![]() Results: 131 PMBCLs were included with a median age of 34 years, 54% were female, 79% had elevated LDH > UNV and 24% had E. Response was evaluated by the Internat Standardized Response Criteria, Cheson 1999. Primary endpoint was event-free survival (EFS), secondary endpoints were progression-free (PFS) and overall survival (OS). Pts were randomized in a 2 x 2 factorial design to 6xR-CHOP-14 or 6x-R-CHOP-21 without RT or with RT (39.6 Gy) to Bulk and E. Methods: The UNFOLDER trial included 18-60 year-old pts (aaIPI = 0 with Bulk or aaIPI = 1) qualifying for radiotherapy to Bulk or extralymphatic involvement (E). Therapy is based on R-CHOP or similar regimens, but the role of treatment intensification and consolidative radiotherapy (RT) is controversial, because data from randomized trials are rare. View details for DOI 10.1097/COC.Department Internal Medicine I, Westpfalzklinikum Kaiserslautern, Kaiserslautern, Germany Department Internal Medicine I, Saarland University Medical School, Homburg/Saar, Germany Department of Radiooncology, Saarland University Medical School, Homburg/Saar, Germany Insitute of Pathology, Robert-Bosch-Krankenhaus, Stuttgart, Germany Department of Medicine III, University Hospital Grosshadern/LMU, Munich, Germany University Hospital of Ulm, Ulm, Germany Department of Haematology and Oncology, University Hospital of Cologne, Cologne, Germany Institute of Haematology, Assuta Medical Centers, Tel Aviv, Israel Onkologie Lerchenfeld, Hamburg, Germany Dept of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy Department of Hematology, Rigshospitalet, Copenhagen, Denmark Universitätsmedizin Göttingen, Goettingen, Germany Department of Radiooncology, University Medical Center, Mainz, Germany Department Internal Medicine A, University Medical School, Muenster, Germany Institute for Medical Informatics, Statistics and Epidemology, University of Leipzig, Leipzig, Germany Institute for Medical Informatics, Statistics and Epidemology, Leipzig University, Leipzig, Germanyīackground: Primary mediastinal B-cell lymphoma (PMBCL) is a distinct entity of aggressive lymphoma, which typically presents in young patients (pts) with a bulky mediastinal mass. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The document also discusses the role of positron emission tomography/computed tomography for predicting outcome and potentially guiding therapy. ![]() The role of radiation as a consolidation is discussed including: (1) the prerituximab randomized trials that challenged the role of radiation, (2) recent prospective studies (UNFOLDER/RICOVER-60), and (3) retrospective studies the last 2 showed a potential benefit of radiation both for early and advanced stage. Treatment approaches with different chemotherapy regimens used is discussed in detail. The management of diffuse large B-cell lymphoma depends on the initial diagnosis including molecular and immunophenotypic characteristics, Ann Arbor staging, and International Prognostic Index (IPI score). American journal of clinical oncology Dabaja, B. ACR Appropriateness Criteria® Diffuse Large B-Cell Lymphoma.
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