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Howell NA, Arya S, Tai PC, Sadeghian H, Sakhdari A, Wu R, Prica A. Guillain-Barré syndrome as an early manifestation of angioimmunoblastic T-cell lymphoma. BMJ Case Rep 2022; 15:e246176. [PMID: 35589261 PMCID: PMC9121415 DOI: 10.1136/bcr-2021-246176] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2022] [Indexed: 11/04/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is a rare condition caused by autoimmune damage of peripheral nerves. We describe a case where a man in his 80s presented with subacute, progressive fatigue and weakness. He had received an outpatient work-up for possible haematological malignancy, but eventually presented to the emergency department for worsening weakness. A physical exam and cerebrospinal fluid analysis suggested a diagnosis of GBS. Subsequently, a pathological diagnosis of angioimmunoblastic T-cell lymphoma was made. The patient underwent intravenous immunoglobulin treatment for GBS and was started on cyclophosphamide, doxorubicin, vincristine and prednisone therapy. Prior research has suggested that incident malignancy may be associated with GBS, which may be caused by a paraneoplastic-type phenomenon, malignancy-associated immune dysregulation or an autoimmune reaction triggered by a common exposure. Clinicians should be aware of the possible association between these two conditions and should remain open minded to the possibility of non-infectious triggers for GBS.
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Affiliation(s)
| | - Sumedha Arya
- Division of Haematology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Peter C Tai
- Division of Neurology, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Hamid Sadeghian
- Division of Neurology, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Ali Sakhdari
- Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario, Canada
| | - Robert Wu
- Division of General Internal Medicine, Department of Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Anca Prica
- Division of Haematology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
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2
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Tsutsumi Y, Kitano S, Yanagita S, Tachibana M. Epstein-Barr virus-positive mucocutaneous ulcer, plasmablastic type, associated with nodal CD4+ angioimmunoblastic T-cell lymphoma and generalised pruritus: a self-limiting lymphoproliferative disorder resembling cutaneous plasmablastic lymphoma. BMJ Case Rep 2022; 15:e247430. [PMID: 35523507 PMCID: PMC9083435 DOI: 10.1136/bcr-2021-247430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2022] [Indexed: 12/16/2022] Open
Abstract
A woman in her 80s reported of generalised pruritus, which was treated with phototherapy and steroid administration. Two months after onset, lymph node biopsy revealed CD4+ angioimmunoblastic T-cell lymphoma with systemic superficial nodal involvement. Intractable prurigo was judged as T-cell lymphoma related. After effective chemotherapy (7 months later), skin nodules appeared multifocally, including on the lip, thumb and lower leg. The biopsied infiltrative lesion on the right lower leg microscopically revealed subcutaneous growth of atypical plasmablasts with nearly 100% Ki-67 labelling and Epstein-Barr virus (EBV)-encoded small nuclear RNA positivity. Plasmablastic lymphoma (CD45/CD19/CD38/CD138/MUM1+, CD20/CD79a/PAX5-) was suspected. Immunoglobulin light-chain restriction and nuclear expression of c-myc protein were undetectable, and the ulcers were spontaneously epithelialised by the cessation of steroid administration. After 10 months, non-progressive prurigos persisted on the extremities, but without regrowth of nodal T-cell lymphoma and cutaneous lymphoproliferative lesion. Reactive nature of the EBV-induced mucocutaneous plasmablastic growth (EBV-positive mucocutaneous ulcer, plasmablastic type) is discussed.
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Affiliation(s)
- Yutaka Tsutsumi
- Division of Diagnostic Pathology, Tsutsumi Byori Shindanka Clinic, Inazawa, Aichi, Japan
- Department of Medical Technology, Yokkaichi Nursing and Medical Care University, Yokkaichi, Mie, Japan
| | - Seiya Kitano
- Department of Dermatology, Shimada General Medical Center, Shimada, Shizuoka, Japan
| | - Soshi Yanagita
- Department of Hematology, Shimada General Medical Center, Shimada, Shizuoka, Japan
| | - Mitsuhiro Tachibana
- Department of Diagnostic Pathology, Shimada General Medical Center, Shimada, Shizuoka, Japan
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3
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Zhang C, Mi L, Wu M, Liu W, Ma H, Ren J, Zhao L, Wang X, Song Y, Zhu J. Angioimmunoblastic T-cell lymphoma: treatment strategies and prognostic factors from a retrospective multicenter study in China. Leuk Lymphoma 2021; 63:1152-1159. [PMID: 34957894 DOI: 10.1080/10428194.2021.2015586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) is a unique sub-type of peripheral T-cell lymphoma (PTCL). We aimed to evaluate treatment programs and prognostic factors of 121 newly diagnosed patients with AITL in China from January 2001 to December 2018. The median age was 58 years with male predominance. Bone marrow involvement appeared in only 8.3% of patients, which was different from the previously published literature. The 5-year progression-free survival (PFS) and 5-year overall survival (OS) were 29.7% and 44.0%, respectively. Univariate and multivariate analyses showed that involvement of >5 nodal areas, age and Beta-2 microglubulin were highly predictive of OS but only the involvement of fewer than five nodal areas was significant for PFS. We identified a novel prognostic model including the three factors that may be applied in clinical practice and offer an alternative to IPI and PIT.
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Affiliation(s)
- Chen Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Lan Mi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Meng Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Weiping Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Hongmei Ma
- Department of Hematology, Cangzhou People's Hospital, Cangzhou, China
| | - Jianxin Ren
- Department of Hematology, Cangzhou People's Hospital, Cangzhou, China
| | - Linjun Zhao
- Department of Lymphoma, Peking University International Hospital, Beijing, China
| | - Xiaopei Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yuqin Song
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jun Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
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Ashaye AO, Burnett H, Abogunrin S, Panchmatia H, Ovcinnikova O, Dalal M. The clinical and economic burden of peripheral T-cell lymphoma: a systematic literature review. Future Oncol 2021; 18:519-535. [PMID: 34851173 DOI: 10.2217/fon-2021-1032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To understand the burden of treatment-naive peripheral T-cell lymphoma (PTCL). Methods: A systematic literature review was conducted in November 2020 following best practice methodology. Results: Fifty-five clinical studies were included, mostly investigating cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) or 'CHOP-like' regimens, with combination regimens showing similar effectiveness to CHOP alone. Aside from the combination of brentuximab vedotin + cyclophosphamide, doxorubicin and prednisone (A+CHP), other available treatments showed no statistically significant benefit over CHOP in terms of overall or progression-free survival in overall PTCL patients. The mean monthly cost per patient in the USA ranged from $6328 to $9356 based on six studies. One economic evaluation demonstrated A+CHP to be a more cost-effective treatment option than CHOP. Conclusion: Further research is needed to understand the humanistic and cost impact of frontline treatment for PTCL and its specific subtypes.
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Affiliation(s)
- Ajibade O Ashaye
- Takeda Development Center Americas, Inc., Lexington, MA 02421, USA
| | | | | | | | | | - Mehul Dalal
- Takeda Development Center Americas, Inc., Lexington, MA 02421, USA
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5
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Xie Y, Jaffe ES. How I Diagnose Angioimmunoblastic T-Cell Lymphoma. Am J Clin Pathol 2021; 156:1-14. [PMID: 34117736 DOI: 10.1093/ajcp/aqab090] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/22/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Angioimmunoblastic T-cell lymphoma (AITL) is a subtype of peripheral T-cell lymphoma derived from T-follicular helper cells. For pathologists, diagnosing AITL may be challenging due to its wide clinical and histopathologic spectrum, which can mimic a variety of reactive and neoplastic processes. METHODS We summarize and discuss the clinicopathologic features of AITL, emphasizing diagnostic tools available to the practicing pathologist. Common diagnostic dilemmas are discussed. RESULTS AITL exhibits various histologic patterns and is often associated with a prominent microenvironment that can obscure the neoplastic cells. Atypical B-cell proliferations, which can take a number of forms, are common in AITL, and clonal B-cell expansion can be seen. The atypical B cells can closely resemble Hodgkin/Reed-Sternberg cells, leading to misdiagnosis as classic Hodgkin lymphoma. Molecular studies have revealed recurrent genetic alterations, which can aid in differential diagnosis, particularly in problematic cases. CONCLUSIONS Given the complex diagnostic challenges in AITL, an integrated approach, incorporating clinical, morphologic, immunophenotypic, and molecular findings, is helpful to reach an accurate diagnosis.
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Affiliation(s)
- Yi Xie
- Department of Laboratory Medicine, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Elaine S Jaffe
- Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
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Ma H, O'Connor OA, Marchi E. Management of Angioimmunoblastic T-Cell Lymphoma (AITL) and other T Follicular Helper Cell lymphomas (TFH PTCL). Semin Hematol 2021; 58:95-102. [PMID: 33906727 DOI: 10.1053/j.seminhematol.2021.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/05/2021] [Accepted: 03/11/2021] [Indexed: 12/26/2022]
Abstract
Despite the remarkable improvements in the treatment and outcome of patients with aggressive B-cell lymphoma, the peripheral T-cell lymphomas (PTCL) continue to carry a poor prognosis with the presently available treatment options. The PTCL are very rare diseases that account for only 10,000 to 15,000 new cases per year in the United States. The World Health Organization's 2016 classification describes 29 distinct subtypes of PTCL, thus making these both rate and incredibly heterogenous. The 2 most common forms of PTCL, for example, peripheral T-cell lymphoma-not otherwise specified and angioimmunoblastic T-cell lymphoma , have an incidence of only 2500 and 1800 cases per year respectively, in the United States.
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Affiliation(s)
- Helen Ma
- Division of Hematology/Oncology, University of California Irvine, Long Beach, CA
| | - Owen A O'Connor
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
| | - Enrica Marchi
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA.
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7
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Maheswaranathan M, Lagoo AS, Diehl L, Shah A. A 79-Year-Old Female with Altered Mental Status and Anemia. Arthritis Care Res (Hoboken) 2021; 74:555-561. [PMID: 33555132 DOI: 10.1002/acr.24571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/05/2021] [Accepted: 02/02/2021] [Indexed: 11/12/2022]
Abstract
The authors declare that there are no disclosures or conflicts of interest regarding the publication of this manuscript. We did not receive any financial support and have no financial interests which could create a potential conflict of interest or the appearance of a conflict of interest with regard to the work.
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Affiliation(s)
| | - Anand S Lagoo
- Department of Pathology, Duke University School of Medicine, Durham, NC, USA
| | - Louis Diehl
- Division of Hematology, Duke University School of Medicine, Durham, NC, USA
| | - Ankoor Shah
- Division of Rheumatology, Duke University School of Medicine, Durham, NC, USA
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Xiong Y, Yang L, Dai J, Zhou F, Zhou Y. Chemotherapy combined with radiotherapy for successful treatment of angioimmunoblastic T-cell lymphoma: a case report. J Med Case Rep 2020; 14:185. [PMID: 33046131 PMCID: PMC7552514 DOI: 10.1186/s13256-020-02489-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 08/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background The incidence of angioimmunoblastic T-cell lymphoma is rare worldwide, and it has a poor prognosis. There is no proven or standard first-line therapy that works for the majority of patients with angioimmunoblastic T-cell lymphoma because of the rarity of this disease. The treatment and management are challenging for clinicians. Case presentation This report presents the diagnosis and treatment of a 65-year-old Chinese man who presented with cough and lymph node swellings in the left axillary region. The patient was diagnosed with angioimmunoblastic T-cell lymphoma. He underwent eight cycles of chemotherapy with CHOP (cyclophosphamide, hydroxydaunorubicin, oncovin, prednisone) followed by TOMO radiotherapy (helical tomotherapy, a kind of radiotherapy for cancer treatment using spiral computed tomographic scanning). After treatment, the therapeutic effects were evaluated by magnetic resonance imaging and computed tomography about every 3 months. The patient recovered well with no sign of tumor recurrence and no obvious severe treatment-related adverse effects. Conclusion This treatment experience indicates an essential role for the combination of radiation therapy with CHOP, which may have a better prognosis than treatments without radiation therapy. But challenges warrant further validation in prospective studies.
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Affiliation(s)
- Yudi Xiong
- Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital, Wuhan University, Wuhan, China.,Department of Radiation Oncology & Medical Oncology, Zhongnan Hospital, Wuhan University, 169 Donghu Road, Wuhan, 430071, China
| | - Lei Yang
- Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital, Wuhan University, Wuhan, China.,Department of Radiation Oncology & Medical Oncology, Zhongnan Hospital, Wuhan University, 169 Donghu Road, Wuhan, 430071, China
| | - Jing Dai
- Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital, Wuhan University, Wuhan, China.,Department of Radiation Oncology & Medical Oncology, Zhongnan Hospital, Wuhan University, 169 Donghu Road, Wuhan, 430071, China
| | - Fuxiang Zhou
- Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital, Wuhan University, Wuhan, China. .,Department of Radiation Oncology & Medical Oncology, Zhongnan Hospital, Wuhan University, 169 Donghu Road, Wuhan, 430071, China.
| | - Yunfeng Zhou
- Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital, Wuhan University, Wuhan, China. .,Department of Radiation Oncology & Medical Oncology, Zhongnan Hospital, Wuhan University, 169 Donghu Road, Wuhan, 430071, China.
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9
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Padilla O, Tam W, Geyer JT. T-cell neoplasms in the spleen. Semin Diagn Pathol 2020; 38:135-143. [PMID: 33199090 DOI: 10.1053/j.semdp.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 11/11/2022]
Abstract
Hematopoietic neoplasms involving the spleen are uncommon, but T cell neoplasms involving the spleen are extremely rare. The rarity of splenic involvement by T cell neoplasms has resulted in a limited body of literature describing their splenic characteristics. As a result, our purpose in this review article is to provide and summarize some of the characteristics seen by different T cell neoplasms that may involve the spleen.
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Affiliation(s)
- Osvaldo Padilla
- Texas Tech University Health Sciences Center, PL Foster School of Medicine, Department of Pathology, 4625 Alberta Ave., El Paso, TX 79905, United States.
| | - Wayne Tam
- Weill Cornell Medicine, Department of Pathology and Laboratory Medicine, 525 E 68th Street, Starr Pavilion 715, New York, NY 10065, United States
| | - Julia T Geyer
- Weill Cornell Medicine, Department of Pathology and Laboratory Medicine, 525 E 68th Street, Starr Pavilion 715, New York, NY 10065, United States
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10
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Niu JY, Zhu HY, Wang L, Fan L, Liang JH, Cao L, Wu W, Xia Y, Wu JZ, Li JY, Xu W. [Prognostic value of lymphocyte-to-monocyte ratio in angioimmunoblastic T cell lymphoma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 39:265-270. [PMID: 29779318 PMCID: PMC7342139 DOI: 10.3760/cma.j.issn.0253-2727.2018.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
目的 探究淋巴细胞/单核细胞比值(LMR)在血管免疫母细胞性T细胞淋巴瘤(AITL)患者中的预后价值。 方法 回顾性分析2009年6月至2017年7月南京医科大学第一附属医院收治的64例初诊AITL患者资料。采用ROC曲线计算LMR临界值,并以此将患者分为高LMR和低LMR组,采用Pearson卡方检验及Fisher精确概率法进行组间比较。采用Kaplan-Meier法和Cox回归分析影响无进展生存(PFS)和总生存(OS)的预后因素。 结果 64例患者中,男39例,女25例,中位年龄63(29~89)岁。LMR临界值为3.07。中位随访33(5~103)个月,低LMR与高LMR组比较,患者的PFS时间(9对13个月,P=0.044)和OS时间(16个月对未达到,P=0.014)差异均有统计学意义。多因素分析显示低LMR是影响患者PFS(HR=0.48, 95% CI 0.26~0.92,P=0.027)和OS(HR=0.38,95% CI 0.18~0.82,P=0.013)的独立预后不良因素。亚组分析结果显示,在中高危至高危[非特指型预后指数(PIT)评分2~4分]患者中,低LMR者有更短的PFS和OS时间(P值分别为0.013、0.031),而在低危至中低危(PIT评分0~1分)患者中其差异均无统计学意义(P值分别为0.949、0.238)。 结论 可根据PIT评分及LMR的状态初步评估患者的疾病风险。低LMR提示患者具有更差的预后。
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Affiliation(s)
- J Y Niu
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
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Epperla N, Ahn KW, Litovich C, Ahmed S, Battiwalla M, Cohen JB, Dahi P, Farhadfar N, Farooq U, Freytes CO, Ghosh N, Haverkos B, Herrera A, Hertzberg M, Hildebrandt G, Inwards D, Kharfan-Dabaja MA, Khimani F, Lazarus H, Lazaryan A, Lekakis L, Murthy H, Nathan S, Nishihori T, Pawarode A, Prestidge T, Ramakrishnan P, Rezvani AR, Romee R, Shah NN, Sureda A, Fenske TS, Hamadani M. Allogeneic hematopoietic cell transplantation provides effective salvage despite refractory disease or failed prior autologous transplant in angioimmunoblastic T-cell lymphoma: a CIBMTR analysis. J Hematol Oncol 2019; 12:6. [PMID: 30630534 PMCID: PMC6329157 DOI: 10.1186/s13045-018-0696-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 12/27/2018] [Indexed: 12/15/2022] Open
Abstract
Background There is a paucity of data on the role of allogeneic hematopoietic cell transplantation (allo-HCT) in patients with angioimmunoblastic T-cell lymphoma (AITL). Using the CIBMTR registry, we report here the outcomes of AITL patients undergoing an allo-HCT. Methods We evaluated 249 adult AITL patients who received their first allo-HCT during 2000–2016. Results The median patient age was 56 years (range = 21–77). Majority of the patients were Caucasians (86%), with a male predominance (60%). Graft-versus-host disease (GVHD) prophylaxis was predominantly calcineurin inhibitor-based approaches while the most common graft source was peripheral blood (97%). Median follow-up of survivors was 49 months (range = 4–170 months). The cumulative incidence of grade 2–4 and grade 3–4 acute GVHD at day 180 were 36% (95% CI = 30–42) and 12 (95% CI = 8–17), respectively. The cumulative incidence of chronic GVHD at 1 year was 49% (95%CI 43–56). The 1-year non-relapse mortality (NRM) was 19% (95% CI = 14–24), while the 4-year relapse/progression, progression-free survival (PFS), and overall survival (OS) were 21% (95% CI = 16–27), 49% (95% CI = 42–56), and 56% (95% CI = 49–63), respectively. On multivariate analysis, chemoresistant status at the time of allo-HCT was associated with a significantly higher risk for therapy failure (inverse of PFS) (RR = 1.73 95% CI = 1.08–2.77), while KPS < 90% was associated with a significantly higher risk of mortality (inverse of OS) (RR = 3.46 95% CI = 1.75–6.87). Conclusion Our analysis shows that allo-HCT provides durable disease control even in AITL patients who failed a prior auto-HCT and in those subjects with refractory disease at the time of allografting. Electronic supplementary material The online version of this article (10.1186/s13045-018-0696-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Narendranath Epperla
- Division of Hematology, Department of Medicine, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 460 W 10th Ave, Columbus, OH, 43210, USA
| | - Kwang W Ahn
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Suite C5500, 8701 W. Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Carlos Litovich
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Suite C5500, 8701 W. Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Sairah Ahmed
- M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Minoo Battiwalla
- Sarah Cannon BMT Program, 2400 Patterson St. Suite 215, Nashville, TN, 37206, USA
| | - Jonathon B Cohen
- Winship Cancer Institute, Emory University School of Medicine, 1365-C Clifton Road NE, Atlanta, GA, 30322, USA
| | - Parastoo Dahi
- Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA
| | - Nosha Farhadfar
- Shands Healthcare and University of Florida, PO Box 100278, Gainesville, FL, 32610, USA
| | - Umar Farooq
- University of Iowa Hospitals and Clinics, 200 Hawkins Drive C332 GH, Iowa City, IA, 52242, USA
| | - Cesar O Freytes
- Texas Transplant Institute, 4410 Medical Drive Suite 410, San Antonio, TX, 78229, USA
| | - Nilanjan Ghosh
- Levine Cancer Institute, 1021 Morehead Medical Drive Suite 5300, Charlotte, NC, 28204, USA
| | - Bradley Haverkos
- University of Colorado Hospital, 1665 Aurora Court F-754, Aurora, CO, 80045, USA
| | - Alex Herrera
- City of Hope National Medical Center, 1500 E Duarte Rd, Duarte, CA, 91010, USA
| | - Mark Hertzberg
- Prince of Wales Hospital, SEALS Level 4 Campus Building, Barker Street, Randwick, NSW, 2031, Australia
| | - Gerhard Hildebrandt
- University of Kentucky Chandler Medical Center, 800 Rose Street CC 301, Lexington, KY, 40536, USA
| | - David Inwards
- Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55902, USA
| | | | - Farhad Khimani
- H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Hillard Lazarus
- Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA.,Univeristy of Miami, 1475 NW 12th Ave, Miami, FL, 33136, USA
| | - Aleksandr Lazaryan
- H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Lazaros Lekakis
- Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA.,Univeristy of Miami, 1475 NW 12th Ave, Miami, FL, 33136, USA
| | - Hemant Murthy
- Division of Hematology/Oncology, University Florida College of Medicine, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Sunita Nathan
- Rush University Medical Center, 849 North Franklin Street Unit 1503, Chicago, IL, 60610, USA
| | - Taiga Nishihori
- H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Attaphol Pawarode
- The University of Michigan, 322 E Liberty St. Unit 4, Ann Arbor, MI, 48104, USA
| | - Tim Prestidge
- Starship Children's Health, Level 7 Blood and Cancer Center Park Road, Grafton, Auckland, 1142, New Zealand
| | - Praveen Ramakrishnan
- UT Southwestern Medical Center - BMT Program, 7800C Stenton Ave. Apt. 210, Philadelphia, PA, 19118, USA
| | - Andrew R Rezvani
- Stanford Health Care, 300 Pasteur Drive, Room H0101 MC 5623, Stanford, CA, 94305, USA
| | - Rizwan Romee
- Dana Farber Cancer Institute - Adults, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Nirav N Shah
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd. PO Box 26509, Milwaukee, WI, 53226, USA
| | - Ana Sureda
- Institut Català d'Oncologia - Hospital Duran I Reynals, Avda. Granvfa 199-203, 08908, Barcelona, Spain
| | - Timothy S Fenske
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd. PO Box 26509, Milwaukee, WI, 53226, USA
| | - Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Suite C5500, 8701 W. Watertown Plank Rd, Milwaukee, WI, 53226, USA. .,Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd. PO Box 26509, Milwaukee, WI, 53226, USA.
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Le Roy A, Terrier B, London J, Paugam A, Mouthon L, Lifermann F. Angioimmunoblastic T-cell lymphoma mimicking eosinophilic granulomatosis with polyangiitis (Churg-Strauss). Joint Bone Spine 2018; 86:273-274. [PMID: 29966769 DOI: 10.1016/j.jbspin.2018.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 06/20/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Audrey Le Roy
- Department of Internal Medicine, Cochin hospital, centre de référence maladies systémiques et autoimmunes rares, Assistance publique-hôpitaux de Paris (AP-HP), 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France; French Military Health Academy, École-du-Val-de-Grâce, 75005 Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, Cochin hospital, centre de référence maladies systémiques et autoimmunes rares, Assistance publique-hôpitaux de Paris (AP-HP), 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France.
| | - Jonathan London
- Department of Internal Medicine, Cochin hospital, centre de référence maladies systémiques et autoimmunes rares, Assistance publique-hôpitaux de Paris (AP-HP), 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - André Paugam
- Department of Parasitology, Cochin hospital, Assistance publique-hôpitaux de Paris (AP-HP), 75014 Paris, France
| | - Luc Mouthon
- Department of Internal Medicine, Cochin hospital, centre de référence maladies systémiques et autoimmunes rares, Assistance publique-hôpitaux de Paris (AP-HP), 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
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13
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Gleeson M, Peckitt C, To YM, Edwards L, Oates J, Wotherspoon A, Attygalle AD, Zerizer I, Sharma B, Chua S, Begum R, Chau I, Johnson P, Ardeshna KM, Hawkes EA, Macheta MP, Collins GP, Radford J, Forbes A, Hart A, Montoto S, McKay P, Benstead K, Morley N, Kalakonda N, Hasan Y, Turner D, Cunningham D. CHOP versus GEM-P in previously untreated patients with peripheral T-cell lymphoma (CHEMO-T): a phase 2, multicentre, randomised, open-label trial. Lancet Haematol 2018; 5:e190-e200. [PMID: 29703335 PMCID: PMC5946805 DOI: 10.1016/s2352-3026(18)30039-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/09/2018] [Accepted: 03/11/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Outcomes with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) or CHOP-like chemotherapy in peripheral T-cell lymphoma are poor. We investigated whether the regimen of gemcitabine, cisplatin, and methylprednisolone (GEM-P) was superior to CHOP as front-line therapy in previously untreated patients. METHODS We did a phase 2, parallel-group, multicentre, open-label randomised trial in 47 hospitals: 46 in the UK and one in Australia. Participants were patients aged 18 years and older with bulky (tumour mass diameter >10 cm) stage I to stage IV disease (WHO performance status 0-3), previously untreated peripheral T-cell lymphoma not otherwise specified, angioimmunoblastic T-cell lymphoma, anaplastic lymphoma kinase-negative anaplastic large cell lymphoma, enteropathy-associated T-cell lymphoma, or hepatosplenic γδ T-cell lymphoma. We randomly assigned patients (1:1) stratified by subtype of peripheral T-cell lymphoma and international prognostic index to either CHOP (intravenous cyclophosphamide 750 mg/m2, doxorubicin 50 mg/m2, and vincristine 1·4 mg/m2 [maximum 2 mg] on day 1, and oral prednisolone 100 mg on days 1-5) every 21 days for six cycles; or GEM-P (intravenous gemcitabine 1000 mg/m2 on days 1, 8, and 15, cisplatin 100 mg/m2 on day 15, and oral or intravenous methylprednisolone 1000 mg on days 1-5) every 28 days for four cycles. The primary endpoint was the proportion of patients with a CT-based complete response or unconfirmed complete response on completion of study chemotherapy, to detect a 20% superiority of GEM-P compared with CHOP, assessed in all patients who received at least one cycle of treatment and had an end-of-treatment CT scan or reported clinical progression as the reason for stopping trial treatment. Safety was assessed in all patients who received at least one dose of study medication. This trial is registered with ClinicalTrials.gov (NCT01719835) and the European Clinical Trials Database (EudraCT 2011-004146-18). FINDINGS Between June 18, 2012, and Nov 16, 2016, we randomly assigned 87 patients to treatment, 43 to CHOP and 44 to GEM-P. A planned unmasked review of efficacy data by the independent data monitoring committee in November, 2016, showed that the number of patients with a confirmed or unconfirmed complete response with GEM-P was non-significantly inferior compared with CHOP and the trial was closed early. At a median follow-up of 27·4 months (IQR 16·6-38·4), 23 patients (62%) of 37 assessable patients assigned to CHOP had achieved a complete response or unconfirmed complete response compared with 17 (46%) of 37 assigned to GEM-P (odds ratio 0·52, 95% CI 0·21-1·31; p=0·164). The most common adverse events of grade 3 or worse in both groups were neutropenia (17 [40%] with CHOP and nine [20%] with GEM-P), thrombocytopenia (4 [10%] with CHOP and 13 [30%] with GEM-P, and febrile neutropenia (12 [29%] with CHOP and 3 [7%] with GEM-P). Two patients (5%) died during the study, both in the GEM-P group, from lung infections. INTERPRETATION The number of patients with a complete response or unconfirmed complete response did not differ between the groups, indicating that GEM-P was not superior for this outcome. CHOP should therefore remain the reference regimen for previously untreated peripheral T-cell lymphoma. FUNDING Bloodwise and the UK National Institute of Health Research.
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Affiliation(s)
- Mary Gleeson
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Clare Peckitt
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Ye Mong To
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Laurice Edwards
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | | | | | | | - Imene Zerizer
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | | | - Sue Chua
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Ruwaida Begum
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Ian Chau
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Peter Johnson
- Cancer Research UK Centre, University of Southampton, Southampton, UK
| | | | - Eliza A Hawkes
- Olivia Newton John Cancer Research Institute, Austin Health, Melbourne, VA, Australia; Eastern Health, Melbourne, VA, Australia
| | | | - Graham P Collins
- Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford, UK
| | - John Radford
- University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | | | | | - Pamela McKay
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Kim Benstead
- Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, UK
| | - Nicholas Morley
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Yasmin Hasan
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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14
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Chams S, Hajj Hussein I, El Sayegh S, Chams N, Zakaria K. Hypercalcemia as a rare presentation of angioimmunoblastic T cell lymphoma: a case report. J Med Case Rep 2018; 12:101. [PMID: 29673407 PMCID: PMC5909213 DOI: 10.1186/s13256-018-1669-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 03/22/2018] [Indexed: 11/29/2022] Open
Abstract
Background Angioimmunoblastic T cell lymphoma is a rare malignancy, accounting for only 2% of all non-Hodgkin lymphomas, first described in the 1970s and subsequently accepted as a distinct entity in the current World Health Organization classification. Due to the paucity of this disease, there is still no identifiable etiology, no consistent risk factors, and the pathogenesis remains unclear. Case presentation An 83-year-old Caucasian man presented to an emergency department with palpitations and was found to have atrial fibrillation. During his hospitalization, he was found to have asymptomatic hypercalcemia with corrected calcium of 11.7. Ten days later while in rehabilitation, he started complaining of progressive fatigue and altered mental status was noted. He was found to have a calcium level of 15.5 and was admitted to the intensive care unit for management and further workup. He was found at that time to have, parathyroid hormone: < 1; 25 hydroxyvitamin D: 74; 1,25 dihydroxyvitamin D: 85.4; angiotensin-converting enzyme: 7; parathyroid hormone-related protein: < 2; and multiple myeloma workup was negative. Computed tomography of his chest and abdomen showed extensive retroperitoneal, pelvic, and mesenteric lymphadenopathy in addition to findings suggestive of peritoneal carcinomatosis. A right axillary lymph node biopsy showed immunohistochemical parameters consistent with angioimmunoblastic T cell lymphoma. After a lengthy discussion with his family, it was decided that no further treatment would be pursued. He had an aggressive course at the hospital during which he developed pleural effusions, ascites, and diffuse petechiae within 2 weeks; these were complications from his malignancy. Considering the poor outcomes of his aggressive disease, he decided to enroll in an out-patient hospice. He died within a few months as a result of cardiorespiratory arrest. Conclusions This case illustrates a rare presentation of an extremely rare disease; that is, hypercalcemia in a patient who was later found to have angioimmunoblastic T cell lymphoma. Diagnosing angioimmunoblastic T cell lymphoma might be the most challenging part due to the wide array of clinical presentations, of which hypercalcemia accounts for only 1%. As seen in this case, most patients present in advanced stages of the disease with poor prognosis.
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Affiliation(s)
- Sana Chams
- Department of Internal Medicine, Wayne State University School of Medicine, Rochester Hills, MI, USA.
| | - Inaya Hajj Hussein
- Department of Biomedical Sciences, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Skye El Sayegh
- Department of Internal Medicine, Wayne State University School of Medicine, Rochester Hills, MI, USA
| | - Nour Chams
- Department of Internal Medicine, Wayne State University School of Medicine, Rochester Hills, MI, USA
| | - Khalid Zakaria
- Department of Internal Medicine, Wayne State University School of Medicine, Rochester Hills, MI, USA
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15
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Wakabayashi SI, Kimura T, Tanaka N, Joshita S, Kawata K, Umemura T, Hiroshima Y, Mori H, Kobayashi H, Wada S, Tanaka E. Emergence of anti-mitochondrial M2 antibody in patient with angioimmunoblastic T-cell lymphoma. Clin J Gastroenterol 2018; 11:302-308. [PMID: 29428971 DOI: 10.1007/s12328-018-0831-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 02/06/2018] [Indexed: 10/18/2022]
Abstract
A 68-year-old woman was referred to our hospital due to fever and rash on the neck and extremities. Laboratory findings revealed hepatic dysfunction and positivity for anti-mitochondrial M2 antibody (AMA-M2). Hepatosplenomegaly and systemic lymphadenopathy were detected by enhanced computed tomography. One week after her first visit, hypoxemia, ascites, and Coomb test-positive autoimmune hemolytic anemia had newly appeared in addition to worsened fever, hepatosplenomegaly, and lymphadenopathy. Results of axillary lymph node, skin, and bone-marrow biopsies led to the diagnosis of angioimmunoblastic T-cell lymphoma (AITL), for which CEPP therapy (cyclophosphamide, etoposide, procarbazine, and prednisolone) was initiated. Her serum levels of hepatobiliary enzymes normalized and AMA-M2 became negative after treatment. The unexpected positivity for AMA-M2 might have been caused by AITL cell-activated intrahepatic immune cells or the tumor cells themselves inflicting bile duct injury that mimicked primary biliary cholangitis. Alternatively, cross reactivity due to the overproduction of immunoglobulins may have caused this phenomenon. The present case may shed light on of the mechanisms of liver dysfunction accompanying AITL.
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Affiliation(s)
- Shun-Ichi Wakabayashi
- Division of Gastroenterology, Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Takefumi Kimura
- Division of Gastroenterology, Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
| | - Naoki Tanaka
- Department of Metabolic Regulation, Shinshu University Graduate School of Medicine, Matsumoto, Japan
| | - Satoru Joshita
- Division of Gastroenterology, Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Kazuhito Kawata
- Department of Hepatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takeji Umemura
- Division of Gastroenterology, Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Yuki Hiroshima
- Department of Hematology, Nagano Red Cross Hospital, Nagano, Japan
| | - Hiromitsu Mori
- Department of Gastroenterology, Nagano Red Cross Hospital, Nagano, Japan
| | - Hikaru Kobayashi
- Department of Hematology, Nagano Red Cross Hospital, Nagano, Japan
| | - Shuichi Wada
- Department of Gastroenterology, Nagano Red Cross Hospital, Nagano, Japan
| | - Eiji Tanaka
- Division of Gastroenterology, Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
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Jin J, Zheng C, Wu S. Therapeutic effect of chidamide on relapsed refractory angioimmunoblastic T-cell lymphoma: A case report and literature review. Medicine (Baltimore) 2018; 97:e9611. [PMID: 29480865 PMCID: PMC5943875 DOI: 10.1097/md.0000000000009611] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Angioimmunoblastic T-cell lymphoma (AITL) is a kind of rare peripheral T cell lymphoma, which usually has acute onset at old age. MATERIALS AND METHODS Here we report a case of relapsed refractory AITL, which has achieved obvious curative effect after treatment with chidamide. RESULTS Initially, the patient received 7 courses of treatment with recombinant human endostatin (endostar)+CHOP. The patient achieved complete remission, but suffered from recurrence later. After changing chemotherapy regimens, the outcome was still not satisfactory, and the patient developed systemic skin infiltration and rashes. After 2 courses of chemotherapy with chidamide (30 mg) twice a week + intravenous injections with cyclophosphamide (0.1 g) twice every other day + thalidomide (50 mg) every night, the patient began with the oral intake of chidamide, and the therapeutic effect was satisfactory, with diminishing systemic rashes and shrunken lymph nodes. DISCUSSION AND CONCLUSIONS Chidamide has good therapeutic effect in the treatment of AITL, which provides a novel therapeutic strategy for relapsed refractory AITL. However, more cases are still needed to further validate its efficacy.
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17
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Angioimmunoblastic T-cell lymphoma: the many-faced lymphoma. Blood 2017; 129:1095-1102. [PMID: 28115369 DOI: 10.1182/blood-2016-09-692541] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 12/09/2016] [Indexed: 02/07/2023] Open
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) is an uncommon subtype of mature peripheral T-cell lymphoma (PTCL). The history of AITL is much longer and deeper than the literature would suggest given the many names that have preceded it. Advanced-stage disease is common with uncharacteristic laboratory and autoimmune findings that often slow or mask the diagnosis. Significant strides in the immunohistochemical and molecular signature of AITL have brought increased ability to diagnose this uncommon type of PTCL. The 2016 World Health Organization classification of lymphoid neoplasms recently acknowledged the complexity of this diagnosis with the addition of other AITL-like subsets. AITL now resides under the umbrella of nodal T-cell lymphomas with follicular T helper phenotype. Induction strategies continue to focus on increasing complete remission rates that allow more transplant-eligible patients to proceed toward consolidative high-dose therapy and autologous stem cell rescue with improving long-term survival. There are several clinical trials in which recently approved drugs with known activity in AITL are paired with induction regimens with the hope of demonstrating long-term progression-free survival over cyclophosphamide, doxorubicin, vincristine, and prednisone. The treatment of relapsed or refractory AITL remains an unmet need. The spectrum of AITL from diagnosis to treatment is reviewed subsequently in a fashion that may one day lead to personalized treatment approaches in a many-faced disease.
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18
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Carson KR, Horwitz SM, Pinter-Brown LC, Rosen ST, Pro B, Hsi ED, Federico M, Gisselbrecht C, Schwartz M, Bellm LA, Acosta MA, Shustov AR, Advani RH, Feldman TA, Lechowicz MJ, Smith SM, Lansigan F, Tulpule A, Craig MD, Greer JP, Kahl BS, Leach JW, Morganstein N, Casulo C, Park SI, Foss FM. A prospective cohort study of patients with peripheral T-cell lymphoma in the United States. Cancer 2016; 123:1174-1183. [PMID: 27911989 DOI: 10.1002/cncr.30416] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 09/27/2016] [Accepted: 10/03/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Long-term survival in patients with aggressive peripheral T-cell lymphoma (PTCL) is generally poor, and there currently is no clear consensus regarding the initial therapy used for these diseases. Herein, the authors analyzed treatment patterns and outcomes in a prospectively collected cohort of patients with a new diagnosis of nodal PTCL in the United States. METHODS Comprehensive Oncology Measures for Peripheral T-cell Lymphoma Treatment (COMPLETE) is a prospective multicenter cohort study designed to identify the most common prevailing treatment patterns used for patients newly diagnosed with PTCL in the United States. Patients with nodal PTCL and completed records regarding baseline characteristics and initial therapy were included in this analysis. All statistical tests were 2-sided. RESULTS Of a total of 499 patients enrolled, 256 (51.3%) had nodal PTCL and completed treatment records. As initial therapy, patients received doxorubicin-containing regimens (41.8%), regimens containing doxorubicin plus etoposide (20.9%), other etoposide regimens (15.8%), other single-agent or combination regimens (19.2%), and gemcitabine-containing regimens (2.1%). Survival was found to be statistically significantly longer for patients who received doxorubicin (log-rank P = .03). After controlling for disease histology and International Prognostic Index, results demonstrated a trend toward significance in mortality reduction in patients who received doxorubicin compared with those who did not (hazard ratio, 0.71; 95% confidence interval, 0.48-1.05 [P = .09]). CONCLUSIONS To the authors' knowledge, there is no clear standard of care in the treatment of patients with PTCL in the United States. Although efforts to improve frontline treatments are necessary, anthracyclines remain an important component of initial therapy for curative intent. Cancer 2017;123:1174-1183. © 2016 American Cancer Society.
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Affiliation(s)
- Kenneth R Carson
- Research Service, St Louis Veterans Affairs Medical Center, St. Louis, Missouri.,Department of Medical Oncology, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Steven M Horwitz
- Department of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | | | - Steven T Rosen
- Provost and Chief Scientific Officer, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Barbara Pro
- Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Eric D Hsi
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Massimo Federico
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | - Mark A Acosta
- Research and Development, Spectrum Pharmaceuticals Inc, Irvine, California
| | - Andrei R Shustov
- Department of Medicine, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ranjana H Advani
- Department of Medicine, Stanford University Medical Center, Stanford, California
| | - Tatyana A Feldman
- Department of Hematology/Oncology, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey
| | - Mary Jo Lechowicz
- Department of Hematology and Oncology, Emory University, Atlanta, Georgia
| | - Sonali M Smith
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Frederick Lansigan
- Department of Medicine, Dartmouth Hitchcock Medical Center, Hanover, New Hampshire
| | - Anil Tulpule
- Department of Medicine, University of Southern California, Los Angeles, California
| | - Michael D Craig
- Department of Medicine, West Virginia University, Morgantown, West Virginia
| | - John P Greer
- Department of Hematology, Vanderbilt University, Nashville, Tennessee
| | - Brad S Kahl
- Department of Medical Oncology, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Joseph W Leach
- Minnesota Oncology, Virginia Piper Cancer Institute, Minneapolis, Minnesota
| | | | - Carla Casulo
- Department of Medicine, University of Rochester, Rochester, New York
| | - Steven I Park
- Department of Internal Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Francine M Foss
- Department of Medical Oncology, Yale University, New Haven, Connecticut
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19
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Yachoui R, Farooq N, Amos JV, Shaw GR. Angioimmunoblastic T-Cell Lymphoma with Polyarthritis Resembling Rheumatoid Arthritis. Clin Med Res 2016; 14:159-162. [PMID: 28188140 PMCID: PMC5302453 DOI: 10.3121/cmr.2016.1334] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 09/29/2016] [Accepted: 10/24/2016] [Indexed: 11/18/2022]
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) is a rare subtype of peripheral T-cell lymphoma (PTCL). AITL typically presents with lymphadenopathy, fever, rash, hepatosplenomegaly, and rarely polyarthritis. We report the case of a 50-year-old female who presented with lymphadenopathy, rash, and symmetric polyarthritis. She was later diagnosed with AITL and was treated with chemotherapy with resolution of arthritis. AITL should be suspected in paitents presenting with rheumatoid-like arthritis and diffuse lymphadenopathy.
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Affiliation(s)
- Ralph Yachoui
- Department of Rheumatology, Marshfield Clinic, Marshfield, Wisconsin USA
| | - Nouman Farooq
- Department of Internal Medicine, Marshfield Clinic, Marshfield Wisconsin USA
| | - Jonathan V Amos
- Department of Internal Medicine, Marshfield Clinic, Marshfield Wisconsin USA
| | - Gene R Shaw
- Department of Pathology, Marshfield Clinic, Marshfield Wisconsin USA
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20
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Ma H, Abdul-Hay M. T-cell lymphomas, a challenging disease: types, treatments, and future. Int J Clin Oncol 2016; 22:18-51. [PMID: 27743148 PMCID: PMC7102240 DOI: 10.1007/s10147-016-1045-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 09/26/2016] [Indexed: 02/06/2023]
Abstract
T-cell lymphomas are rare and aggressive malignancies associated with poor outcome, often because of the development of resistance in the lymphoma against chemotherapy as well as intolerance in patients to the established and toxic chemotherapy regimens. In this review article, we discuss the epidemiology, pathophysiology, current standard of care, and future treatments of common types of T-cell lymphomas, including adult T-cell leukemia/lymphoma, angioimmunoblastic T-cell lymphoma, anaplastic large-cell lymphoma, aggressive NK/T-cell lymphoma, and cutaneous T-cell lymphoma.
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Affiliation(s)
- Helen Ma
- Department of Internal Medicine, New York University, New York, NY, USA
| | - Maher Abdul-Hay
- Department of Internal Medicine, New York University, New York, NY, USA. .,Perlmutter Cancer Center, New York University, New York, NY, USA.
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21
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Yang YQ, Liang JH, Wu JZ, Wang L, Qu XY, Cao L, Zhao XL, Huang DP, Fan L, Li JY, Xu W. Elevated absolute monocyte count predicts unfavorable outcomes in patients with angioimmunoblastic T-cell lymphoma. Leuk Res 2015; 42:88-92. [PMID: 26764222 DOI: 10.1016/j.leukres.2015.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 11/12/2015] [Accepted: 12/20/2015] [Indexed: 12/22/2022]
Abstract
This study was aimed at investigating the prognostic significance of the absolute monocyte count (AMC) in peripheral blood in patients with newly diagnosed angioimmunoblastic T cell lymphoma (AITL). AMC was performed in 73 therapy-naive patients with AITL in 2 institutions during 2008-2015, and higher AMC was observed in those with extranodal sites >1, bone marrow involvement, high lactate dehydrogenase level, the EBV infection, no response to treatment and high IPI, PIT, PIAI score group. The best AMC cut-off level at diagnosis was 0.8 × 10(9)/L and the 3-year overall survival (OS) was 64% for patients with low AMC group (≤ 0.8 × 10(9)/L) compared to 10% in high AMC group (>0.8 × 10(9)/L) (P<0.001). Multivariate analysis showed that elevated AMC remained an adverse prognostic parameter. Our results suggest that AMC is an independent prognostic parameter for OS in patients with AITL, and AMC >0.8 × 10(9)/L can routinely be used to identify high-risk patients with unfavorable survival.
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Affiliation(s)
- Yu-Qiong Yang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China; Department of Hematology, the First Affiliated Hospital of Wannan Medical College, Yijishan Hospital, Wuhu 241000, Anhui, China
| | - Jin-Hua Liang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Jia-Zhu Wu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Li Wang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Xiao-Yan Qu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Lei Cao
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Xiao-Li Zhao
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Dong-Ping Huang
- Department of Hematology, the First Affiliated Hospital of Wannan Medical College, Yijishan Hospital, Wuhu 241000, Anhui, China
| | - Lei Fan
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Jian-Yong Li
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China; Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing 210029, China.
| | - Wei Xu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China.
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Beer T, Dorion P. Angioimmunoblastic T-Cell Lymphoma Presenting with an Acute Serologic Epstein-Barr Virus Profile. Hematol Rep 2015; 7:5893. [PMID: 26331002 PMCID: PMC4508553 DOI: 10.4081/hr.2015.5893] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 05/18/2015] [Indexed: 12/11/2022] Open
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) is an aggressive peripheral T-cell lymphoma typically characterized by prominent lymphadenopathy and B-symptoms at the time of presentation, polyclonal hypergammaglobulinemia, autoimmune hemolysis and frequent but highly variable involvement of Epstein-Barr virus (EBV). Lymph node biopsy findings typically include effacement of nodal architecture, polymorphic infiltrate, atypical T-cells (usually CD4+/CD10+/PD1+) and prominent proliferations of high endothelial venules and follicular dendritic cells. However, this classic constellation of pathologic findings is often initially obscured by a prominence of EBV+ B-immunoblasts with or without associated peripherally circulating EBV DNA. Here we document the first reported case of an acute serologic EBV profile (VCA-IgM) in a patient with AITL, and we recommend that clinicians maintain a high index of suspicion for AITL in the appropriate clinical scenario, irrespective of Epstein-Barr related findings.
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Affiliation(s)
- Timothy Beer
- Department of General Internal Medicine, Geisinger Medical Center, Danville , PA, USA
| | - Patrick Dorion
- Department of Hematopathology, Geisinger Medical Center, Danville , PA, USA
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Kameoka Y, Takahashi N, Itou S, Kume M, Noji H, Kato Y, Ichikawa Y, Sasaki O, Motegi M, Ishiguro A, Tagawa H, Ishizawa K, Ishida Y, Ichinohasama R, Harigae H, Sawada K. Analysis of clinical characteristics and prognostic factors for angioimmunoblastic T-cell lymphoma. Int J Hematol 2015; 101:536-42. [PMID: 25739382 DOI: 10.1007/s12185-015-1763-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 02/23/2015] [Accepted: 02/23/2015] [Indexed: 12/31/2022]
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) is a distinct peripheral T-cell lymphoma entity exhibiting peculiar clinical features and poor prognosis. Its clinical characteristics and prognostic factors are not well established. To clarify the clinical characteristics and prognostic features of AITL, we conducted a multicenter, retrospective study. Fifty-six patients were enrolled. The median patient age was 68 years. Immunohistochemical examinations of tumor cells showed positivity for CD10 and T-cell markers, and chromosomal examination detected several types of abnormalities. More than 80 % of patients show advanced disease at diagnosis and poor prognostic scores. A high proportion of patients showed accompanying B symptoms, splenomegaly, and hepatomegaly at diagnosis. The 5-year overall survival (OS) rate was 48 % and progression-free survival was 25 %. Univariate analysis revealed higher age, fever, poor performance status, anemia, and low albumin level to be poor prognostic factors for OS. In addition to these factors, both IPI and PIT were also predictive of OS. Multivariate analysis indicated only a low level of serum albumin to be a significant prognostic factor for OS. Serum albumin may be one of the important prognostic factors for AITL. Further investigation is needed to confirm these results.
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Argyris PP, Koutlas IG, Cooley S, Yohe SL, Bhakta K, Gopalakrishnan R. Angioimmunoblastic T-cell lymphoma of the oral cavity presenting as gingival mass: report of the histopathologic and molecular characteristics of an unusual case featuring clonal T-cell receptor γ gene rearrangement by polymerase chain reaction. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:e198-204. [PMID: 25311166 DOI: 10.1016/j.oooo.2014.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 07/01/2014] [Accepted: 07/10/2014] [Indexed: 12/22/2022]
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) is a rare neoplastic process constituting 15% to 20% of peripheral T-cell lymphomas. We report the clinicopathologic and molecular characteristics of an unusual intraoral manifestation of AITL. A 35-year-old white man with a history of AITL presented with a 2.5-cm, poorly circumscribed, erythematous, exophytic lesion occupying the free and attached buccal gingiva of the right maxillary lateral incisor and canine. Histopathologically, the tumor showed diffuse and intense polymorphic infiltration by small to medium-sized lymphocytes admixed with numerous eosinophils. The neoplastic cells showed strong and diffuse reactivity for CD2, CD3, CD4, CD10, and PD-1 (programmed cell death 1 [PDCD1]). Rare immunopositivity was seen with BCL6 (B-cell CLL/lymphoma 6) and CXCL13 (chemokine [C-X-C motif] ligand 13). Neoplastic cells were negative for CD7 and EBER ISH (Epstein-Barr virus-encoded small RNA in situ hybridization). CD21 did not show any increased follicular dendritic cell component. Polymerase chain reaction-based assay found monoclonal T-cell receptor γ (TRG) gene rearrangements. Diagnosis of recurrent/residual AITL was rendered. Chemotherapy was administered, with the intraoral tumor resolving completely 3 months later.
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Affiliation(s)
- Prokopios P Argyris
- Division of Oral and Maxillofacial Pathology, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - Ioannis G Koutlas
- Division of Oral and Maxillofacial Pathology, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - Sarah Cooley
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Sophia L Yohe
- Division of Hematopathology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Keta Bhakta
- Division of Oral and Maxillofacial Pathology, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - Rajaram Gopalakrishnan
- Division of Oral and Maxillofacial Pathology, School of Dentistry, University of Minnesota, Minneapolis, MN, USA.
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Humeniuk MS, Liang JJ, Howard M, Inwards DJ. Spontaneous complete remission of angioimmunoblastic T-cell lymphoma. Proc AMIA Symp 2014; 27:242-5. [PMID: 24982577 DOI: 10.1080/08998280.2014.11929126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) is a rare hematologic neoplasm that typically presents with B symptoms, anemia, and lymphadenopathy. Its overall prognosis is poor, with a 5-year survival rate of 30%. We present a case of AITL that went into spontaneous remission, an uncommon occurrence.
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Affiliation(s)
- Michael S Humeniuk
- Department of Medicine (Humeniuk, Liang), Division of Hematopathology (Howard), and Division of Hematology (Inwards), Mayo Clinic, Rochester, Minnesota
| | - Jackson J Liang
- Department of Medicine (Humeniuk, Liang), Division of Hematopathology (Howard), and Division of Hematology (Inwards), Mayo Clinic, Rochester, Minnesota
| | - Matthew Howard
- Department of Medicine (Humeniuk, Liang), Division of Hematopathology (Howard), and Division of Hematology (Inwards), Mayo Clinic, Rochester, Minnesota
| | - David J Inwards
- Department of Medicine (Humeniuk, Liang), Division of Hematopathology (Howard), and Division of Hematology (Inwards), Mayo Clinic, Rochester, Minnesota
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Lohneis P, Jakob C, Hummel M, Jöhrens K, Anagnostopoulos I. Unusual relapse of an angioimmunoblastic T cell lymphoma 11 years after initial manifestation. Ann Hematol 2014; 94:347-9. [PMID: 24923452 DOI: 10.1007/s00277-014-2129-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 06/02/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Philipp Lohneis
- Institute of Pathology, Charité Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany,
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Wang X, Zhang D, Wang L, Huang J, Yang Z, Wang J, Chen J, Liu L. Cyclosporine treatment of angioimmunoblastic T-cell lymphoma relapsed after an autologous hematopoietic stem cell transplant. EXP CLIN TRANSPLANT 2014; 13:203-5. [PMID: 24918480 DOI: 10.6002/ect.2013.0265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
An angioimmunoblastic T-cell lymphoma is a unique type of peripheral T-cell lymphoma; it has an aggressive course and a poor prognosis. There is no standard therapy for angioimmunoblastic T-cell lymphoma, especially for refractory or relapsed cases. Here, we report a case of 53-year-old woman with angioimmunoblastic T-cell lymphoma who underwent high-dose chemotherapy with an autologous hematopoietic stem cell transplant after several cycles of chemotherapy, but soon relapsed with severe autoimmune hemolytic anemia. The patient was given dexamethasone and thalidomide, but responded poorly; however, she responded well to cyclosporine and finally achieved a sustained response. Thus, we conclude that cyclosporine has an effect in relapsed angioimmunoblastic T-cell lymphoma after an autologous hematopoietic stem cell transplant.
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Affiliation(s)
- Xianxuan Wang
- From the Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing China
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Abstract
The genetics of angioimmunoblastic T-cell lymphoma (AITL) are very poorly understood. We defined the mutational landscape of AITL across 219 genes in 85 cases from the United States and Europe. We identified ≥2 mutations in 34 genes, nearly all of which were not previously implicated in AITL. These included loss-of-function mutations in TP53 (n = 4), ETV6 (n = 3), CCND3 (n = 2), and EP300 (n = 5), as well as gain-of-function mutations in JAK2 (n = 2) and STAT3 (n = 4). TET2 was mutated in 65 (76%) AITLs, including 43 that harbored 2 or 3 TET2 mutations. DNMT3A mutations occurred in 28 (33%) AITLs; 100% of these also harbored TET2 mutations (P < .0001). Seventeen AITLs harbored IDH2 R172 substitutions, including 15 with TET2 mutations. In summary, AITL is characterized by high frequencies of overlapping mutations in epigenetic modifiers and targetable mutations in a subset of cases.
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Lachenal F, Berger F, Cimarelli S, Formaglio M, Ghesquières H. Primary cerebral angioimmunoblastic T-cell lymphoma. J Clin Oncol 2013; 31:e64-8. [PMID: 23295811 DOI: 10.1200/jco.2012.43.8226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Florence Lachenal
- Department of Oncology and Hematology, Hôpital Pierre Oudot, 30 Blvd du médipôle, 38300 Bourgoin-Jallieu, France.
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Chen XG, Huang H, Tian Y, Guo CC, Liang CY, Gong YL, Zou BY, Cai RQ, Lin TY. Cyclosporine, prednisone, and high-dose immunoglobulin treatment of angioimmunoblastic T-cell lymphoma refractory to prior CHOP or CHOP-like regimen. CHINESE JOURNAL OF CANCER 2013; 30:731-8. [PMID: 21959050 PMCID: PMC4012273 DOI: 10.5732/cjc.011.10071] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) is a rare, distinct subtype of peripheral T-cell lymphoma, possessing an aggressive course and poor prognosis with no standard therapy. Twelve patients who have failed at least two initial CHOP or CHOP-like regimens were enrolled in this study and treated with individualized cyclosporine (CsA), prednisone (PDN), and monthly, high-dose intravenous immunoglobulin (HDIVIG). The dose of CsA was adjusted individually based on the blood trough concentration of CsA and renal function. All patients were examined for response, toxicity and survival. The most significant toxicities (≥ grade 2) were infection (16.7%), renal insufficiency (8.3%), hypertension (8.3%), diabetes (8.3%) and insomnia (16.7%). Discontinuation of treatment occurred in one patient (8.3%) due to grade 3 renal toxicity and subsequent grade 4 pulmonary infection. Treatment-related death was not observed. The overall response rate was 75.0% (complete response, 33.3%; partial response, 41.7%). With a median follow-up of 25.5 months, the median duration of response was 20 months (range, 12 to 49 months) and the median progression-free survival (PFS) was 25.5 months (range, 10 to 56 months). The 2-year PFS rate was 81.5%. Our findings indicate the combination of CsA, PDN and HDIVIG is an effective salvage regimen for refractory or relapsed AITL with predictable and manageable toxicity.
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Affiliation(s)
- Xing-Gui Chen
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
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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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Assessment of gemcitabine, cisplatin and methylprednisolone (GEM-P) combination treatment for non-Hodgkin T cell lymphoma. Med Oncol 2012; 29:3535-9. [PMID: 22825684 DOI: 10.1007/s12032-012-0309-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 07/09/2012] [Indexed: 01/13/2023]
Abstract
T cell lymphoma is rare with few dedicated studies and no consensus regarding optimal treatment. We undertook a retrospective hospital review to assess the efficacy of gemcitabine, cisplatin and methylprednisolone (GEM-P) combination therapy. Twenty-nine patients were followed up for a median duration of 28 months. Twenty-three patients received standard GEM-P. Due to hearing impairment, 3 patients had cisplatin substituted with carboplatin and 1 with oxaliplatin. In 2 cases, rituximab was added to GEM-P in view of the presence of EBV + B cell clones. Overall response rate (RR) [complete response (CR) + partial response (PR)] was 73 % (95 % CI range 54-86 %). 11/29 (38 %) achieved CR and 10/29 (35 %) had PR. In first-line treatment, 4/10 patients achieved CR and 4/10 had PR relating to a RR of 80 %. CR was seen in 4/9 (45 %), 2/8 (25) and 1/2 (50 %) patients treated in the second, third and fifth-sixth line respectively. Thus, GEM-P was found to be effective as first-line or salvage therapy in T cell lymphoma.
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BCL2 expression in CD105 positive neoangiogenic cells and tumor progression in angioimmunoblastic T-cell lymphoma. Mod Pathol 2012; 25:805-14. [PMID: 22322190 PMCID: PMC3625836 DOI: 10.1038/modpathol.2012.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The angiogenic microenvironment has been known to be a component of angioimmunoblastic T-cell lymphoma since its initial characterization. We have shown that angioimmunoblastic T-cell lymphoma endothelial cells produce vascular endothelial growth factor-A (VEGFA), and participate in lymphoma progression. In squamous cell carcinoma, endothelial BCL2 expression induces a crosstalk with tumor cells through VEGFA, a major mediator of tumoral angiogenesis. In the present study, we analyzed BCL2 and VEGFA in 30 angioimmunoblastic T-cell lymphomas, using triple immunofluorescence to identify protein coexpression in well-characterized lymphoma cells and microenvironment neoangiogenic endothelial cells. Using quantitative real-time PCR, we assessed mRNA expression levels in laser-microdissected endothelial and lymphoma cells. In lymphoma cells, as in endothelial cells, BCL2 and VEGFA proteins were coexpressed. BCL2 was expressed only in neoangiogenic CD34(+)CD105(+) endothelial cells. In laser-microdissected cells, mRNA studies showed a significant relationship between BCL2 and VEGFA levels in CD34(+) endothelial cells, but not in CD3(+)CD10(+)lymphoma cells, or in CD34(+) endothelial cells from lymph node hyperplasia. Further study showed that, in AITL, BCL2 mRNA levels in CD34(+)CD105(+) neoangiogenic endothelial cells also correlated with microvessel density, International Prognostic Index, Ann Arbor stage, bone marrow involvement and elevated LDH. BCL2 expression by CD105(+) neoangiogenic endothelial cells is related to tumor progression in angioimmunoblastic T-cell lymphoma.
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Key Words
- adult
- aged
- aged, 80 and over
- antigens, cd
- analysis
- antigens, cd34
- case-control studies
- chi-square distribution
- disease progression
- disease-free survival
- endothelial cells
- chemistry
- immunology
- pathology
- female
- fluorescent antibody technique
- humans
- immunoblastic lymphadenopathy
- genetics
- metabolism
- mortality
- therapy
- kaplan-meier estimate
- laser capture microdissection
- lymph nodes
- blood supply
- lymphoma, t-cell
- male
- microvessels
- middle aged
- multivariate analysis
- neovascularization, pathologic
- paris
- proportional hazards models
- proto-oncogene proteins c-bcl-2
- rna, messenger
- real-time polymerase chain reaction
- receptors, cell surface
- risk assessment
- risk factors
- time factors
- treatment outcome
- tumor markers, biological
- tumor microenvironment
- vascular endothelial growth factor a
- angioimmunolbastic t-cell lyphoma, bcl2, cd105, endothelial cell, neoangiogenesis, vegf
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Primary cutaneous, composite, Epstein-Barr virus-associated, diffuse large B-cell lymphoma and peripheral T-cell lymphoma. Am J Dermatopathol 2012; 33:719-25. [PMID: 21946762 DOI: 10.1097/dad.0b013e3181fe363b] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
T-cell lymphomas have a broad spectrum of cutaneous involvement. Several subtypes of T-cell lymphomas are associated with Epstein-Barr virus (EBV)-driven lymphoproliferative processes. We present a case of a composite, primary, cutaneous, EBV-associated, diffuse, large B-cell lymphoma and mature T-cell lymphoma occurring in a patient with Klinefelter karyotype (47, XXY). The patient had a characteristic clinical course of a systemic mature T-cell lymphoma before the presentation of the composite, primary, EBV-associated, diffuse, large B-cell lymphoma. Although similar cases have been described in extracutaneous locations, we believe that this is the first description with a primary cutaneous presentation.
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Uncommon late relapse of angioimmunoblastic T-cell lymphoma after 16-year remission period. Pathol Oncol Res 2011; 18:737-41. [PMID: 22127590 DOI: 10.1007/s12253-011-9475-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 11/03/2011] [Indexed: 10/15/2022]
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Zhao S, Zhang L, Zhang M, Yao G, Zhang X, Zhao W, Ren W, Wang J, Zhang Q. Angioimmunoblastic T-cell lymphoma: the effect of initial treatment and microvascular density in 31 patients. Med Oncol 2011; 29:2311-6. [PMID: 22038726 DOI: 10.1007/s12032-011-0094-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 10/13/2011] [Indexed: 01/19/2023]
Abstract
The objectives of this study are to explore the clinical features and treatment outcomes and to investigate the correlation between microvessel density (MVD) and survival in patients with angioimmunoblastic T-cell lymphoma (AITL). We retrospectively analyzed clinical and follow-up data of 31 patients treated in two hospitals during 1995-2009 histologically proven AITL. We also assessed MVD in the lump of 31 previously untreated patients using α-CD34 immunohistochemical staining. The median age of the 31 patients was 48 years, eighty percent of the patients were in an advanced stage. 67.7% of them had B symptoms, with the follow-up of 2-13 years, the 5-year overall survival rate was 25.8%. The response rates (RR) of CHOP group and COP (cyclophosphamide, vincristine and prednisolone) group are 76.5 and 75%, respectively, which is no significant difference (P=0.894). RR did not differ whether chemotherapy regimens contained anthracycline or not. The 3-year PFS rate for patients who received COP and CHOP regimen was 25.4 and 35.3% (P=0.562), while 5-year OS rates were 25.0 and 29.4%, respectively (P=0.667). The median PFS for patients with high MVD and low MVD were 15.1 and 30.0 months (P=0.048), while the median OS were 20 and 45 months, respectively (P=0.038). Patients who were sensitive to initial chemotherapy COP regimen have the similar therapeutic effect to CHOP regimen. Patients with high MVD measured in the microenvironment had worse PFS and OS than AITL patients with low expression.
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Affiliation(s)
- Shu Zhao
- Department of Medical Oncology, The Third Affiliated Hospital of Harbin Medical University, Haping Road 150 of Nangang District, Harbin, Heilongjiang Province, 150081, China
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Balaraman B, Conley JA, Sheinbein DM. Evaluation of cutaneous angioimmunoblastic T-cell lymphoma. J Am Acad Dermatol 2011; 65:855-862. [DOI: 10.1016/j.jaad.2010.05.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 05/09/2010] [Accepted: 05/20/2010] [Indexed: 01/01/2023]
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Phillips AA, Owens C, Lee S, Bhagat G. An update on the management of peripheral T-cell lymphoma and emerging treatment options. J Blood Med 2011; 2:119-29. [PMID: 22287871 PMCID: PMC3262352 DOI: 10.2147/jbm.s8627] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Indexed: 11/23/2022] Open
Abstract
Peripheral T-cell lymphomas (PTCLs) comprise a rare and heterogeneous subset of non-Hodgkin’s lymphomas (NHLs) that arise from post-thymic T-cells or natural killer (NK)-cells at nodal or extranodal sites. Worldwide, PTCLs represent approximately 12% of all NHLs and the 2008 World Health Organization (WHO) classification includes over 20 biologically and clinically distinct T/NK-cell neoplasms that differ significantly in presentation, pathology, and response to therapy. Because of the rarity and heterogeneity of these diseases, large clinical trials have not been conducted and optimal therapy is not well defined. Most subtypes are treated with similar combination chemotherapy regimens as used for aggressive B-cell NHL, but with poorer outcomes. New treatment combinations and novel agents are currently being explored for PTCLs and this review highlights a number of options that appear promising.
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AbouYabis AN, Shenoy PJ, Sinha R, Flowers CR, Lechowicz MJ. A Systematic Review and Meta-Analysis of Front-line Anthracycline-Based Chemotherapy Regimens for Peripheral T-Cell Lymphoma. ISRN HEMATOLOGY 2011; 2011:623924. [PMID: 22084700 PMCID: PMC3197255 DOI: 10.5402/2011/623924] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 04/20/2011] [Indexed: 12/21/2022]
Abstract
Anthracycline-based chemotherapy remains standard treatment for peripheral T-cell lymphoma (PTCL) although its benefits have been questioned. We performed systematic literature review and meta-analyses examining the complete response (CR) and overall survival (OS) rates for patients with PTCL. The CR rate for PTCL patients ranged from 35.9% (95% CI 23.4-50.7%) for enteropathy-type T-cell lymphoma (ETTL) to 65.8% (95% CI 54.0-75.9%) for anaplastic large cell lymphoma (ALCL). The 5-year OS was 38.5% (95% CI 35.5-41.6%) for all PTCL patients and ranged from 20.3% (95% CI 12.5-31.2%) for ETTL to 56.5% (95% CI 42.8-69.2%) for ALCL. These data suggest that there is marked heterogeneity across PTCL subtypes in the benefits of anthracycline-based chemotherapy. While anthracyclines produce CR in half of PTCL patients, this yields reasonable 5-year OS for patients with ALCL but not for those with PTCL-NOS or ETTL. Novel agents and regimens are needed to improve outcomes for these patients.
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Affiliation(s)
- Abeer N. AbouYabis
- Department of Internal Medicine, Mercer University, Central Georgia Cancer Care, 1062 Forsyth Street, Suite 1B Macon, Georgia, GA 31201, USA
| | - Pareen J. Shenoy
- Department of Hematology Oncology, Winship Cancer Institute, Emory University, 2365 Clifton Road, N.E. Building C, Atlanta, GA 30322, USA
| | - Rajni Sinha
- Department of Hematology Oncology, Winship Cancer Institute, Emory University, 2365 Clifton Road, N.E. Building C, Atlanta, GA 30322, USA
| | - Christopher R. Flowers
- Department of Hematology Oncology, Winship Cancer Institute, Emory University, 2365 Clifton Road, N.E. Building C, Atlanta, GA 30322, USA
| | - Mary Jo Lechowicz
- Department of Hematology Oncology, Winship Cancer Institute, Emory University, 2365 Clifton Road, N.E. Building C, Atlanta, GA 30322, USA
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Dearden CE, Johnson R, Pettengell R, Devereux S, Cwynarski K, Whittaker S, McMillan A. Guidelines for the management of mature T-cell and NK-cell neoplasms (excluding cutaneous T-cell lymphoma). Br J Haematol 2011; 153:451-85. [PMID: 21480860 DOI: 10.1111/j.1365-2141.2011.08651.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The peripheral T-cell neoplasms are a biologically and clinically heterogeneous group of rare disorders that result from clonal proliferation of mature post-thymic lymphocytes. Natural killer (NK) cell neoplasms are included in this group. The World Health Organization classification of haemopoietic malignancies has divided this group of disorders into those with predominantly leukaemic (disseminated), nodal, extra-nodal or cutaneous presentation. They usually affect adults and are more commonly reported in males than in females. The median age at diagnosis is 61 years with a range of 17-90 years. Although some subtypes may follow a relatively benign protracted course most have an aggressive clinical behaviour and poor prognosis. Excluding anaplastic lymphoma kinase (ALK)-positive anaplastic large cell lymphoma (ALCL), which has a good outcome, 5-year survival for other nodal and extranodal T-cell lymphomas is about 30%. Most patients present with unfavourable international prognostic index scores (>3) and poor performance status. The rarity of these diseases and the lack of randomized trials mean that there is no consensus about optimal therapy for T- and NK-cell neoplasms and recommendations in this guideline are therefore based on small case series, phase II trials and expert opinion.
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Abouyabis AN, Shenoy PJ, Lechowicz MJ, Flowers CR. Stem cell transplantation as a biological therapy for peripheral T-cell lymphomas. Expert Opin Biol Ther 2010; 11:31-40. [DOI: 10.1517/14712598.2011.534451] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Amengual JE, Raphael BG. Sustained, durable responses with alemtuzumab in refractory angioimmunoblastic T-cell lymphoma. Leuk Lymphoma 2010; 51:1347-50. [DOI: 10.3109/10428194.2010.486091] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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45
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de Leval L, Gisselbrecht C, Gaulard P. Advances in the understanding and management of angioimmunoblastic T-cell lymphoma. Br J Haematol 2010; 148:673-89. [DOI: 10.1111/j.1365-2141.2009.08003.x] [Citation(s) in RCA: 183] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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46
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Abramson JS, Digumarthy S, Ferry JA. Case records of the Massachusetts General Hospital. Case 27-2009. A 56-year-old woman with fever, rash, and lymphadenopathy. N Engl J Med 2009; 361:900-11. [PMID: 19710489 DOI: 10.1056/nejmcpc0902223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
MESH Headings
- Biopsy
- Chromosome Aberrations
- Diagnosis, Differential
- Exanthema/etiology
- Female
- Fever/etiology
- Gene Rearrangement, B-Lymphocyte
- Humans
- Immunoglobulin Heavy Chains/genetics
- Karyotyping
- Lymph Nodes/pathology
- Lymphatic Diseases/etiology
- Lymphoma, Large-Cell, Immunoblastic/complications
- Lymphoma, Large-Cell, Immunoblastic/genetics
- Lymphoma, Large-Cell, Immunoblastic/pathology
- Lymphoma, T-Cell/complications
- Lymphoma, T-Cell/genetics
- Lymphoma, T-Cell/pathology
- Middle Aged
- Remission Induction
- Tomography, X-Ray Computed
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Affiliation(s)
- Jeremy S Abramson
- Cancer Center, Massachusetts General Hospital, and Department of Medicine, Harvard Medical School, USA
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47
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Kyriakou C, Canals C, Finke J, Kobbe G, Harousseau JL, Kolb HJ, Novitzky N, Goldstone AH, Sureda A, Schmitz N. Allogeneic stem cell transplantation is able to induce long-term remissions in angioimmunoblastic T-cell lymphoma: a retrospective study from the lymphoma working party of the European group for blood and marrow transplantation. J Clin Oncol 2009; 27:3951-8. [PMID: 19620487 DOI: 10.1200/jco.2008.20.4628] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE To analyze the long-term outcome in terms of nonrelapse mortality (NRM), relapse rate (RR), progression-free survival (PFS), and overall survival (OS) in patients with angioimmunoblastic T-cell lymphoma (AITL) treated with allogeneic stem-cell transplantation (alloSCT). PATIENTS AND METHODS Forty-five patients with AITL who had undergone an alloSCT between January 1998 and December 2005 and were registered in the European Group for Blood and Marrow Transplantation database were analyzed. Median age was 48 years (range, 23 to 68 years), 34 patients had received > or = two lines of chemotherapy before alloSCT, and 11 patients had experienced treatment failure with a prior autologous stem-cell transplantation. Twenty-five patients underwent a myeloablative alloSCT, and 20 underwent a reduced-intensity alloSCT. Donors were HLA-identical siblings in 26 patients. Twenty-seven patients were allografted in chemotherapy-sensitive disease, and 18 were allografted in refractory disease. RESULTS The cumulative incidence of NRM was 18%, 22%, and 25% at 3, 6, and 12 months, respectively. Patients with poor performance status had a significantly higher NRM (P = .01). RR was estimated as 16% and 20% at 2 and 3 years, respectively, and was lower in patients developing chronic graft-versus-host disease (cGVHD). PFS and OS rates were 62% and 53% and 66% and 64% at 1 and 3 years, respectively, and were significantly better in chemotherapy-sensitive patients. CONCLUSION AlloSCT represents a valid therapeutic option for patients with AITL. Both the lower RR after transplantation as well as the decreased RR in patients developing cGVHD after the alloSCT suggests the existence of a clinically relevant graft-versus-lymphoma effect.
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48
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Dunleavy K, Wilson WH. Angioimmunoblastic T-cell lymphoma: Immune modulation as a therapeutic strategy. Leuk Lymphoma 2009; 48:449-51. [PMID: 17454581 DOI: 10.1080/10428190701245138] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Kieron Dunleavy
- Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA.
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49
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Advani R, Horwitz S, Zelenetz A, Horning SJ. Angioimmunoblastic T cell lymphoma: Treatment experience with cyclosporine. Leuk Lymphoma 2009; 48:521-5. [PMID: 17454592 DOI: 10.1080/10428190601137658] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Angioimmunoblastic T cell lymphoma is a distinct entity for which there is no standard therapy. On the basis of the rationale that CsA may represent a novel drug for AITL, a disease with considerable immune dysregulation, and encouraging case reports, the authors have treated 12 patients with this agent. Ten had failed prior steroids and/or chemotherapy and two had no prior therapy. CsA was administered at a dose of 3 - 5 mg/kg PO bid for 6 - 8 weeks and gradually tapered by 50 mg every 1 - 3 weeks. Responding patients received a maintenance dose of 50 - 100 mg, with a gradual taper after a maximal response was achieved as tolerated. Doses were titrated for renal dysfunction or hypertension. CsA levels were not monitored. Eight of 12 patients responded (three complete and five partial remissions). Dose reductions were required in six patients; renal insufficiency (n = 3), fatigue (n = 2), and hypertension (n = 1). Two patients developed acute infections and one patient died shortly after active treatment. These results suggest that CsA deserves further testing as a novel therapy for AITL. By interrupting T-cell activation, CsA may alter the immune dysregulation that characterizes AILT. The efficacy of CsA is being explored in patients with recurrent AILT in a prospective trial (ECOG 2402).
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Affiliation(s)
- Ranjana Advani
- Stanford University Medical Center, Stanford, CA 94305-5821, USA.
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50
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Hauswirth AW, Skrabs C, Schützinger C, Gaiger A, Lechner K, Jäger U. Autoimmune hemolytic anemias, Evans' syndromes, and pure red cell aplasia in non-Hodgkin lymphomas. Leuk Lymphoma 2009; 48:1139-49. [PMID: 17577777 DOI: 10.1080/10428190701385173] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We analyzed 108 cases of non-CLL non-Hodgkin lymphoma (NHL) associated with autoimmune hemolytic anemia (AIHA) (+/- pure red cell aplasia (PRCA)) or Evans' syndrome. The analysis was based on cases reported in the literature, which were retrieved by means of Pubmed and Medline searches and of an original series of 121 patients with NHL as well as reference lists of papers in the field. The number of cases in various NHL subtypes was small (n = 6-25). Nevertheless, interesting and sometimes unexpected differences in sex prevalence, temporal relationship between onset of lymphoma and AIHA, stage of lymphoma, relative frequency of warm antibody-AIHA (WA-AIHA) and cold antibody (CA-AIHA), association with PRCA and response of AIHA to treatments were noted for various lymphoma entities. WA-AIHA was more frequent in B-cell lymphomas, while CA-AIHA and PRCA predominantly occurred in T-cell lymphomas. Anti-lymphoma treatment seemed to be more effective against AIHA than conventional therapy with steroids or immunoglobulin. Although generated by a literature survey, this compilation of data indicates a complex relation of lymphoma and AIHA and warrants more attention and specific studies.
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MESH Headings
- Anemia, Hemolytic, Autoimmune/diagnosis
- Anemia, Hemolytic, Autoimmune/etiology
- Anemia, Hemolytic, Autoimmune/therapy
- Humans
- Leukemia, Hairy Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Lymphoma, B-Cell/complications
- Lymphoma, Follicular/complications
- Lymphoma, Mantle-Cell/complications
- Lymphoma, Non-Hodgkin/complications
- Lymphoma, T-Cell, Peripheral/complications
- Multiple Myeloma/complications
- Prognosis
- Purpura, Thrombocytopenic, Idiopathic/etiology
- Red-Cell Aplasia, Pure/etiology
- Risk Factors
- Syndrome
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Affiliation(s)
- Alexander W Hauswirth
- Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Austria.
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