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PMLBCL : Treatment & Prognosis

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Treatment & Prognosis of Primary Mediastinal Large B-cell Lymphoma (PMLBCL) : The treatment consists of multiagent chemotherapy and rituximab (monoclonal anti-CD20 antibody) with or without radiation. Pembrolizumab - a PD-1 checkpoint inhibitor - has been approved for refractory or relapsed PMLBCL. The overall 5-yr survival rate ranges from 79% to 97% and the cure rate ranges from 50% to 80%. The prognosis is comparable to diffuse large B-cell lymphoma, NOS.

Poor prognostic indicators include: pleural or pericardial effusion, involvement of multiple extranodal sites, high serum LDH level, and low performance scores.

About 10-30% of PMLBCL patients relapse or have refractory disease and require salvage therapy. Recurrent PMLBCL has a tendency to involve unusual sites such as kidney, CNS, adrenal gland, liver, pancreas, GI tract, and ovary.

This image of PMLBCL shows tumor cells with clear or pale cytoplasm and large round, oval, or irregular multilobated nuclei. A few delicate sclerotic bands are seen surrounding the tumor cells.

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