# Dose-adjusted EPOCH-rituximab therapy in primary mediastinal B-cell lymphoma

Source: https://onco.cc/key-papers/paper-dunleavy-da-epoch-r-pmbcl-nejm-2013/  
OnCo record `paper-dunleavy-da-epoch-r-pmbcl-nejm-2013` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Infusional dose-adjusted EPOCH with rituximab cured almost every patient with primary mediastinal B-cell lymphoma without any radiotherapy, sparing young patients the heart and breast cancer risks of chest irradiation.

## Summary

Prospective single-centre phase 2 study of 51 patients with untreated primary mediastinal B-cell lymphoma treated with dose-adjusted EPOCH-rituximab for six to eight cycles without radiotherapy, with a retrospective validation cohort of 16 patients at Stanford.

At a median follow-up of 5 years, event-free survival was 93 percent and overall survival 97 percent; only two patients received radiotherapy, and PET scans after treatment had a low positive predictive value.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: New England Journal of Medicine
- Year: 2013
- DOI: 10.1056/NEJMoa1214561
- Authors: Dunleavy K, Pittaluga S, Maeda LS, et al.
- Findings: Five-year event-free survival 93 percent; overall survival 97 percent.; Radiotherapy avoided in 96 percent of patients.
- What it means: Dose-adjusted EPOCH-R without radiotherapy became a standard for primary mediastinal B-cell lymphoma, particularly in the United States, and the IELSG37 trial later confirmed radiotherapy can be omitted after a negative PET.
- Caveats: Single-arm study from one centre with a small validation cohort.; Six-day infusional regimen is demanding; R-CHOP with PET-guided radiotherapy is an alternative.

## Sources

- N Engl J Med 2013: https://doi.org/10.1056/NEJMoa1214561
- PubMed: https://pubmed.ncbi.nlm.nih.gov/23574119/

## Connected records

- cancers: [Primary mediastinal (thymic) large B-cell lymphoma](https://onco.cc/cancers/primary-mediastinal-b-cell-lymphoma/)
- drugs: [Rituximab](https://onco.cc/drugs/rituximab/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)

---
JSON: https://onco.cc/api/v1/entities/paper-dunleavy-da-epoch-r-pmbcl-nejm-2013.json