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Federico M, Rudiger T, Bellei M, Nathwani BN, Luminari S, Coiffier B, Harris NL, Jaffe ES, Pileri SA, Savage KJ, Weisenburger DD, Armitage JO, Mounier N, Vose JM. Clinicopathologic characteristics of angioimmunoblastic T-cell lymphoma: analysis of the international peripheral T-cell lymphoma project. J Clin Oncol 2013; 31:240-6. [PMID: 22869878 PMCID: PMC3532394 DOI: 10.1200/jco.2011.37.3647] [Citation(s) in RCA: 238] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The International Peripheral T-Cell Lymphoma Project was undertaken to better understand the subtypes of T-cell and natural killer (NK) -cell lymphomas. PATIENTS AND METHODS Angioimmunoblastic T-cell lymphoma (AITL) was diagnosed according to the 2001 WHO criteria by a central review process consisting of panels of expert hematopathologists. Clinical, pathologic, immunophenotyping, treatment, and survival data were correlated. RESULTS Of 1,314 patients, 243 (18.5%) were diagnosed with AITL. At presentation, generalized lymphadenopathy was noted in 76% of patients, and 89% had stages III to IV disease. Skin rash was observed in 21% of patients. Hemolytic anemia and hypergammoglobulinemia occurred in 13% and 30% of patients, respectively. Five-year overall and failure-free survivals were 33% and 18%, respectively. At presentation, prognostic models were evaluated, including the standard International Prognostic Index, which comprised the following factors: age ≥ 60 years, stages III to IV disease, lactic dehydrogenase (LDH) > normal, extranodal sites (ENSs) > one, and performance status (PS) ≥ 2; the Prognostic Index for Peripheral T-Cell Lymphoma, comprising: age ≥ 60 years, PS ≥ 2, LDH > normal, and bone marrow involvement; and the alternative Prognostic Index for AITL (PIAI), comprising: age > 60 years, PS ≥ 2, ENSs > one, B symptoms, and platelet count < 150 × 10(9)/L. The simplified PIAI had a low-risk group (zero to one factors), with 5-year survival of 44%, and a high-risk group (two to five factors), with 5-year survival of 24% (P = .0065). CONCLUSION AITL is a rare clinicopathologic entity characterized by an aggressive course and dismal outcome with current therapies.
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Affiliation(s)
- Massimo Federico
- Massimo Federico, Monica Bellei, and Stefano Luminari, Università di Modena e Reggio Emilia, Modena; Stefano A. Pileri, Università di Bologna, Bologna, Italy; Thomas Rudiger, Stadisches Klinikum Karlsruhe, Karlsruhe, Germany; Bharat N. Nathwani, Ceders-Sinai Medical Center and University of Southern California Keck School of Medicine, Los Angeles, CA; Bertrand Coiffier, Hospices Civils de Lyon, Lyon; Nicholas Mounier, Hospital l'Archet, Nice, France; Nancy L. Harris, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Elaine S. Jaffe, National Cancer Institute, Bethesda, MD; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Dennis D. Weisenburger, James O. Armitage, and Julie M. Vose, University of Nebraska Medical Center, Omaha, NE
| | - Thomas Rudiger
- Massimo Federico, Monica Bellei, and Stefano Luminari, Università di Modena e Reggio Emilia, Modena; Stefano A. Pileri, Università di Bologna, Bologna, Italy; Thomas Rudiger, Stadisches Klinikum Karlsruhe, Karlsruhe, Germany; Bharat N. Nathwani, Ceders-Sinai Medical Center and University of Southern California Keck School of Medicine, Los Angeles, CA; Bertrand Coiffier, Hospices Civils de Lyon, Lyon; Nicholas Mounier, Hospital l'Archet, Nice, France; Nancy L. Harris, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Elaine S. Jaffe, National Cancer Institute, Bethesda, MD; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Dennis D. Weisenburger, James O. Armitage, and Julie M. Vose, University of Nebraska Medical Center, Omaha, NE
| | - Monica Bellei
- Massimo Federico, Monica Bellei, and Stefano Luminari, Università di Modena e Reggio Emilia, Modena; Stefano A. Pileri, Università di Bologna, Bologna, Italy; Thomas Rudiger, Stadisches Klinikum Karlsruhe, Karlsruhe, Germany; Bharat N. Nathwani, Ceders-Sinai Medical Center and University of Southern California Keck School of Medicine, Los Angeles, CA; Bertrand Coiffier, Hospices Civils de Lyon, Lyon; Nicholas Mounier, Hospital l'Archet, Nice, France; Nancy L. Harris, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Elaine S. Jaffe, National Cancer Institute, Bethesda, MD; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Dennis D. Weisenburger, James O. Armitage, and Julie M. Vose, University of Nebraska Medical Center, Omaha, NE
| | - Bharat N. Nathwani
- Massimo Federico, Monica Bellei, and Stefano Luminari, Università di Modena e Reggio Emilia, Modena; Stefano A. Pileri, Università di Bologna, Bologna, Italy; Thomas Rudiger, Stadisches Klinikum Karlsruhe, Karlsruhe, Germany; Bharat N. Nathwani, Ceders-Sinai Medical Center and University of Southern California Keck School of Medicine, Los Angeles, CA; Bertrand Coiffier, Hospices Civils de Lyon, Lyon; Nicholas Mounier, Hospital l'Archet, Nice, France; Nancy L. Harris, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Elaine S. Jaffe, National Cancer Institute, Bethesda, MD; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Dennis D. Weisenburger, James O. Armitage, and Julie M. Vose, University of Nebraska Medical Center, Omaha, NE
| | - Stefano Luminari
- Massimo Federico, Monica Bellei, and Stefano Luminari, Università di Modena e Reggio Emilia, Modena; Stefano A. Pileri, Università di Bologna, Bologna, Italy; Thomas Rudiger, Stadisches Klinikum Karlsruhe, Karlsruhe, Germany; Bharat N. Nathwani, Ceders-Sinai Medical Center and University of Southern California Keck School of Medicine, Los Angeles, CA; Bertrand Coiffier, Hospices Civils de Lyon, Lyon; Nicholas Mounier, Hospital l'Archet, Nice, France; Nancy L. Harris, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Elaine S. Jaffe, National Cancer Institute, Bethesda, MD; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Dennis D. Weisenburger, James O. Armitage, and Julie M. Vose, University of Nebraska Medical Center, Omaha, NE
| | - Bertrand Coiffier
- Massimo Federico, Monica Bellei, and Stefano Luminari, Università di Modena e Reggio Emilia, Modena; Stefano A. Pileri, Università di Bologna, Bologna, Italy; Thomas Rudiger, Stadisches Klinikum Karlsruhe, Karlsruhe, Germany; Bharat N. Nathwani, Ceders-Sinai Medical Center and University of Southern California Keck School of Medicine, Los Angeles, CA; Bertrand Coiffier, Hospices Civils de Lyon, Lyon; Nicholas Mounier, Hospital l'Archet, Nice, France; Nancy L. Harris, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Elaine S. Jaffe, National Cancer Institute, Bethesda, MD; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Dennis D. Weisenburger, James O. Armitage, and Julie M. Vose, University of Nebraska Medical Center, Omaha, NE
| | - Nancy L. Harris
- Massimo Federico, Monica Bellei, and Stefano Luminari, Università di Modena e Reggio Emilia, Modena; Stefano A. Pileri, Università di Bologna, Bologna, Italy; Thomas Rudiger, Stadisches Klinikum Karlsruhe, Karlsruhe, Germany; Bharat N. Nathwani, Ceders-Sinai Medical Center and University of Southern California Keck School of Medicine, Los Angeles, CA; Bertrand Coiffier, Hospices Civils de Lyon, Lyon; Nicholas Mounier, Hospital l'Archet, Nice, France; Nancy L. Harris, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Elaine S. Jaffe, National Cancer Institute, Bethesda, MD; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Dennis D. Weisenburger, James O. Armitage, and Julie M. Vose, University of Nebraska Medical Center, Omaha, NE
| | - Elaine S. Jaffe
- Massimo Federico, Monica Bellei, and Stefano Luminari, Università di Modena e Reggio Emilia, Modena; Stefano A. Pileri, Università di Bologna, Bologna, Italy; Thomas Rudiger, Stadisches Klinikum Karlsruhe, Karlsruhe, Germany; Bharat N. Nathwani, Ceders-Sinai Medical Center and University of Southern California Keck School of Medicine, Los Angeles, CA; Bertrand Coiffier, Hospices Civils de Lyon, Lyon; Nicholas Mounier, Hospital l'Archet, Nice, France; Nancy L. Harris, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Elaine S. Jaffe, National Cancer Institute, Bethesda, MD; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Dennis D. Weisenburger, James O. Armitage, and Julie M. Vose, University of Nebraska Medical Center, Omaha, NE
| | - Stefano A. Pileri
- Massimo Federico, Monica Bellei, and Stefano Luminari, Università di Modena e Reggio Emilia, Modena; Stefano A. Pileri, Università di Bologna, Bologna, Italy; Thomas Rudiger, Stadisches Klinikum Karlsruhe, Karlsruhe, Germany; Bharat N. Nathwani, Ceders-Sinai Medical Center and University of Southern California Keck School of Medicine, Los Angeles, CA; Bertrand Coiffier, Hospices Civils de Lyon, Lyon; Nicholas Mounier, Hospital l'Archet, Nice, France; Nancy L. Harris, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Elaine S. Jaffe, National Cancer Institute, Bethesda, MD; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Dennis D. Weisenburger, James O. Armitage, and Julie M. Vose, University of Nebraska Medical Center, Omaha, NE
| | - Kerry J. Savage
- Massimo Federico, Monica Bellei, and Stefano Luminari, Università di Modena e Reggio Emilia, Modena; Stefano A. Pileri, Università di Bologna, Bologna, Italy; Thomas Rudiger, Stadisches Klinikum Karlsruhe, Karlsruhe, Germany; Bharat N. Nathwani, Ceders-Sinai Medical Center and University of Southern California Keck School of Medicine, Los Angeles, CA; Bertrand Coiffier, Hospices Civils de Lyon, Lyon; Nicholas Mounier, Hospital l'Archet, Nice, France; Nancy L. Harris, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Elaine S. Jaffe, National Cancer Institute, Bethesda, MD; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Dennis D. Weisenburger, James O. Armitage, and Julie M. Vose, University of Nebraska Medical Center, Omaha, NE
| | - Dennis D. Weisenburger
- Massimo Federico, Monica Bellei, and Stefano Luminari, Università di Modena e Reggio Emilia, Modena; Stefano A. Pileri, Università di Bologna, Bologna, Italy; Thomas Rudiger, Stadisches Klinikum Karlsruhe, Karlsruhe, Germany; Bharat N. Nathwani, Ceders-Sinai Medical Center and University of Southern California Keck School of Medicine, Los Angeles, CA; Bertrand Coiffier, Hospices Civils de Lyon, Lyon; Nicholas Mounier, Hospital l'Archet, Nice, France; Nancy L. Harris, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Elaine S. Jaffe, National Cancer Institute, Bethesda, MD; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Dennis D. Weisenburger, James O. Armitage, and Julie M. Vose, University of Nebraska Medical Center, Omaha, NE
| | - James O. Armitage
- Massimo Federico, Monica Bellei, and Stefano Luminari, Università di Modena e Reggio Emilia, Modena; Stefano A. Pileri, Università di Bologna, Bologna, Italy; Thomas Rudiger, Stadisches Klinikum Karlsruhe, Karlsruhe, Germany; Bharat N. Nathwani, Ceders-Sinai Medical Center and University of Southern California Keck School of Medicine, Los Angeles, CA; Bertrand Coiffier, Hospices Civils de Lyon, Lyon; Nicholas Mounier, Hospital l'Archet, Nice, France; Nancy L. Harris, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Elaine S. Jaffe, National Cancer Institute, Bethesda, MD; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Dennis D. Weisenburger, James O. Armitage, and Julie M. Vose, University of Nebraska Medical Center, Omaha, NE
| | - Nicholas Mounier
- Massimo Federico, Monica Bellei, and Stefano Luminari, Università di Modena e Reggio Emilia, Modena; Stefano A. Pileri, Università di Bologna, Bologna, Italy; Thomas Rudiger, Stadisches Klinikum Karlsruhe, Karlsruhe, Germany; Bharat N. Nathwani, Ceders-Sinai Medical Center and University of Southern California Keck School of Medicine, Los Angeles, CA; Bertrand Coiffier, Hospices Civils de Lyon, Lyon; Nicholas Mounier, Hospital l'Archet, Nice, France; Nancy L. Harris, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Elaine S. Jaffe, National Cancer Institute, Bethesda, MD; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Dennis D. Weisenburger, James O. Armitage, and Julie M. Vose, University of Nebraska Medical Center, Omaha, NE
| | - Julie M. Vose
- Massimo Federico, Monica Bellei, and Stefano Luminari, Università di Modena e Reggio Emilia, Modena; Stefano A. Pileri, Università di Bologna, Bologna, Italy; Thomas Rudiger, Stadisches Klinikum Karlsruhe, Karlsruhe, Germany; Bharat N. Nathwani, Ceders-Sinai Medical Center and University of Southern California Keck School of Medicine, Los Angeles, CA; Bertrand Coiffier, Hospices Civils de Lyon, Lyon; Nicholas Mounier, Hospital l'Archet, Nice, France; Nancy L. Harris, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Elaine S. Jaffe, National Cancer Institute, Bethesda, MD; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Dennis D. Weisenburger, James O. Armitage, and Julie M. Vose, University of Nebraska Medical Center, Omaha, NE
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