The prognostic significance of the immunotype in diffuse large-cell lymphoma: a comparative study of the T-cell and B-cell phenotype

Abstract

The clinical significance of immunophenotyping of the non-Hodgkin's lymphomas is controversial. Therefore, we conducted the present study of 103 consecutively accrued diffuse large-cell lymphoma (DLCL) patients to define, independently of histologic subtypes, the prognostic importance of phenotyping. We used an extensive panel of monoclonal antibodies to T- and B-cell antigens to assign all patients immunologically into the T-cell (20 patients) or B-cell group (83 patients). The only significant differences in pretreatment clinical variables between the two patient groups were the higher frequency of bulky disease (greater than 10 cm) in B-cell patients (P = .008) and more frequent skin involvement in the T-cell group (P less than or equal to .001). Multiagent doxorubicin-containing chemotherapy regimens were employed as initial therapy in over 83% of the patients in each group. Our study revealed that disease-free survival (DFS) was significantly shorter in the T-cell patients than in the B-cell DLCL patients (median DFS, 10.8 months for T-cell and 42.7 months for B- cell; P = .01, log rank). No patient with T-cell DLCL remained disease free for longer than 2 years, whereas 55% of the B-cell group were disease free at 2 years. Univariate and multivariate analyses of all major prognostic factors of DFS suggest that the T-cell phenotype indicates an incurable subset of DLCL patients. Although the B-cell group had a twofold advantage in median survival (35 months v 18 months), actuarial overall survival was not significantly different between the two patient groups (P = .23). Our results indicate the need for new approaches in the search for a curative treatment for T-cell DLCL.

Clinical relevance of immunophenotype in a retrospective comparative study of 297 peripheral T‐cell lymphomas, unspecified, and 496 diffuse large B‐cell lymphomas

“…From a clinical point of view, PTCL is considered an aggressive malignancy, and in agreement with this characterization, many investigators have found the T‐cell phenotype to be an independent adverse prognostic factor2, 3, 9; others, however, have been unable to confirm this finding 10–13. PTCL is no longer included in the WHO classification system, and the significant clinical heterogeneity of malignancies that fall under the umbrella of PTCL has been emphasized.…”

“…In addition, a new subclass of PTCL has been identified and appropriately termed peripheral T‐cell lymphoma, unspecified ( PTCL‐U ); however, this is a blanket term that is used to describe a heterogeneous array of lymphomas with differing clinical features, histologic characteristics, genetic alterations, responses to treatment, and associated prognoses. The complex nature of PTCL is evident,2, 3, 9–24 but various indicators can assist in the prediction of a given PTCL's clinical course. In this context, the International Prognostic Index (IPI),25 which was developed for the assessment of aggressive lymphomas, represents a possible foundation on which to base a more appropriate clinical definition of PTCL‐U 26.…”

Lymphoma of the nasal cavity and paranasal sinuses

“…The explanation for the discrepancy between the two series is unclear, but the high percentage of AILs in the Hong Kong experience is one possible explanation. When compared with B‐cell lymphomas, T‐cell lymphomas have been reported to have a significantly worse recurrence free survival and OS when treated with combination chemotherapy 46, 47. In addition, Aviles et al reported that the presence of angiocentric features in sinonasal lymphomas predict for lower recurrence free survival when treated by XRT alone as well as an inferior salvage rate with combination chemotherapy 39…”

Non‐Hodgkin's lymphomas: Recent concepts in classification and treatment

“…Large cell NHL are the most common subtypes, and 80-88% express B cell lineage antigens (43,44,45). The WF recognizes 3 morphologic subtypes: D-M and D-L of follicular center cell origin, and IB of nonfollicular center cell origin.…”