Interim results of the PML-16, PML-19 protocols for primary mediastinal large B-cell lymphoma therapy

Introduction. Primary mediastinal lymphoma (PML) is an aggressive lymphoid tumor treatment success of which determined by induction therapy. To date, none the standard chemotherapy regimens (CT) have demonstrated advantage in efficacy. Intensive therapy programs are associated with high toxicity. Aim — to evaluate efficacy and toxicity two pilot prospective protocols PML-16 PML-19 as well possibility using analysis freely circulating DNA (ctDNA) assess MRD patients PML. Materials methods. From January 2016 2022, 34 previously untreated PML were included study; average age 32; stage > I 60 %; extramediastinal lesions 14.7 bulky disease 73.5 % patients. Positron emission tomography combined computed (PET-CT) was performed; ctDNA completeness remission. Results. Eighteen received according protocol (6 courses chemotherapy; 2 blocks RmNHL-BFM-90 + 4 R-EPOCH). After end therapy, all 18 achieved PET-negative The next 16 (4 R-mNHL-BFM-90 R-EPOCH) combination lenalidomide. 9 (56 %) remission; 7 (44 retained pathological activity (D4–5 points). 3 6 months 15 (94 normalization metabolic activity. Considering frequency false-positive results PML, a study performed determine depth remission had complete elimination ctDNA. Of these, 5 (33 remained PET-positive at treatment. During further observation, after 3–6 months, level decreased physiological without use consolidating one patient suffered new coronavirus infection, COVID-19. A month later, residual formation SUVmax 14.2 mediastinum. currently under observation. With median follow-up 36 (9 76 months) Conclusion. effectiveness made it possible abandon consolidation refuted idea need for CT. based on application principle high-dose shortpulse (R-mNHL-BFM-90) prolonged administration medium doses (R-EPOCH) crucial achieving successful result. inclusion lenalidomide “PML-19” program achieve 100 cases courses. shown.