A childhood chemotherapy protocol improves overall survival among adults with T-lymphoblastic lymphoma

Abstract

A broadly accepted standard treatment for adult T-lymphoblastic lymphoma (T-LBL) has not yet been defined. To address that issue, we retrospectively compared three chemotherapy regimens used to treat 110 adult patients with newly diagnosed T-LBL. These included two adult regimens (ECOG2993 and hyper-CVAD) and a childhood regimen (BFM-90). These intensive drug regimens are mainly used to treat childhood and adult acute lymphoblastic leukemia. They included induction, consolidation, and maintenance chemotherapy protocols and were administered over the course of 2 years. Seventy-five patients (80%) achieved a complete remission (CR). Within a median follow-up time of 31 months (range: 5–152 months), the 5-year overall survival (OS) and progression-free survival (PFS) rates were 47.7% (95% CI, 35.0–69.8%) and 45.7% (95% CI, 27.6–56.6%), respectively. Shorter survival was associated with age > 40 years, poor ECOG PS and bone marrow involvement. Elevated lactic dehydrogenase (LDH) level, Ann Arbor stage and International Prognostic Index (IPI) score had no prognostic value. The childhood chemotherapy regimen improved CR and the overall survival rate more than the adult regimen in patients aged < 40 years.

Patients over 40 years old with precursor T-cell lymphoblastic lymphoma have different prognostic factors comparing to the youngers

“…Nevertheless, those had no relationship with outcome of patients less than 40 years old. The findings can be compared with that reported previously 6 , 13 . Majority patients received ALL-like regimen such as DA-BFM-90 and Hyper-CVAD.…”

“…Meanwhile, the rate was similar to each other for two subgroups (57.6% and 50.0%, respectively). Recently, Zhu 6 demonstrated that childhood chemotherapy regimen improved the overall survival rate more than the adult regimen in patients aged <40 years. In our cohort, the result was coincident with those observed previously.…”

“…And Zhu et al . 6 demonstrated that satisfactory OS cann’t be received for patients less than 40 years old. Surprisingly, there has been no comparison for different age groups with Pre-T-LBL.…”

Adult T-type lymphoblastic lymphoma: Treatment advances and prognostic indicators

“…For the various treatment protocols, CR rates tend to be higher and survival rates longer in patients under 40 years of age than in older patients (Table 4) [24,28,53]. This may be due to a lower tolerance of intensive chemotherapy regimens in older individuals [42].…”

“…Patients with bone marrow [32,[53][54][55] or CNS involvement [30,31] at diagnosis generally do not survive as long as patients without. Some studies have reported shorter survival [56] and lower CR rates [24,57] in patients with elevated lactate dehydrogenase levels than in patients with normal levels.…”