Outcome of adult patients with T-lymphoblastic lymphoma treated according to protocols for acute lymphoblastic leukemia

Abstract

We treated 45 adult patients with T-lymphoblastic lymphoma (T-LBL) (age range 15-61 years) with 2 protocols designed for adult acute lymphoblastic leukemia (ALL). An encouraging cure rate of 90% was recently reported for T-LBL in children treated with a similar approach. In our study, an 8-drug standard induction was administered over 8 weeks including prophylactic cranial (24 Gy) and mediastinal irradiation (24 Gy) followed by consolidation and reinduction therapy. At diagnosis, 91% of the 45 patients showed a mediastinal tumor and 40% had pleural/pericardial effusions; 73% of the patients had stage III/IV disease. Overall, 42 patients (93%) achieved a complete remission (CR), 2 patients (4%) achieved a partial remission, and 1 patient (2%) died during induction. In patients with stage I-III disease (n ‫؍‬ 18) the CR rate was 100% compared with 89% in stage IV (n ‫؍‬ 27). There were 15 patients who relapsed (36%) within 12 months. The majority of relapses (47%) occurred in the mediastinum (n ‫؍‬ 7) despite mediastinal irradiation with 24 Gy in 6 out of 7 patients. The estimates for overall survival, continuous CR, and disease-free survival at 7 years are 51%, 65%, and 62%, respectively. Stage, age, lactate dehydrogenase, and all other parameters had no influence on achievement of CR or outcome. This study demonstrates in a large cohort of patients with adult T-LBL that a high CR rate and a favorable outcome can be achieved with an ALL-type regimen. Mediastinal recurrence was the major obstacle and further improvement by intensification of chemotherapy, increased dose of mediastinal irradiation (36 Gy), and extended indications for stem cell transplantation seem to be required. (Blood. 2002; 99:4379-4385)

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

“…Some prognostic factors have been found to significantly affect the survival of patients with LBL: age, stage IV disease, LDH level 4500 or anemia. 6,18,19,20 In our study, age at diagnosis was the only factor to significantly influence the OS rate, in agreement with Morel et al, 40 years appears to be the cut-off for OS and 30 years for Slater et al 18 Neither CNS nor BM involvement influenced OS and EFS. 19 The age-adjusted IPI score tended to have an effect on OS, but not EFS.…”

“…A recent article on T-LBL reported the same inability of IPI index to predict LBL outcome. 20 Our 5-year OS and EFS rates of, respectively, 32% and 22% were very poor and much lower than those obtained for other aggressive lymphomas (nearly 50%) 13,14 or LBL treated with similar regimens, for example, 50% survival for Colgan et al, 5 51% for Morel et al 6 and 56% at 3 years for Coleman et al 19 However, it must be kept in mind that our multicenter study included more unselected patients who were older, had a lower CR rate and a longer follow-up.…”

“…21 Comparisons between children and adults with LBL remains difficult, but use of ALL therapies always gave much poorer results in adults. However, compared to aggressive lymphoma chemotherapy, only ALL chemotherapy regimens seem to improve the CR: 80% for Slater et al, 18 89% for Morel et al 6 and 92% for Hoelzer et al 20 Another therapeutic alternative is based on HDT including BMT. The largest study (n ¼ 105) by Sweetenham et al 7 reported an EFS rate at 4 years of 67% and similar rates were achieved by Milpied et al 8 and Baro et al 22 These encouraging results have to be moderated by the fact that only patients in CR underwent ABMT.…”

The German competence network ‘Acute and chronic leukemias’

“…[12][13][14] The prolongation of survival achieved over the years for the various leukemias by the study groups forming the network are depicted in Figure 3-5. [15][16][17][18] The orientation of the network towards innovation and success makes the network attractive for new participants. The cooperation within the network and the thereby accomplished synergy yield an added value for all network partners.…”

Short intensive sequential therapy followed by autologous stem cell transplantation in adult Burkitt, Burkitt-like and lymphoblastic lymphoma

“…8 Lymphoblastic lymphoma (LyLy), a disease mainly seen in adolescents has a very poor outcome in adults treated with conventional chemotherapy. Adult patients with extensive bone marrow involvement at presentation have better outcomes with more intensive treatment approaches such as those used for treatment of acute lymphoblastic leukemia, [13][14][15][16] but the optimal treatment for patients with less extensive disease remains to be elucidated.…”