Outcome of adult T-lymphoblastic lymphoma depends on ALL-type chemotherapy, prognostic factors, and performance of allogeneic hematopoietic stem cell transplantation

Hu, Meiwei; Wang, Huafeng; Wang, Lei; Yang, Min; Lou, Yinjun; Jin, Jie

doi:10.1097/md.0000000000011374

Cited by 13 publications

(13 citation statements)

References 24 publications

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“…In a multicenter retrospective study of 49 patients with LBL treated with the hyper-CVAD regimen, transplanted patients ( N = 24) showed better OS (76% at 3 years) and progression-free survival (78% at 3 years) when compared with complete responders without HSCT consolidation 5 . Other studies have reported the superiority of HSCT consolidation after chemotherapies, but the wide variety of initial chemotherapies (ALL-type regimens were used only in half of the study group) 18 and extremely shorter periods of observation (median was 31.5 months) 24 unfortunately somewhat dilutes the external validity in these studies. On the other hand, one study suggested that allo-HSCT in CR1 should not be considered due to the relatively favorable outcomes even without HSCT 25 ; their claim, however, depends on the prognosis in mature T-ALL/LBL patients, which is a relatively rare subtype in LBL 26 .…”

Section: Discussionmentioning

confidence: 90%

Indication and benefit of upfront hematopoietic stem cell transplantation for T-cell lymphoblastic lymphoma in the era of ALL-type induction therapies

Morita-Fujita

Arai

Yoshioka

et al. 2020

Sci Rep

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Since the introduction of leukemia-type induction therapies for T-cell lymphoblastic lymphoma (T-LBL), improvements in the long-term outcomes of T-LBL have been reported. However, indications for and the appropriate timing of hematopoietic stem cell transplantation (HSCT) have not yet been established. Therefore, we performed a multicenter retrospective cohort study of patients with T-LBL treated using leukemia-type initial therapies to compare the outcomes after HSCT at different disease stages. We enrolled 21 patients with T-LBL from a total of 11 centers, and all patients received hyper-CVAD as a leukemia-type initial regimen. HSCT was performed during the CR1/PR1 (standard disease) stage in 11 patients, while it was completed at a later or non-remission (advanced disease) stage in 10 patients. Following HSCT, the overall survival rate was significantly greater in standard disease than in advanced-disease patients (79.5% vs. 30.0% at 5 years; hazard ratio (HR) 5.97; p = 0.03), with trend to the lower incidence of relapse in the former group (27.3% vs. 60.0% at 5 years; HR 2.29; p = 0.19). A prognostic difference was not detected between cases treated with allogeneic and autologous HSCTs. Our study suggests that frontline HSCT may be a feasible treatment option for T-LBL, even in the era of leukemia-type initial therapy.

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Section: Discussionmentioning

confidence: 90%

Indication and benefit of upfront hematopoietic stem cell transplantation for T-cell lymphoblastic lymphoma in the era of ALL-type induction therapies

Morita-Fujita

Arai

Yoshioka

et al. 2020

Sci Rep

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“…92 Although many of T-LBL prognostic factors have been reported, such as age above 30-40, elevated LDH, bone marrow involvement, stage IV, B symptoms, or early CNS invasion, these need to be furtherly elaborated on. Meiwei et al 93 reported that Ki-67≥75%, elevated LDH, pleural effusion and no OR after chemotherapy affected survival. 93 IPI score is frequently used.…”

Section: T-lymphoblastic Lymphomamentioning

confidence: 99%

“…Meiwei et al 93 reported that Ki-67≥75%, elevated LDH, pleural effusion and no OR after chemotherapy affected survival. 93 IPI score is frequently used. Feng et al observed the outcome of 75 newly diagnosed adult patients with T-lymphoblastic lymphoma (T-LBL) in correlation to LMR, NLR and PLR values.…”

Section: T-lymphoblastic Lymphomamentioning

confidence: 99%

<p>The Neutrophil to Lymphocyte and Lymphocyte to Monocyte Ratios as New Prognostic Factors in Hematological Malignancies – A Narrative Review</p>

Stefaniuk¹,

Szymczyk²,

Podhorecka³

2020

CMAR

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Despite the presence of many hematological prognostic indexes, clinical course and overall survival are often highly variable even within the same patient subgroup. Recent studies suggest that simple, cost-effective, low-risk tests such as neutrophil to lymphocyte ratio (NLR) and lymphocyte to monocyte ratio (LMR) may be used to evaluate the prognosis. Their role has been well confirmed in diffuse large B-cell lymphoma (DLBCL), Hodgkin lymphoma (HL) and multiple myeloma (MM), but until now the prognostic significance of NLR and LMR in leukemias has not been widely reported. In this article, we analyze the literature data on prognostic value of NLR and LMR in haematological malignancies in the context of classic prognostic factors and clinical course.

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“…Both TCR rearrangement positive- and negative-T-LBL/ALL are treated with similar multi-drug high-dose chemotherapy regimens such as Hyper-CVAD (cyclophosphamide, Changchun sheen, dexamethasone, and epirubicin); or BFM-90; combined with central nervous system prophylaxis and local radiotherapy. The addition of autologous stem cell transplantation or bone marrow transplantation significantly improves complete response and overall survival rates ( 9 ). Prognostic factors include age, gender, size of the primary mass, mediastinal and bone marrow involvement, peripheral blood tumor cell and LDH contents, Ann Arbor stage, and treatment regimen.…”

Section: Discussionmentioning

confidence: 99%

T-lymphoblastic lymphoma/leukemia without clonal TCR gene rearrangements: case report and literature review

Wang¹,

Jiang²,

Zhao³

et al. 2021

Transl Cancer Res TCR

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T-lymphoblastic lymphoma (T-LBL) is a highly aggressive malignancy originating from T-lymphocyte precursors. Incidence is highest in children and adolescents. T-cell receptor (TCR) gene rearrangement is usually present. TCR gene rearrangement-negative cases are considered rare. Here, we investigated the clinicopathological features, differential diagnosis, therapy, and prognosis of TCR gene rearrangement-negative T-lymphoblastic lymphoma/leukemia (T-LBL/ALL) by case report and literature review. An 18-year-old male with polyglandular lymphadenopathy underwent an excisional lymph node biopsy and bone marrow aspiration that disclosed diffuse distribution of round, small to medium sized cells with scant cytoplasm, delicate chromatin, and frequent mitotic figures. Immunophenotyping showed expression of TDT, CD3, CD7, and CD5, no CD34, CD20, CD56, bcl-6, CD4, CD8, or MPO in lymph node tissue. Immunohistochemical staining for pathological consultation was performed by Streptavidin peroxidase (SP) method, EB virus coded small RNA (EBER) tested by in situ hybridization (ISH), (EBER-ISH). And flow cytometry of bone marrow aspirate showed that tumor cells expressed CD3, CD5, CD7; partial expression of CD2, CD10, CD38, TDT; and no expression of CD1a, CD34, CD4, CD8, mCD3, CD33, CD56, CD19, CD79a, HLA-DR and MPO. These findings led to the diagnosis of T-LBL/-ALL. Molecular genetic testing showed no TCR gene rearrangement. The patient received chemotherapy consisting of vinorelbine, pirarubicin, cyclophosphamide, asparaginase, and prednisone. Prophylactic chemotherapy of the central nervous system and radiotherapy of the mediastinum were also given. And responded to combined chemotherapy and radiotherapy. Although T-LBL/ALL typically features TCR gene rearrangement, rare cases without rearrangement may occur. Diagnosis is based on clinical characteristics, histopathology, immunotyping, and molecular genetics.

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Outcome of adult T-lymphoblastic lymphoma depends on ALL-type chemotherapy, prognostic factors, and performance of allogeneic hematopoietic stem cell transplantation

Abstract: Supplemental Digital Content is available in the text

Cited by 13 publications

References 24 publications

Indication and benefit of upfront hematopoietic stem cell transplantation for T-cell lymphoblastic lymphoma in the era of ALL-type induction therapies

Indication and benefit of upfront hematopoietic stem cell transplantation for T-cell lymphoblastic lymphoma in the era of ALL-type induction therapies

<p>The Neutrophil to Lymphocyte and Lymphocyte to Monocyte Ratios as New Prognostic Factors in Hematological Malignancies – A Narrative Review</p>

T-lymphoblastic lymphoma/leukemia without clonal TCR gene rearrangements: case report and literature review

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