN involvement versus PMLBCL.
• To evaluate the efficacy of a modified NHL-BFM-90 (M-NHL-BFM-90) treatment program for these specific LBCL entities.

Summary:

• The study analyzed 60 patients with LBCL primarily involving mediastinal lymph nodes.
• Histological, phenotypic, and molecular analyses differentiated PMLBCL (39 patients) from DLBCL with primary mediastinal LN involvement (21 patients).
• The M-NHL-BFM-90 protocol yielded high 5-year survival rates (95% for DLBCL, 86% for PMLBCL), with event-free survival at 95% and 78%, respectively. Pregnant patients with PMLBCL achieved remission with specific chemotherapy regimens.

Impact:

• The findings highlight the heterogeneity of LBCL presenting with mediastinal lymph node involvement.
• Treatment outcomes differ significantly between PMLBCL and DLBCL, despite similar initial presentations.
• This research underscores the importance of accurate differential diagnosis for optimizing therapeutic strategies in mediastinal LBCL.