{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T06:19:41Z","timestamp":1790144381182,"version":"4.0.1"},"reference-count":16,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2015,8,21]],"date-time":"2015-08-21T00:00:00Z","timestamp":1440115200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["American J Hematol"],"published-print":{"date-parts":[[2015,9]]},"abstract":"<jats:p>Gray zone lymphoma (GZL) with features between classical Hodgkin lymphoma and diffuse large B\u2010cell lymphoma (DLBCL) is a recently recognized entity reported to present primarily with mediastinal disease (MGZL). We examined detailed clinical features, outcomes, and prognostic factors among 112 GZL patients recently treated across 19 North American centers. Forty\u2010three percent of patients presented with MGZL, whereas 57% had non\u2010MGZL (NMGZL). NMGZL patients were older (50 versus 37 years,<jats:italic>P<\/jats:italic>\u2009=\u20090.0001); more often had bone marrow involvement (19% versus 0%,<jats:italic>P<\/jats:italic>\u2009=\u20090.001); &gt;1 extranodal site (27% versus 8%,<jats:italic>P<\/jats:italic>\u2009=\u20090.014); and advanced stage disease (81% versus 13%,<jats:italic>P<\/jats:italic>\u2009=\u20090.0001); but they had less bulk (8% versus 44%,<jats:italic>P<\/jats:italic>\u2009=\u20090.0001), compared with MGZL patients. Common frontline treatments were cyclophosphamide\u2010doxorubicin\u2010vincristine\u2010prednisone +\/\u2212 rituximab (CHOP+\/\u2212R) 46%, doxorubicin\u2010bleomycin\u2010vinblastine\u2010dacarbazine +\/\u2212 rituximab (ABVD+\/\u2212R) 30%, and dose\u2010adjusted etoposide\u2010doxorubicin\u2010cyclophosphamide\u2010vincristine\u2010prednisone\u2010rituximab (DA\u2010EPOCH\u2010R) 10%. Overall and complete response rates for all patients were 71% and 59%, respectively; 33% had primary refractory disease. At 31\u2010month median follow\u2010up, 2\u2010year progression\u2010free survival (PFS) and overall survival rates were 40% and 88%, respectively. Interestingly, outcomes in MGZL patients seemed similar compared with that of NMGZL patients. On multivariable analyses, performance status and stage were highly prognostic for survival for all patients. Additionally, patients treated with ABVD+\/\u2212R had markedly inferior 2\u2010year PFS (22% versus 52%,<jats:italic>P<\/jats:italic>\u2009=\u20090.03) compared with DLBCL\u2010directed therapy (CHOP+\/\u2212R and DA\u2010EPOCH\u2010R), which persisted on Cox regression (hazard ratio, 1.88; 95% confidence interval, 1.03\u20133.83;<jats:italic>P<\/jats:italic>\u2009=\u20090.04). Furthermore, rituximab was associated with improved PFS on multivariable analyses (hazard ratio, 0.35; 95% confidence interval, 0.18\u20130.69;<jats:italic>P<\/jats:italic>\u2009=\u20090.002). Collectively, GZL is a heterogeneous and likely more common entity and often with nonmediastinal presentation, whereas outcomes seem superior when treated with a rituximab\u2010based, DLBCL\u2010specific regimen. Am. J. Hematol. 90:778\u2013783, 2015. \u00a9 2015 Wiley Periodicals, Inc.<\/jats:p>","DOI":"10.1002\/ajh.24082","type":"journal-article","created":{"date-parts":[[2015,6,4]],"date-time":"2015-06-04T13:25:03Z","timestamp":1433424303000},"page":"778-783","source":"Crossref","is-referenced-by-count":77,"title":["Gray zone lymphoma with features intermediate between classical<scp>H<\/scp>odgkin lymphoma and diffuse large<scp>B<\/scp>\u2010cell lymphoma:<scp>C<\/scp>haracteristics, outcomes, and prognostication among a large multicenter cohort"],"prefix":"10.1002","volume":"90","author":[{"given":"Andrew M.","family":"Evens","sequence":"first","affiliation":[{"name":"Tufts Medical Center Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer A.","family":"Kanakry","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurie 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