Adult lymphoblastic lymphoma: a retrospective analysis of 92 patients under 61 years included in the LNH87/93 trials

Abstract

Since 1987, the GELA has initiated multicenter prospective trials for aggressive non-Hodgkin's lymphomas (NHL). Lymphoblastic lymphomas (LBL) were included in those studies until 1997, and 92 LBL patients under 61 years were identified after histological review. The protocols prescribed high-dose anthracycline regimens, four cycles given every 15 days as induction and lasted for p6 months. A total of 23 patients underwent high-dose therapy consolidation followed by autologous stem-cell transplantation and 69 received standard chemotherapy regimens. Clinical characteristics showed a male predominance (66%) with a median age of 31 years, bone marrow (BM) involvement (22%), mediastinal involvement (66%) and elevated LDH (62%). At the end of treatment, it was seen that 71% of the patients achieved complete remission; four (4%) patients died during induction; 43 patients relapsed at a median time of 10 months. With a median follow-up of 34 months, the 5-year overall survival (OS) and event-free survival (EFS) rates were 32 and 22%, respectively. The only favorable factor significantly associated with survival was young age. These results are poorer than those obtained in other aggressive lymphomas treated with the same regimens and suggest that adult LBL patients should be treated with acute lymphoblastic leukemia protocols.

Results of a lymphoblastic leukemia-like chemotherapy program with risk-adapted mediastinal irradiation and stem cell transplantation for adult patients with lymphoblastic lymphoma

“…In the NILG program, induction chemotherapy was integrated with early mediastinal irradiation in patients with suboptimal tumor regression, whereas the molecular analysis of MRD was used for the first time in adult LL to decide between SCT and standard maintenance for postinduction therapy. The general results reflected the high rate of CR that can be attained in LL with ALL-like regimens [4][5][6][8][9][10][11][12] in contrast to regimens for non-Hodgkin lymphoma [7,21].…”

Non-Hodgkin’s Lymphomas

“…109 Lymphoblastic lymphoma has generally been treated with regimens appropriate for ALL. 110 TLS is more common in patients with lymphoblastic lymphoma and should be managed as outlined in the section on Tumor Lysis Syndrome (page 323).…”

High survival rate with the LMT-89 regimen in lymphoblastic lymphoma (LL), but not in T-cell acute lymphoblastic leukemia (T-ALL)

“…Results achieved with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone) or CHOP-like regimens seems to yield poor results with complete remission (CR) rates ranging from 20 to 50% and disease-free survival (DFS) rates from 20 to 50%. 2,3,4,[7][8][9] Acute lymphoblastic leukemia-type chemotherapy seems to yield better results with CR rates ranging from 70 to 80% and DFS from 30 to 60%. 3,[10][11][12][13][14][15][16] The small number of patients reported for each type of therapy, especially for the ALL-type regimen may account for the lack of a definite consensus regarding LL chemotherapy.…”