Primary mediastinal B-cell lymphoma

Primary mediastinal B-cell lymphoma (PMBCL) is an aggressive (fast-growing) type of non-Hodgkin lymphoma (NHL). It may also be called mediastinal B-cell lymphoma or mediastinal (thymic) large B-cell lymphoma.

PMBCL develops in the thymus or in lymph nodes in the centre of the chest (called the mediastinum). When lymph nodes around the lungs and behind the breastbone become enlarged, they can cause symptoms such as a cough or an ache or pain in the chest.

You may be offered the following treatments for PMBCL. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Chemotherapy uses drugs to destroy cancer cells. It is combined with the targeted therapy drug rituximab (Rituxan and biosimilars) as the main treatment for PMBCL.

The most common drug combinations used to treat PMBCL are:

• R-CHOP – rituximab, cyclophosphamide (Procytox), doxorubicin, vincristine and prednisone
• DA-EPOCH-R – dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin and rituximab

Find out more about chemotherapy for NHL.

Radiation therapy uses high-energy rays or particles to destroy cancer cells. It is sometimes used if there are still areas of PMBCL in the chest after treatment with chemotherapy.

Find out more about radiation therapy for NHL.

Immunotherapy helps to strengthen or restore the immune system's ability to fight cancer. It is sometimes used if PMBCL stops responding to or comes back after at least 2 other types of treatment. The following immunotherapy drugs may not be covered by all provincial or territorial health plans.

Pembrolizumab (Keytruda) is an immune checkpoint inhibitor that may be offered for PMBCL.

Axicabtagene ciloleucel (Yescarta) is a CAR T-cell therapy that may be offered for PMBCL.

Bispecific antibodies are a new type of immunotherapy. They may be used to treat PMBCL after 2 or more lines of systemic therapy and if you previously had CAR T-cell therapy or if you can't to have CAR T-cell therapy.

The following bispecific antibodies may be offered:

• epcoritamab (Epkinly)
• glofitamab (Columvi)

Find out more about immunotherapy for NHL.

A stem cell transplant replaces stem cells. It may be used to treat PMBCL that comes back after treatment or that stops responding to treatment.

Find out more about stem cell transplant for NHL.

Talk to your doctor about clinical trials open to people with NHL in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.