T-lymphoblastic leukemia/lymphoma: a single center retrospective study of outcome

Abstract

T-lymphoblastic leukemia/lymphoma (LBL and ALL) is a rare lymphoid malignancy typically presenting in adolescent and young adult males. Patients are traditionally treated with ALL-type protocols, with no consensus on the role of maintenance therapy, or allogeneic or autologous transplant. Outcome results are thus difficult to interpret. The successful use of intensified ALL protocols in patients <25 years with lymphoblastic malignancies without transplant prompted the Haematology Unit at St James's Hospital (SJH) to change practice in 2005 from transplanting in first complete remission (CR1) to treating patients <25 years with chemotherapy alone. We reviewed the outcome of patients treated before 2005 in order to compare the pre- and post-2005 management approaches in the future. This retrospective study included 31 patients with T-LBL treated from 1980 to 2004. The patients were divided into group A (16-25 years) and group B (>25 years). Twenty-one patients had an allograft in CR1 (group A, n = 12 and group B, n = 9). For the allografted patients the 5-year EFS and OS was 57%, with a treatment related mortality of 10%. In conclusion, this series confirms that allograft in CR1 has an acceptable cure rate, and we will use these results to benchmark outcomes using pediatric-type protocols in the future.

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

“…Auto- and allo-HSCT have both been used in consolidation therapy of high-risk T-LBL. [ 10 , 19 , 21 ] The difference between autologous and allogeneic HSCT is post-transplant disease recurrence and TRM. In our hospitals, 5 patients underwent autologous stem cell transplantation, and all relapsed at the end.…”

An unusual presentation of lymphoma: Chylotamponade

“…7 It is most common in young men. Although patients usually present with painless lymphadenopathy, 50% to 75% of patients have mediastinal mass.…”

Selection of hematopoietic stem cell transplantation for T-cell lymphoblastic lymphoma

“…Similarly, some studies have also shown that CR1 is also a risk factor affecting the efficacy of allogeneic transplantation in T-ALL/LBL patients ( 28 , 39 ). Moreover, in patients younger than 25 years of age, treatment with ALL intensive regimens up to CR1 followed by allo-HSCT resulted in a 5-year OS of 57% and a treatment-related mortality of only 10% ( 40 ). In multicenter study of 24 adult T-LBL patients who underwent HSCT after remission with hyper-CVAD chemotherapy, there was no difference in survival outcomes between the 16 patients with auto-HSCT and the 8 patients with allo-HSCT ( 41 ).…”