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Chen H, Qin Y, Yang J, Liu P, He X, Zhou S, Zhang C, Yang S, Gui L, Sun Y, Shi Y. Dismal outcome of relapsed or primary refractory adult T-cell lymphoblastic lymphoma: A retrospective study from China. Asia Pac J Clin Oncol 2021; 18:e87-e95. [PMID: 34161657 DOI: 10.1111/ajco.13562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 12/29/2020] [Indexed: 11/27/2022]
Abstract
AIM Little is known about the outcome and prognostic factors of relapsed or refractory T-cell lymphoblastic lymphoma (T-LBL), especially in adult patients. The aim of this study was to analyze the characteristics, outcome and prognostic factors for this patient population. METHODS Between January 2006 and December 2017, we retrospectively analyzed 84 adult patients with T-LBL, and 44 relapsed or primary refractory patients were included in this analysis. Clinical features, treatment and follow-up information were collected. RESULTS For all 44 patients, the median time to disease progression or relapse was 9.5 months after diagnosis. At a median follow-up of 19.6 months, 40 (90.9%) patients died. The 3- and 5-year overall survival (OS) rates after disease progression or relapse were 7.8% and 5.2%, respectively. Among 30 patients who had detailed information of second-line treatment, only eight achieved a second complete remission (CR). Two of these eight patients subsequently underwent autologous or allogeneic stem cell transplantation (SCT), of whom one died from disease progression after autologous SCT, and one was free of event at 84 months after allogeneic SCT. Three of the rest six patients in second CR were still alive after chemotherapy alone. All the remaining patients who failed to gain second CR eventually died. In univariate analysis, only the achievement of second CR was positively predictive of OS (hazard ratio (HR) = 0.307; 95% confidence interval (CI), 0.104-0.905; P = 0.032). CONCLUSION The outcome of adult patients with relapsed or refractory T-LBL is extremely dismal. Patients with relapsed or refractory T-LBL should be encouraged to participate in clinical trials where novel therapeutic approaches are available.
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Affiliation(s)
- Haizhu Chen
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Yan Qin
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Jianliang Yang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Peng Liu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Xiaohui He
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Shengyu Zhou
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Changgong Zhang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Sheng Yang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Lin Gui
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Yan Sun
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Yuankai Shi
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
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Event-free survival at 24 months is a robust surrogate endpoint for long-term survival in pediatric, adolescent, and adult T cell lymphoblastic lymphoma. Ann Hematol 2020; 99:2847-2857. [PMID: 32712792 DOI: 10.1007/s00277-020-04195-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/20/2020] [Indexed: 12/29/2022]
Abstract
T cell lymphoblastic lymphoma (T-LBL) has an aggressive clinical behavior. To date, powerful and consistent prognostic factors have not been established for T-LBL. In this study, we first evaluated the association of event-free survival (EFS) at 24 months (EFS24) with overall survival (OS) in T-LBL patients. Besides, we sought to identify clinical factors of prognostic importance in this rare entity. Between January 2006 and December 2017, ninety-one patients with newly diagnosed T-LBL were retrospectively analyzed. EFS was defined as the time from diagnosis to relapse or progression, unplanned retreatment, death from any cause, or to the last follow-up. In total, 91 patients with a median age of 24 years were enrolled. At a median follow-up of 40.4 months (range, 1.4 to 163.3 months), the 5-year OS and EFS was 47.9% and 43.2%, respectively. Of all patients, 45 (49.5%) achieved EFS24 and 46 (50.5%) did not. Patients who achieved EFS24 showed a markedly superior outcome, compared with those who failed to achieve EFS24 (5-year OS, 90.5% vs 3%, P < 0.001). Univariate analysis indicated bone marrow involvement, response to induction treatment, and stem cell transplantation (SCT) consolidation to be prognostic factors for EFS and OS. In addition, compared with the patients receiving non-Hodgkin's lymphoma (NHL)-like treatment protocols, patients treated with hyper-CVAD showed significantly improved EFS and OS. Such survival advantage in terms of EFS and OS was also observed of BMF-90 regimens over NHL-like therapy, despite that the difference in EFS did not reach statistical significance (P = 0.056). Multivariate analysis demonstrated that achievement of complete remission (CR) after induction therapy and SCT consolidation were independent prognostic indicators for both EFS and OS. We confirm that EFS24 is a strong surrogate endpoint for long-term survival in T-LBL, which is clinically useful for individualized risk reassessment, future clinical trial design, and biomarker discovery validation. Further validation in the context of directed prospective clinical trials is warranted.
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Jain P, Kantarjian H, Jain N, Short NJ, Yin CC, Kanagal-Shamanna R, Khoury J, Konopleva M, Sasaki K, Kadia TM, Garris R, Pierce S, Estrov Z, Wierda W, Cortes J, O'Brien S, Ravandi F, Jabbour E. Clinical characteristics and outcomes of previously untreated patients with adult onset T-acute lymphoblastic leukemia and T-lymphoblastic lymphoma with hyper-CVAD based regimens. Am J Hematol 2017. [PMID: 28646517 DOI: 10.1002/ajh.24833] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Preetesh Jain
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Hagop Kantarjian
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Nitin Jain
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Nicholas J. Short
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Cameron C. Yin
- Department of Hematopathology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Rashmi Kanagal-Shamanna
- Department of Hematopathology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Joseph Khoury
- Department of Hematopathology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Marina Konopleva
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Koji Sasaki
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Tapan M. Kadia
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Rebecca Garris
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Sherry Pierce
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Zeev Estrov
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - William Wierda
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Jorge Cortes
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Susan O'Brien
- Chao Family Comprehensive Cancer Center, University of California Irvine; Orange California
| | - Farhad Ravandi
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Elias Jabbour
- Department of Leukemia; The University of Texas MD Anderson Cancer Center; Houston Texas
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Becker S, Vermeulin T, Cottereau AS, Boissel N, Vera P, Lepretre S. Predictive value of 18F-FDG PET/CT in adults with T-cell lymphoblastic lymphoma: post hoc analysis of results from the GRAALL-LYSA LLO3 trial. Eur J Nucl Med Mol Imaging 2017; 44:2034-2041. [PMID: 28733763 DOI: 10.1007/s00259-017-3776-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 07/06/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE We examined whether FDG PET can be used to predict outcome in patients with lymphoblastic lymphoma (LL). METHODS This was a retrospective post hoc analysis of data from the GRAAL-LYSA LL03 trial, in which the treatment of LL using an adapted paediatric-like acute lymphoblastic leukaemia protocol was evaluated. PET data acquired at baseline and after induction were analysed. Maximum standardized uptake values (SUVmax), total metabolic tumour volume and total lesion glycolysis were measured at baseline. The relative changes in SUVmax from baseline (ΔSUVmax) and the Deauville score were determined after induction. RESULTS The population analysed comprised 36 patients with T-type LL. SUVmax using a cut-off value of ≤8.76 vs. >8.76 was predictive of 3-year event-free survival (31.6% vs. 80.4%; p = 0.013) and overall survival (35.0% vs. 83.7%; p = 0.028). ΔSUVmax using a cut-off value of ≤80% vs. >80% tended also to be predictive of 3-year event-free survival (40.0% vs. 76.0%; p = 0.054) and overall survival (49.2% vs. 85.6%; p = 0.085). Total metabolic tumour volume, baseline total lesion glycolysis and response according to the Deauville score were not predictive of outcome. CONCLUSIONS A low initial SUVmax was predictive of worse outcomes in our series of patients with T-type LL. Although relatively few patients were included, the study also suggested that ΔSUVmax may be useful for predicting therapeutic efficacy.
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Affiliation(s)
- Stéphanie Becker
- Department of Nuclear Medicine, Centre Henri-Becquerel, Rue d'Amiens, 76038, Rouen Cedex, France.
- QuantIF-LITIS (EA [Equipe d'Accueil] 4108), Faculty of Medicine, University of Rouen, Rouen, France.
| | - Thomas Vermeulin
- Department of Biostatistics, Rouen University Hospital, Rouen, France
| | | | - Nicolas Boissel
- Department of Hematology, Hôpital Saint-Louis, AP-HP, Université Paris Diderot, EA3518, Paris, France
| | - Pierre Vera
- Department of Nuclear Medicine, Centre Henri-Becquerel, Rue d'Amiens, 76038, Rouen Cedex, France
- QuantIF-LITIS (EA [Equipe d'Accueil] 4108), Faculty of Medicine, University of Rouen, Rouen, France
| | - Stéphane Lepretre
- Inserm U1245 and Department of Hematology, Centre Henri Becquerel and Normandie Univ UNIROUEN, Rouen, France
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Adult T-type lymphoblastic lymphoma: Treatment advances and prognostic indicators. Exp Hematol 2017; 51:7-16. [DOI: 10.1016/j.exphem.2017.04.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/24/2017] [Accepted: 04/03/2017] [Indexed: 12/19/2022]
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Prognostic Factors and Outcomes of Adult Lymphoblastic Lymphoma in the United States. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017. [PMID: 28647403 DOI: 10.1016/j.clml.2017.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND T-lymphoblastic lymphoma (T-LL) and B-lymphoblastic lymphoma (B-LL) are aggressive lymphoid neoplasms accounting for 2% to 4% of adult non-Hodgkin lymphoma. The aim of the present analysis was to characterize the clinical features and histologic subtypes and to assess the clinical prognostic factors for 696 adult patients with LL, the largest epidemiologic sample to date. PATIENTS AND METHODS The present retrospective cohort study used the Surveillance, Epidemiology, and End Results database to identify adult patients (age, > 18 years) with LL with data recorded from 2001 to 2012. We used multivariate Cox regression models to test the clinical prognostic factors, stratified by the histologic subtype. RESULTS Of 696 patients with LL (median age, 39 years), 367 (53%) had T-LL and 131 (19%) had B-LL. Patients with T-LL tended to be younger (33 years vs. 48 years), male (66% vs. 50.4%), and less likely to have extranodal involvement (6% vs. 32%) compared with those with B-LL. The 5-year survival rate for those with B-LL versus those with T-LL was not significantly different (45% vs. 48%; P = .58), even in a model adjusted for clinical features, disease stage, primary site, radiotherapy, and year of diagnosis (adjusted hazard ratio, 0.93; 95% confidence interval, 0.69-1.25; P = .63). Multivariate analysis identified age, race, and radiotherapy as independent prognostic factors for outcome in T-LL. Limited tumor stage and the most recent year of diagnosis were favorable prognostic factors for B-LL. CONCLUSION Adult patients with LL have poor long-term outcomes and novel therapies are needed. Radiotherapy had a positive effect on T-LL outcomes.
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Brunvand MW, Carson J. Complete remission with romidepsin in a patient with T-cell acute lymphoblastic leukemia refractory to induction hyper-CVAD. Hematol Oncol 2017; 36:340-343. [PMID: 28560733 PMCID: PMC5836898 DOI: 10.1002/hon.2421] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 03/14/2017] [Accepted: 03/20/2017] [Indexed: 11/09/2022]
Abstract
T‐cell acute lymphoblastic leukemia (T‐ALL) and T‐cell lymphoblastic lymphoma (T‐LBL) are neoplasms that originate from T‐cell precursors. Outcomes in adult patients with T‐ALL/LBL remain unsatisfactory; early relapse following intensive induction chemotherapy is a concern, and patients with relapsed or refractory disease have a poor prognosis. Romidepsin is a potent, class 1 selective histone deacetylase inhibitor approved for the treatment of patients with peripheral T‐cell lymphoma who have had ≥1 prior therapy and patients with cutaneous T‐cell lymphoma who have had ≥1 prior systemic therapy. Here, we report the case of an adult patient with T‐ALL refractory to induction hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (hyper‐CVAD). Treatment with romidepsin was initiated, and romidepsin in combination with hyper‐CVAD resulted in complete remission, with mild tumor lysis syndrome as the only detectable additional toxicity. The patient eventually underwent allogeneic stem cell transplant while in first complete remission. Prior studies have shown that romidepsin is capable of inducing durable responses with manageable toxicities in patients with mature T‐cell lymphomas. This case study describes the successful use of romidepsin in combination with hyper‐CVAD in an adult patient with refractory T‐ALL and highlights the activity of romidepsin in the T‐cell lineage. The potential of romidepsin‐containing regimens in patients with T‐ALL/LBL deserves further study.
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Affiliation(s)
| | - John Carson
- Colorado Blood Cancer Institute, Denver, CO, USA
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Cortelazzo S, Ferreri A, Hoelzer D, Ponzoni M. Lymphoblastic lymphoma. Crit Rev Oncol Hematol 2017; 113:304-317. [DOI: 10.1016/j.critrevonc.2017.03.020] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 03/12/2017] [Accepted: 03/15/2017] [Indexed: 12/15/2022] Open
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Servitzoglou M, De Vathaire F, Oberlin O, Patte C, Thomas-Teinturier C. Dose-Effect Relationship of Alkylating Agents on Testicular Function in Male Survivors of Childhood Lymphoma. Pediatr Hematol Oncol 2016; 32:613-23. [PMID: 26561347 DOI: 10.3109/08880018.2015.1085933] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of our study was to assess the gonadal function in male survivors of childhood lymphoma. We studied 171 male survivors of childhood lymphoma (83 with B-cell non-Hodgkin lymphoma [B-NHL], 32 with T-cell non-Hodgkin lymphoma [T-NHL], 50 with Hodgkin lymphoma [HL], and 6 with anaplastic large-cell lymphoma [ALCL]), measuring follicle-stimulating hormone [FSH] and luteinizing hormone [LH] levels at a median age of 21.1 (17-30.4) years after a median delay of 9.3 (2-22.4) years from treatment. FSH levels were above normal range (≥10 IU/L) in 42.1% and LH levels ≥8 IU/L in only 8.9% of survivors. In multivariate analysis, only the following chemotherapeutic agents were associated with higher FSH or LH levels: cyclophosphamide (P < .0001, .04), lomustine (CCNU; P = .002, 0.04), and procarbazine (P < .0001, .07). No significant correlation was found between FSH or LH levels and age or pubertal status at diagnosis. Mean FSH level was significantly lower in NHL survivors treated more recently: 6 ± 5.1 IU/L in B-NHL survivors treated since 1986 versus 12.3 ± 5.4 IU/L for those treated before 1981 (P = .0001), and 6.8 ± 9.6 IU/L in T-NHL survivors treated since 1989 versus 9.4 ± 5.7 IU/L for those treated before 1989 (P = .035). In HL, mean FSH level was 12.4 ± 9.9 IU/L following procarbazine containing chemotherapy versus 3.4 ± 1.9 IU/L in the absence of procarbazine and increased significantly with the number of MOPP/OPPA (mechlorethamine, Oncovin [vincristine], procarbazine, and prednisone/Oncovin, procarbazine, and prednisone, and Adriamycin [doxorubicin]) courses received, from 6.8 ± 5.7 IU/L for 1-2 MOPP/OPPA to 12.6 ± 7.5 for 3-4 MOPP/OPPA and 19.6 ± 13.3 for more than 4 MOPP/OPPA (P for trend = .006). Testicular toxicity of alkylating agents on childhood lymphoma survivors is dose dependent and not correlated to diagnosis, age, or pubertal status at diagnosis.
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Affiliation(s)
- Marina Servitzoglou
- a Department of Pediatric Oncology , Institut Gustave Roussy , Villejuif , France
| | - Florent De Vathaire
- b Radiation Epidemiology Group, Center for Research in Epidemiology and Population Health (CESP), Inserm U1018 , Université Paris-Sud XI , Villejuif , France
| | - Odile Oberlin
- a Department of Pediatric Oncology , Institut Gustave Roussy , Villejuif , France
| | - Catherine Patte
- a Department of Pediatric Oncology , Institut Gustave Roussy , Villejuif , France
| | - Cécile Thomas-Teinturier
- b Radiation Epidemiology Group, Center for Research in Epidemiology and Population Health (CESP), Inserm U1018 , Université Paris-Sud XI , Villejuif , France.,c Department of Pediatric Endocrinology, APHP , Hôpitaux Paris-Sud , Site Bicetre , Le Kremlin-Bicetre , France
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Results of treatment of lymphoblastic lymphoma at the children cancer hospital Egypt - A single center experience. J Egypt Natl Canc Inst 2016; 28:175-81. [PMID: 27339800 DOI: 10.1016/j.jnci.2016.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 05/05/2016] [Accepted: 05/09/2016] [Indexed: 12/22/2022] Open
Abstract
Introduction Lymphoblastic lymphoma (LBL) and acute lymphoblastic leukemia (ALL) are neoplasms of immature B or T-cell precursors. They are considered as a unique biological entity in the 2008 World Health Organization Classification of Hematologic Neoplasm. Both entities are arbitrarily separated by a cut-off point of 20-25% of blast cells in the bone marrow. Treatment of LBL has evolved over time from conventional high-grade NHL schedules to ALL-derived protocols. The aim of this work is to report the clinical characteristics, overall survival (OS), event free survival (EFS), and common chemotherapy toxicities of lymphoblastic lymphoma (LBL) patients during a 5.5year period. Patients and methods A Retrospective review of patient's charts diagnosed and treated as LBL during the period between July 2007 and end of December 2012 was done. Patients were treated according to St. Jude Children Research Hospital ALL Total Therapy XV protocol, standard risk arm. Results This study included 77 patients. T-cell LBL patients were 67, while 10 were of B-cell origin. The median age at diagnosis was 9years (95% CI: 7-10). The majority were males 54/77. Stage III patients were 51, stage IV 13, stage II 11 and stage I 2 patients. Two patients were excluded from analysis as they died before receiving chemotherapy. Complete remission post induction chemotherapy was seen in 22 patients considered early responders, and partial remission in 55 considered late responders. With a median follow up duration of 47months (95% CI: 38-56), the 4year overall survival and event free survival were 86.45% (95% CI: 73.78-94.09) and 82.18% (95% CI: 69.25-90.61) respectively. Twelve patients died during the study period; 2 early deaths before starting chemotherapy from disease progression, 2 in CR due to chemotherapy related toxicity and 8 from disease progression. All the relapsed patients were T-cell, had advanced disease at presentation (6 with stage III; 2 with stage IV). Two patients (2.6%) had isolated local, BM, and CNS relapse each, while 1 (1.3%) had both local and CNS relapse. Disease recurrence was local in 3 patients (3.9%), and systemic in 5 (6.4%), while it was early in 6 (7.8%), and late in 2 (2.6%) patients. Median time to disease progression was 20months (range 5-39months). All relapsed patients did not survive salvage chemotherapy. The most common chemotherapy toxicities were cerebral venous thrombosis (20%), followed by bone infarcts (10.6%), and avascular necrosis (AVN) of head of femur (9.3%). One patient developed secondary acute myeloid leukemia after 3years of FU with unfavorable cytogenetic abnormalities. Conclusion Results of treatment of LBL on the St Jude's total therapy XV study are comparable to most of the similar reported studies. Outcome of relapsing patients is extremely poor, hence there is a need to identify biologic or clinical prognostic factors including minimal residual tumor to better evaluate chemotherapy response. Steroid induced AVN, and cerebral vascular thrombosis were the main chemotherapeutic adverse events.
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Alderuccio JP, Amarapurkar P, Chapman JR, Vega F, Lossos IS. Characteristics and outcomes of lymphoblastic lymphoma - the University of Miami experience. Leuk Lymphoma 2016; 58:195-198. [PMID: 27252116 DOI: 10.1080/10428194.2016.1177774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Juan Pablo Alderuccio
- a Department of Medicine, Division of Hematology-Oncology , Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine , Miami , FL , USA
| | - Pooja Amarapurkar
- b Department of Medicine, Division of Internal Medicine , Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine , Miami , FL , USA
| | - Jennifer R Chapman
- c Department of Pathology and Laboratory Medicine, Division of Hematopathology , Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine , Miami , FL , USA
| | - Francisco Vega
- a Department of Medicine, Division of Hematology-Oncology , Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine , Miami , FL , USA.,c Department of Pathology and Laboratory Medicine, Division of Hematopathology , Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine , Miami , FL , USA
| | - Izidore S Lossos
- a Department of Medicine, Division of Hematology-Oncology , Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine , Miami , FL , USA.,d Department of Molecular and Cellular Pharmacology , Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine , Miami , FL , USA
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12
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Kim SY, Shin DY, Kim SM, Lee M, Kim EJ. Aberrant DNA methylation-induced gene inactivation is associated with the diagnosis and/or therapy of T-cell leukemias. Leuk Res 2016; 47:116-22. [PMID: 27318093 DOI: 10.1016/j.leukres.2016.05.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/13/2016] [Accepted: 05/26/2016] [Indexed: 12/31/2022]
Abstract
Aberrant hypermethylation of tumor suppressor genes is known to play an important role in the development of many tumors, and aberrant DNA hypermethylation was recently identified in hematologic malignancies, where it is thought to hold relevance in leukemogenesis. Here, we report that there are differences in the DNA methylation patterns seen in normal peripheral blood and two T-cell leukemia cell lines. We identify nine genes (CLEC4E, CR1, DBC1, EPO, HAL-DOA, IGF2, IL12B, ITGA1, and LMX1B) that are significantly hypermethylated in T-cell leukemias cell lines, and suggest that aberrant hypermethylation of these normally unmethylated genes may induce their transcriptional and expressional silencing. Furthermore, we observed that the expression levels of DNMT1 and DNMT3a were significantly decreased by 5-aza-2'-deoxycytidine (5-Aza-dC), which is a demethylation agent known to deplete DNA methyltransferases (DNMTs) in leukemia cancer cells and restore the expression levels of their target genes in Jurkat cells. This result suggests that the overexpression of DNMTs could contribute to the development of T-cell leukemias by inducing hypermethylation of the target genes. Together, our results show that aberrant hypermethylation is an important molecular mechanism in the progression of T-cell leukemias, and thus could prove useful as a prognostic and/or diagnostic marker. Moreover, 5-Aza-dC might be a promising candidate for the treatment of T-cell leukemia.
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Affiliation(s)
- Sun Young Kim
- Division of Radiation Effect, Korea Institute of Radiological & Medical Sciences, Seoul 01812, Korea
| | - Dong-Yeop Shin
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Sang-Man Kim
- Health Services Management, KH School of Management, Kyung Hee University, Seoul 02453, Korea
| | - Minyoung Lee
- Division of Radiation Effect, Korea Institute of Radiological & Medical Sciences, Seoul 01812, Korea.
| | - Eun Ju Kim
- Division of Radiation Effect, Korea Institute of Radiological & Medical Sciences, Seoul 01812, Korea; Health Services Management, KH School of Management, Kyung Hee University, Seoul 02453, Korea.
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Sever C, Abbott CL, de Baca ME, Khoury JD, Perkins SL, Reichard KK, Taylor A, Terebelo HR, Colasacco C, Rumble RB, Thomas NE. Bone Marrow Synoptic Reporting for Hematologic Neoplasms: Guideline From the College of American Pathologists Pathology and Laboratory Quality Center. Arch Pathol Lab Med 2016; 140:932-49. [PMID: 26905483 DOI: 10.5858/arpa.2015-0450-sa] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT -There is ample evidence from the solid tumor literature that synoptic reporting improves accuracy and completeness of relevant data. No evidence-based guidelines currently exist for synoptic reporting for bone marrow samples. OBJECTIVE -To develop evidence-based recommendations to standardize the basic components of a synoptic report template for bone marrow samples. DESIGN -The College of American Pathologists Pathology and Laboratory Quality Center convened a panel of experts in hematopathology to develop recommendations. A systematic evidence review was conducted to address 5 key questions. Recommendations were derived from strength of evidence, open comment feedback, and expert panel consensus. RESULTS -Nine guideline statements were established to provide pathology laboratories with a framework by which to develop synoptic reporting templates for bone marrow samples. The guideline calls for specific data groups in the synoptic section of the pathology report; provides a list of evidence-based parameters for key, pertinent elements; and addresses ancillary testing. CONCLUSION -A framework for bone marrow synoptic reporting will improve completeness of the final report in a manner that is clear, succinct, and consistent among institutions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Nicole E Thomas
- From the Department of Hematopathology, Pathology Associates of Albuquerque, Albuquerque, New Mexico (Dr Sever); the Department of Pathology, Berkshire Medical Center, Pittsfield, Massachusetts (Dr Abbott); Medical Laboratory Associates, Seattle, Washington (Dr de Baca); the Department of Pathology, University of Texas MD Anderson Cancer Center, Houston (Dr Khoury); the Department of Pathology, University of Utah, Salt Lake City (Dr Perkins); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Dr Reichard); Utah Pathology Services, Inc, Salt Lake City (Dr Taylor); the Department of Hematology/Medical Oncology, Newland Medical Associates, Novi, Michigan (Dr Terebelo); the Departments of Governance (Ms Colasacco) and Surveys (Ms Thomas), College of American Pathologists, Northfield, Illinois; and the Quality and Guidelines Department, American Society of Clinical Oncology, Alexandria, Virginia (Mr Rumble)
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Bassan R, Maino E, Cortelazzo S. Lymphoblastic lymphoma: an updated review on biology, diagnosis, and treatment. Eur J Haematol 2016; 96:447-60. [DOI: 10.1111/ejh.12722] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2015] [Indexed: 12/21/2022]
Affiliation(s)
- Renato Bassan
- Unità Operativa Complessa di Ematologia; Ospedale dell'Angelo & Ospedale SS. Giovanni e Paolo; Mestre-Venezia Italy
| | - Elena Maino
- Unità Operativa Complessa di Ematologia; Ospedale dell'Angelo & Ospedale SS. Giovanni e Paolo; Mestre-Venezia Italy
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Shi Y, Zhou S, He X, Han X, Wu S, Pan F, Liu P, Liu Y, Lei Y, Zhang H, Yang J, Qin Y, Zhang C, Yang S, Zhao L, Luo K, Wu G, Sun Y, Shi Y. Autologous hematopoietic stem cell transplantation in chemotherapy-sensitive lymphoblastic lymphoma: treatment outcome and prognostic factor analysis. Chin J Cancer Res 2015; 27:66-73. [PMID: 25717228 DOI: 10.3978/j.issn.1000-9604.2015.02.04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 01/23/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The study evaluated the effectiveness of autologous hematopoietic stem cell transplantation (AHSCT) in the treatment of lymphoblastic lymphoma (LL). METHODS We retrospectively analyzed the data from 41 patients with chemotherapy-sensitive LL who underwent hematopoietic stem cell transplantation (HSCT) from December 1989 to December 2009 in a single institution. RESULTS HSCT was conducted as first-line consolidation therapy and salvage therapy in 36 and 5 patients, respectively. The median follow-up was 97.1 months (range, 24.6-173.1 months). The 5-year overall survival (OS) and event-free survival (EFS) rate were 64% and 47% for the initially treated patients, respectively, and were both 20% for the relapsed ones. Bone marrow (BM) involvement and chemotherapy cycles prior to transplantation were identified as significant prognostic factors for EFS in multivariate analysis. CONCLUSIONS These results confirm that AHSCT is a reasonable option for chemotherapy-sensitive LL patients in first complete remission (CR1).
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Affiliation(s)
- Youwu Shi
- 1 Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China ; 2 National Center for Anticancer Drugs Clinical Study, Beijing 100021, China ; 3 Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China ; 4 Department of Radiation Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Shengyu Zhou
- 1 Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China ; 2 National Center for Anticancer Drugs Clinical Study, Beijing 100021, China ; 3 Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China ; 4 Department of Radiation Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Xiaohui He
- 1 Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China ; 2 National Center for Anticancer Drugs Clinical Study, Beijing 100021, China ; 3 Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China ; 4 Department of Radiation Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Xiaohong Han
- 1 Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China ; 2 National Center for Anticancer Drugs Clinical Study, Beijing 100021, China ; 3 Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China ; 4 Department of Radiation Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Shikai Wu
- 1 Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China ; 2 National Center for Anticancer Drugs Clinical Study, Beijing 100021, China ; 3 Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China ; 4 Department of Radiation Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Feng Pan
- 1 Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China ; 2 National Center for Anticancer Drugs Clinical Study, Beijing 100021, China ; 3 Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China ; 4 Department of Radiation Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Peng Liu
- 1 Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China ; 2 National Center for Anticancer Drugs Clinical Study, Beijing 100021, China ; 3 Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China ; 4 Department of Radiation Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Yinyu Liu
- 1 Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China ; 2 National Center for Anticancer Drugs Clinical Study, Beijing 100021, China ; 3 Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China ; 4 Department of Radiation Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Yingheng Lei
- 1 Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China ; 2 National Center for Anticancer Drugs Clinical Study, Beijing 100021, China ; 3 Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China ; 4 Department of Radiation Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Hongzhi Zhang
- 1 Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China ; 2 National Center for Anticancer Drugs Clinical Study, Beijing 100021, China ; 3 Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China ; 4 Department of Radiation Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Jianliang Yang
- 1 Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China ; 2 National Center for Anticancer Drugs Clinical Study, Beijing 100021, China ; 3 Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China ; 4 Department of Radiation Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Yan Qin
- 1 Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China ; 2 National Center for Anticancer Drugs Clinical Study, Beijing 100021, China ; 3 Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China ; 4 Department of Radiation Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Changgong Zhang
- 1 Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China ; 2 National Center for Anticancer Drugs Clinical Study, Beijing 100021, China ; 3 Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China ; 4 Department of Radiation Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Sheng Yang
- 1 Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China ; 2 National Center for Anticancer Drugs Clinical Study, Beijing 100021, China ; 3 Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China ; 4 Department of Radiation Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Liya Zhao
- 1 Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China ; 2 National Center for Anticancer Drugs Clinical Study, Beijing 100021, China ; 3 Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China ; 4 Department of Radiation Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Kehuan Luo
- 1 Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China ; 2 National Center for Anticancer Drugs Clinical Study, Beijing 100021, China ; 3 Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China ; 4 Department of Radiation Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Guanqing Wu
- 1 Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China ; 2 National Center for Anticancer Drugs Clinical Study, Beijing 100021, China ; 3 Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China ; 4 Department of Radiation Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Yan Sun
- 1 Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China ; 2 National Center for Anticancer Drugs Clinical Study, Beijing 100021, China ; 3 Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China ; 4 Department of Radiation Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Yuankai Shi
- 1 Department of Medical Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China ; 2 National Center for Anticancer Drugs Clinical Study, Beijing 100021, China ; 3 Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China ; 4 Department of Radiation Oncology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
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Ryu IH, Cho IS, Ryu AJ, Kim MG, Jeon JW, Kim JS, Lee JJ, Choi JW, Kang DW. Long-Term Survival after T-cell Lymphoblastic Lymphoma Treated with One Cycle of Hyper-CVAD Regimen. Cancer Res Treat 2014; 47:115-9. [PMID: 25152191 PMCID: PMC4296853 DOI: 10.4143/crt.2013.122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 09/15/2013] [Indexed: 11/21/2022] Open
Abstract
T-lymphoblastic lymphoma (T-LBL) is a rare form of aggressive non-Hodgkin's lymphoma. The standard approach for management of T-LBL involves intensive multiagent chemotherapy regimens for induction and consolidation phases with central nervous system prophylaxis and a maintenance phase lasting 12-18 months. We report on a case of long-term survival after one cycle of hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (hyper-CVAD) and high-dose methotrexate. A 30-year-old woman diagnosed with T-LBL with a large mediastinal mass underwent one cycle of hyper-CVAD. Four days after the start of treatment, the mediastinal mass was markedly reduced. Treatment continued with one cycle of consolidation chemotherapy, comprising high-dose methotrexate and high-dose cytarabine. The patient then refused all further chemotherapeutic treatment. Seven years have passed without relapse.
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Affiliation(s)
- Il Hwan Ryu
- Departments of Internal Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - In Sung Cho
- Departments of Internal Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Ah Jeong Ryu
- Departments of Internal Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Min Gyu Kim
- Departments of Internal Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Jae Woong Jeon
- Departments of Internal Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Joo Seok Kim
- Departments of Internal Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Jae Joon Lee
- Departments of Internal Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Ji Wook Choi
- Departments of Internal Medicine, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Dong Wook Kang
- Departments of Pathology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
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Bersvendsen H, Kolstad A, Blystad AK, Aurlien E, Fosså A, Kvaløy SO, Holte H, Lauritzsen GF. Multimodal treatment with ALL-like chemotherapy, Auto-SCT and radiotherapy for lymphoblastic lymphoma. Acta Oncol 2014; 53:680-7. [PMID: 24237392 DOI: 10.3109/0284186x.2013.855816] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Recommended treatment for lymphoblastic lymphomas, a highly aggressive, relatively rare lymphoma entity predominantly seen in teenagers and young adults, includes acute lymphoblastic leukemia (ALL)-like induction chemotherapy. Whether these patients should be consolidated with maintenance chemotherapy or autologous stem cell transplantation (Auto-SCT) and the use of radiotherapy are matters of debate. METHODS We reviewed treatment and outcome for 25 consecutive patients above the age of 15 years with lymphoblastic lymphoma (T-lineage; T-LBL, n = 19; B-lineage; B-LBL, n = 6) seen at a single center during a 12-year period (1999-2011). Patients were given an ALL-like chemotherapy induction regimen, and responding patients were consolidated with Auto-SCT and local radiotherapy when applicable. RESULTS Median age at diagnosis was 33 years (range 15-65). Seventeen of the T-LBL patients had a mediastinal mass, three patients had central nervous system (CNS) involvement. Chemotherapy with intensified CNS prophylaxis induced an overall response rate of 92% (CR 84%, PR 8%). In total 23/25 (92%) patients underwent Auto-SCT in first remission while 13 of 14 eligible patients with mediastinal involvement received local radiotherapy. Twenty percent of the patients had hepatotoxicity grade 3-4 and 32% thromboembolic events (TE). Two patients (8%) died of treatment-related toxicity. One patient had progressive disease and died of lymphoma. Three patients have relapsed, but two of these (both B-LBL) are currently alive in second CR after Allo-SCT. With a median follow-up of 98 months (range 1-163) the 5- and 8-year PFS and OS are 76% and 84%, respectively. CONCLUSIONS Combined intensive ALL-like induction and early consolidation chemotherapy followed by Auto-SCT and local radiation therapy resulted in high sustained cure rates.
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Affiliation(s)
- Hanne Bersvendsen
- Department of Oncology, University Hospital of Northern Norway HF , Tromsø , Norway
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18
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Wang K, Chen X, Wuxiao Z, Wang Z, Sun X, Zeng Z, Li S, Xia ZJ. Long-term outcomes of modified Berlin-Frankfurt-Münster-90 regimen in adults with T-lymphoblastic lymphoma: a single-center experience. Leuk Lymphoma 2014; 55:1800-5. [PMID: 24475787 DOI: 10.3109/10428194.2013.828350] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The standard treatment for adult T-Lymphoblastic lymphoma (T-LBL) has not been defined. This study was to analyze the efficiency of modified BFM-NHL-90 regimen in 36 adult patients with newly diagnosed T-LBL at the Sun Yat-Sen cancer center between August 2000 and December 2010. After the induction protocols, 34/36 (94%) of the patients achieved complete remission or unconfirmed complete remission. At the median follow-up of 36 months, 13 patients relapsed, but no relapses were observed in the CNS. The 3-year overall survival and 3-year event-free survival rates were 66.9% and 65.4%, respectively. Patients of female gender with hepatomegaly and hemoglobin less than 120 g/L, and the time interval exceeding 38 days between induction 1a and 1b, had inferior EFS and OS. The results was comparable to the previous regimens and the regimen could prevent CNS relapse with 4 high-dose MTX every 3 months during the maintenance phase.
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Affiliation(s)
- Kefeng Wang
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center , Guangzhou, Guangdong , P. R. China
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Abstract
Adult lymphoblastic lymphoma (LBL) is an aggressive form of non-Hodgkin lymphoma occurring in predominantly adolescent and young adult men. Lymphoblastic lymphoma is rare, accounting for 1% to 2% of all non-Hodgkin lymphomas and is of T-cell phenotype in 90% of cases. Lymphoblastic lymphoma is morphologically indistinct from acute lymphoblastic leukemia (ALL). Both express their lineage-specific markers as well as terminal deoxynucleotidyl transferase. The differences are often made on clinical grounds. Lymphoblastic lymphoma is characterized by a predominantly nodal distribution of disease, often with a large mediastinal mass. Patients with less than 25% bone marrow involvement have typically been categorized as LBL rather than ALL, although this has not been applied consistently in the literature. Gene expression studies have identified differences in gene expression, with LBL expressing higher levels of genes associated with cytoskeleton, adhesion, angiogenesis, and chemotaxis than ALL. Although LBL and ALL can be distinct clinically, chemotherapy strategies are often very similar. Acute lymphoblastic leukemia regimens, which incorporate intensive multidrug induction, consolidation, delayed intensification, and maintenance, have been shown to be superior to standard lymphoma regimens. As central nervous system (CNS) relapse is common, CNS prophylaxis with high-dose chemotherapy and intrathecal therapy is also standard. The prophylactic use of CNS irradiation has declined with the introduction of chemotherapy regimens incorporating high doses of CNS-penetrating drugs such as cytarabine and methotrexate. The use of consolidative radiation to the mediastinum remains uncertain. High-dose chemotherapy followed by autologous or allogeneic transplantation as consolidation for patients in CR1 is controversial with modern intensive chemotherapy regimens, although transplantation has a proven role in the relapse setting.
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20
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Lymphoblastic lymphoma. Crit Rev Oncol Hematol 2011; 79:330-43. [DOI: 10.1016/j.critrevonc.2010.12.003] [Citation(s) in RCA: 124] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 11/09/2010] [Accepted: 12/23/2010] [Indexed: 12/21/2022] Open
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Cortelazzo S, Intermesoli T, Oldani E, Ciceri F, Rossi G, Pogliani EM, Mattei D, Romani C, Cortelezzi A, Borlenghi E, Corti C, Peruta B, Spinelli O, Rambaldi A, Bassan R. Results of a lymphoblastic leukemia-like chemotherapy program with risk-adapted mediastinal irradiation and stem cell transplantation for adult patients with lymphoblastic lymphoma. Ann Hematol 2011; 91:73-82. [DOI: 10.1007/s00277-011-1252-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 05/02/2011] [Indexed: 10/18/2022]
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Okur FV, Karadeniz C, Buyukpamukcu M, Oguz A, Yucel A, Cinaz P, Emir S, Varan A. Clinical significance of serum vascular endothelial growth factor, endostatin, and leptin levels in children with lymphoma. Pediatr Blood Cancer 2010; 55:1272-7. [PMID: 20734403 DOI: 10.1002/pbc.22722] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Accepted: 05/27/2010] [Indexed: 11/09/2022]
Abstract
BACKGROUND A number of clinical studies conducted in adults have demonstrated the prognostic significance of angiogenic factors in malignancies, however, only a limited number of studies have been conducted in children. The aim of this study was to determine serum vascular endothelial growth factor (VEGF), endostatin, and leptin levels in children with lymphoma and to investigate whether these factors provide prognostic information. PROCEDURE Serum samples from 36 children with lymphoma (non-Hodgkin lymphoma (NHL) N = 21, Hodgkin lymphoma (HL) N = 15) were collected at diagnosis and during remission. Serum samples were also collected from 18 healthy children as the control group. Serum VEGF and endostatin levels were quantified by using enzyme-linked immunosorbent assay (ELISA) and serum leptin by immunoradiometric assay. RESULTS The serum VEGF levels were found elevated in patients compared to controls (P = 0.033), while endostatin and leptin levels were lower in patients than in controls (endostatin, 43.9 ± 5.8 ng/ml vs. 123.6 ± 13.5 ng/ml, P < 0.001; leptin, 5 ± 1.5 ng/ml vs. 6.7 ± 1.2 ng/ml, P = 0.013). VEGF levels declined (pre, 151.6 ± 55.9 pg/ml vs. post, 16.2 ± 7.9 pg/ml, P = 0.041), while endostatin and leptin levels increased in patients who achieved remission (33 of 36 patients) when compared to pre-treatment levels (endostatin pre, 43.1 ± 5.9 ng/ml vs. post, 65.9 ± 6.8 ng/ml, P = 0.047; leptin, pre, 5.3 ± 1.6 ng/ml vs. post, 9.8 ± 2.7 ng/ml, P = 0.012). Serum VEGF, endostatin, and leptin levels were not predictive of survival. CONCLUSION Serial measurement of serum VEGF, endostatin, and leptin levels could potentially be used to predict response to treatment or progressive disease in children with lymphoma.
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Affiliation(s)
- Fatma Visal Okur
- Faculty of Medicine, Department of Pediatric Oncology, Gazi University, Ankara, Turkey.
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Hoelzer D, Gökbuget N. T-cell lymphoblastic lymphoma and T-cell acute lymphoblastic leukemia: a separate entity? CLINICAL LYMPHOMA & MYELOMA 2009; 9 Suppl 3:S214-21. [PMID: 19778844 DOI: 10.3816/clm.2009.s.015] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
T-cell acute lymphoblastic leukemia (T-ALL) and T-cell lymphoblastic lymphoma (T-LBL) are considered the same disease, differing by the extent of bone marrow infiltration. According to recent gene expression profiling data, T-ALL and T-LBL can be separated by prediction analysis of microarrays showing an overexpression of MML1 in T-LBL and CD47 in T-ALL. Immunophenotypes of T-LBL and T-ALL are identical but differ in frequency, with a higher rate of cortical or mature immunophenotypes in T-LBL, which is probably related to the higher rate (> 90%) of mediastinal tumors. Treatment approaches in T-LBL changed from conventional non-Hodgkin lymphoma (NHL) protocols to intensive NHL protocols but recently to ALL-designed protocols. T-ALL remission rates are 90%, and overall survival (OS) has improved to 60%-70%. Mediastinal tumors resolve in most cases of T-ALL with chemotherapy only, whereas in T-LBL additional mediastinal irradiation seems to be beneficial. Strategies for stem cell transplantation (SCT) in T-LBL and T-ALL differ. Autologous SCT in complete remission (CR) in T-LBL gives a 70% survival rate, which is similar to chemotherapy alone. In T-ALL, the subtypes of early and mature T-ALL have a poor outcome with chemotherapy alone (< 30%) and might profit from an allogeneic transplantation in first CR (OS > 50%). There seems to be no need for transplantation in thymic T-ALL in first CR. Prognostic factors are published for T-ALL but not for T-LBL. MRD may guide further treatment strategies in T-ALL and probably also in T-LBL as indications for a SCT or for the evaluation of novel, particularly T-cell-specific, drugs.
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Stark B, Avigad S, Luria D, Manor S, Reshef-Ronen T, Avrahami G, Yaniv I. Bone marrow minimal disseminated disease (MDD) and minimal residual disease (MRD) in childhood T-cell lymphoblastic lymphoma stage III, detected by flow cytometry (FC) and real-time quantitative polymerase chain reaction (RQ-PCR). Pediatr Blood Cancer 2009; 52:20-5. [PMID: 19006253 DOI: 10.1002/pbc.21823] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Despite overlapping features of T-cell lymphoblastic lymphoma (T-LLy) and T-cell acute lymphoblastic leukemia (T-ALL), which respond favorably to T-ALL treatment, clinical and biological differences exist. We retrospectively assessed the prevalence of submicroscopic bone marrow (BM) minimal disseminated disease (MDD) at diagnosis and the early response to treatment (minimal residual disease--MRD) and their prognostic significance in 17 children with stage III T-LLy treated according to Berlin-Frankfurt-Munster (BFM) non-Hodgkin lymphoma protocols. PROCEDURE Four-color flow cytometry (FC) was used for lymphoma associated immunophenotype and real-time quantitative polymerase chain reaction (RQ-PCR) for T-cell receptor (TCR beta/delta/gamma) gene rearrangements with at least 0.01% sensitivity. RESULTS Two markers per patient were identified in all cases using FC and in 80% using RQ-PCR. BM MDD at diagnosis of >or=0.01% was detected by FC and RQ-PCR in 88% and 80% of patients, respectively, and by at least one of the methods in all patients. A significant correlation was achieved between the methods by Pearson correlation analysis (P = 0.004). MRD levels significantly decreased to very low levels on day 33 in 9 out of 10 patients studied. The only patient that remained positive relapsed. CONCLUSIONS MDD was prevalent in stage III T-LLy, for which we could not prove a prognostic significance in the context of ALL-like treatment. This study shows that both FC and RQ-PCR methods are efficient for MDD and MRD analyses in T-LLy.
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Affiliation(s)
- Batia Stark
- Center of Pediatric Hematology/Oncology, Schneider Children's Medical Center of Israel, Petah Tiqwa, Israel.
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Baleydier F, Decouvelaere AV, Bergeron J, Gaulard P, Canioni D, Bertrand Y, Lepretre S, Petit B, Dombret H, Beldjord K, Molina T, Asnafi V, Macintyre E. T Cell Receptor Genotyping and HOXA/TLX1 Expression Define Three T Lymphoblastic Lymphoma Subsets which Might Affect Clinical Outcome. Clin Cancer Res 2008; 14:692-700. [DOI: 10.1158/1078-0432.ccr-07-1927] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Current Awareness in Hematological Oncology. Hematol Oncol 2006. [DOI: 10.1002/hon.755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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