Angioimmunoblastic T-cell Lymphoma as a Very Poor-Prognosis Malignancy – a Single Centre Experience

Česká verzia

Authors: S. Vokurka ¹; V. Koza ¹; V. Vozobulová ¹; P. Jindra ¹; K. Steinerová ¹; M. Schutzova ¹; L. Boudová ²
Authors place of work: Hematologicko-onkologické oddělení, FN Plzeň ¹; Patologicko-anatomický ústav, FN Plzeň ²
Published in the journal: Klin Onkol 2012; 25(3): 206-211
Category: Původní práce

Summary

Background:
Angioimmunoblastic T-lymphoma (AITL) is a poor prognosis malignancy. Because of relatively rare incidence and lack of publications in Czech, we decided to share our experience. Patients and Methods: Retrospective analysis of newly diagnosed AITL patients treated at our institution between 1/2000–12/2010.

Results:
Twelve patients with median age of 64 (43–82) years were analysed. Two patients over 80 years were treated with corticosteroids. Ten patients were treated with 6 cycles of CHOP-21 chemotherapy resulting in: 2/10 (20%) stable disease, 5/10 (50%) partial remission and 3/10 (30%) complete remission. The median EFS and OS of chemotherapy-treated patients were 8 and 10 months, resp. The EFS and OS were both significantly longer in patients who achieved complete remission within the first line of CHOP or autologous stem cells transplantation therapy: 43 vs 6 (p = 0.0052) and 46 vs 6 months (p = 0.0023), respectively. It was not possible to perform autologous transplantation in 4/7 (57%) patients in need for further reduction of the disease because of poor performance status or early progression of lymphoma and death during salvage chemotherapy.

Conclusion:
AITL is a poor prognosis malignancy with a very high risk of early relapse after CHOP induction chemotherapy. In fit patients, autologous transplantation should be performed immediately after induction chemotherapy; information about availability of stem cells donor, both in the family or any available register, should be found during the induction treatment.

Key words:
lymphoma – chemotherapy – transplantation

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Submitted:
17. 5. 2011

Accepted:
24. 8. 2011

Zdroje

1. Swerdlow SH, Campo E, Harris NL et al. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. 4^th ed. Lyon: World Health Organization 2008.

2. Frizzera G, Moran EM, Rappaport H. Angio-immunoblastic lymphadenopathy with dysproteinaemia. Lancet 1974; 1(7866): 1070–1073.

3. Lukes RJ, Tindle BH. Immunoblastic lymphadenopathy. A hyperimmune entity resembling Hodgkin’s disease. N Engl J Med 1975; 292(1): 1–8.

4. Lennert K. Nature, prognosis and nomenclature of angioimmunoblastic (lymphadenopathy, lymphogranulomatosis X or T-zone lymphoma). Dtsch Med Wochenschr 1979; 104(35): 1246–1247.

5. Shimoyama M, Minato K. Clinical, cytological and immunological analysis of T-cell type lymphoid malignancies: a classification of T-cell type lymphoid malignancy (author’s transl). Rinsho Ketsueki 1979; 20(9): 1056–1069.

6. Harris NL, Jaffe ES, Stein H et al. A revised European--American classification of lymphoid neoplasms: a proposal from the International Lymphoma Study Group. Blood 1994; 84(5): 1361–1392.

7. Trněný M, Vášová I, Pytlík R et al. Distribuce podtypů non-hodgkinského lymfomu v České republice a jejich přežití. Klin Onkol 2007; 20(5): 341–348.

8. The Non-Hodgkin’s Lymphoma Classification Project. A clinical evaluation of the International Lymphoma Study Group classification of non-Hodgkin’s lymphoma. Blood 1997; 89(11): 3909–3918.

9. de Leval L, Gisselbrecht C, Gaulard P. Advances in the understanding and management of angioimmunoblastic T-cell lymphoma. Br J Haematol 2010; 148(5): 673–689.

10. Armitage J, Vose J, Weisenburger D. Internatitonal T-Cell Lymphoma Project. International peripheral T-cell and natural killer/T-cell lymphoma study: pathology findings and clinical outcomes. J Clin Oncol 2008; 26(25): 4124–4130.

11. Mourad N, Mounier N, Brière J et al. Clinical, biologic, and pathologic features in 157 patients with angioimmunoblastic T-cell lymphoma treated within the Groupe d‘Etude des Lymphomes de l‘Adulte (GELA) trials. Blood 2008; 111(9): 4463–4470.

12. Delmer A, Fitoussi O, Gaulard P et al. A phase II study of bortezomib in combination with intensified CHOP-like regimen (ACVBP) in patients with previously untreated T-cell lymphoma: Results of the GELA LNH05–1T trial. J Clin Oncol 2009; 27 (Suppl 15): 8554.

13. Escalón MP, Liu NS, Yang Y et al. Prognostic factors and treatment of patients with T-cell non-Hodgkin lymphoma: the M. D. Anderson Cancer Center experience. Cancer 2005; 103(10): 2091–2098.

14. Tilly H, Lepage E, Coiffier B et al. Intensive conventional chemotherapy (ACVBP regimen) compared with standard CHOP for poor-prognosis aggressive non-Hodgkin lymphoma. Blood 2003; 102(13): 4284–4289.

15. Karakas T, Bergmann L, Stutte HJ et al. Peripheral T-cell lymphomas respond well to vincristine, adriamycin, cyclophosphamide, prednisone and etoposide (VACPE) and have a similar outcome as high-grade B-cell lymphomas. Leuk Lymphoma 1996; 24(1–2): 121–129.

16. Mounier N, Gisselbrecht C, Brière J et al. All aggressive lymphoma subtypes do not share similar outcome after front-line autotransplantation: a matched-control analysis by the Groupe d’Etude des Lymphomes de l’Adulte (GELA). Ann Oncol 2004; 15(12): 1790–1797.

17. Kyriakou C, Canals C, Goldstone A et al. High-dose therapy and autologous stem-cell transplantation in angioimmunoblastic lymphoma: complete remission at transplantation is the major determinant of Outcome-Lymphoma Working Party of the European Group for Blood and Marrow Transplantation. J Clin Oncol 2008; 26(2): 218–224.

18. Reimer P, Rüdiger T, Geissinger E et al. Autologous stem-cell transplantation as first-line therapy in peripheral T-cell lymphomas: results of a prospective multicenter study. J Clin Oncol 2009; 27(1): 106–113.

19. Le Gouill S, Milpied N, Buzyn A et al. Graft-versus-lymphoma effect for aggressive T-cell lymphomas in adults: a study by the Société Francaise de Greffe de Moëlle et de Thérapie Cellulaire. J Clin Oncol 2008; 26(14): 2264–2271.

20. Corradini P, Dodero A, Zallio F et al. Graft-versus-lymphoma effect in relapsed peripheral T-cell non--Hodgkin’s lymphomas after reduced-intensity conditioning followed by allogeneic transplantation of hematopoietic cells. J Clin Oncol 2004; 22(11): 2172–2176.

21. Vášová I, Boudová L, Trněný M et al. Primární testikulární lymfom, klinickopatologická multicentrická retrospektivní studie a data registru Kooperativní lymfomové skupiny (KLS). Klin Onkol 2007; 20(5): 302–306.

22. Boudová L, Kazakov D, Jindra P et al. Primární kožní velkobuněčný anaplastický T-lymfom s koexpresí CD30 a CD56, bohatý na neutrofily a histiocyty. Popis raritního případu s přehledem literatury. Klin Onkol 2007; 20(3): 260–263.

23. Fabian P, Boudová L. Poznámky ke 4. vydání klasifikace lymfomů WHO. Klin Onkol 2009; 22(3): 121–122.

24. Quintanilla-Martinez L, Ott G. Angioimmunoblastic T-cell lymphoma. In: Jaffé ES, Harris NL, Vardiman JW et al (eds). Hematopathology. Philadelphia: Elsevier 2011.