How do you choose your systemic treatment for primary mediastinal grey zone lymphomas?

Most of the literature (although not prospective) supports treating with an R-CHOP/EPOCH vs. traditional ABVD. As such, I tend to treat with R-DA-EPOCH. When I have had the unfortunate case of a relapsed/refractory patient, I have tended to treat with some of the newer HL salvage regimens.

The specifics of the case would be relevant; patient age, presentation, and phenotype. I am more inclined to do R-EPOCH in general but may do ABVD instead if the case has more cHL like features.

Would agree with DA-EPOCH. Occasionally use consolidative radiotherapy for localized and/or bulky disease.