{"entity":{"id":"paper-dunleavy-da-epoch-r-pmbcl-nejm-2013","kind":"paper","name":"Dose-adjusted EPOCH-rituximab therapy in primary mediastinal B-cell lymphoma","aka":[],"tldr":"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.\n\nAt 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.","asOf":"2026-09-17","links":[{"label":"N Engl J Med 2013","url":"https://doi.org/10.1056/NEJMoa1214561"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/23574119/"}],"tags":[],"related":[],"cancers":["primary-mediastinal-b-cell-lymphoma"],"sections":[],"technologies":[],"targets":[],"drugs":["rituximab"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["nejm"],"dependsOn":[],"notes":[],"journal":"New England Journal of Medicine","year":2013,"doi":"10.1056/NEJMoa1214561","pmid":"23574119","authors":"Dunleavy K, Pittaluga S, Maeda LS, et al.","paperType":"observational","findings":["Five-year event-free survival 93 percent; overall survival 97 percent.","Radiotherapy avoided in 96 percent of patients."],"whatItMeans":"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."],"changedPractice":true,"participants":51},"route":"/key-papers/paper-dunleavy-da-epoch-r-pmbcl-nejm-2013/","neighbours":{"cancer":[{"id":"primary-mediastinal-b-cell-lymphoma","kind":"cancer","name":"Primary mediastinal (thymic) large B-cell lymphoma","route":"/cancers/primary-mediastinal-b-cell-lymphoma/"}],"drug":[{"id":"rituximab","kind":"drug","name":"Rituximab","route":"/drugs/rituximab/"}],"journal":[{"id":"nejm","kind":"journal","name":"New England Journal of Medicine","route":"/journals/nejm/"}]}}