Body mass index at diagnosis is associated with survival outcome in peripheral T-cell lymphoma: a study of Chinese population

Abstract Objective Obesity increases the risk for many diseases, including some malignancies. We found that in diffuse large B-cell lymphoma, the most common form of non-Hodgkin’s lymphoma, patients with higher body mass index had significantly longer overall survival. Patients with peripheral T-cell lymphoma usually have worse outcomes than those with diffuse large B-cell lymphoma. Nonetheless, the association between body mass index at diagnosis and survival in patients with peripheral T-cell lymphoma remains unclear. Methods This retrospective study included 411 peripheral T-cell lymphoma patients from January 2010 to July 2017. Patients were stratified by body mass index into low body mass index (<24.0 kg/m2) and high body mass index (≥24.0 kg/m2) groups. We mainly used Cox modelling and the Kaplan–Meier method to evaluate survival and other variables. Results Multivariate analysis demonstrated that body mass index, international prognostic index and triglyceride level were independent prognostic factors of overall survival. Interestingly, patients with high body mass index had significantly longer overall survival (P < 0.01), with 69% of patients alive at 3 years versus 43% in the low body mass index group. Cox analysis showed reduced mortality in the high body mass index group compared with the low body mass index group (hazard ratio = 0.511, 95% CI, 0.309–0.846, P = 0.009). In addition, patients with high body mass index and low international prognostic index had the longest overall survival (P < 0.001). Conclusions High body mass index at the time of diagnosis was associated with improved overall survival in Chinese peripheral T-cell lymphoma patients.

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Increased body mass index is associated with improved overall survival in extranodal natural killer/T-cell lymphoma, nasal type

Oncotarget ◽

10.18632/oncotarget.13988 ◽

2016 ◽

Vol 8 (3) ◽

pp. 4245-4256 ◽

Cited By ~ 2

Author(s):

Ya-Jun Li ◽

Ping-Yong Yi ◽

Ji-Wei Li ◽

Xian-Ling Liu ◽

Xi-Yu Liu ◽

...

Keyword(s):

Body Mass Index ◽

Overall Survival ◽

T Cell ◽

Natural Killer ◽

Body Mass ◽

Cell Lymphoma ◽

T Cell Lymphoma ◽

Nasal Type ◽

Natural Killer T Cell ◽

Killer T Cell

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Monocytosis As Prognostic Factor in Aggressive, Non-Primary Cutaneous Peripheral T-Cell Lymphoma: A Study of 251 Cases

Blood ◽

10.1182/blood.v120.21.1608.1608 ◽

2012 ◽

Vol 120 (21) ◽

pp. 1608-1608

Author(s):

Brady E Beltran ◽

Erick Cotacallapa ◽

Jorge J Castillo

Keyword(s):

Overall Survival ◽

T Cell ◽

Who Classification ◽

Cell Lymphoma ◽

Statistical Significance ◽

Prognostic Index ◽

T Cell Lymphoma ◽

Peripheral T Cell Lymphoma ◽

Worse Prognosis

Abstract Abstract 1608 Background: Peripheral T-cell lymphoma (PTCL) is a heterogeneous family of entities with a worse prognosis, stage by stage, than their B-cell counterparts. We have previously reported that an absolute lymphocyte count (ALC) <1000/uL is associated with a worse prognosis in Peruvian patients with PTCL (Castillo et al. 2010). The goal of this study is to investigate the prognostic value of absolute monocyte count (AMC) in the survival of patients with PTCL. Methods: A total of 251 cases of aggressive, non-primary cutaneous PTCL diagnosed at our institution between January 1997 and January 2012 were reviewed, reevaluated according to their morphological, immunological and clinical characteristics, and reclassified according to the 2008 WHO classification of lymphoid neoplasms. Characteristics will be presented descriptively. Kaplan-Meier method was used to estimate overall survival (OS) curves, which were compared using the log-rank test. The multivariate analysis was performed using the Cox proportional-hazard regression test. Results: According to the new WHO classification of lymphoid neoplasms, 104 cases (41%) were classified as adult T-cell leukemia/lymphoma (ATLL), 103 cases (41%) as PTCL, unspecified (PTCLU), 27 cases (11%) as analplastic lymphoma kinase (ALK)-negative anaplastic large cell lymphoma (ALCL), 11 cases (4%) as extranodal NK/T-cell lymphoma (NKTCL), nasal type, 4 cases (2%) as angioimmunoblastic lymphoma (AIL), and 2 cases (1%) were diagnosed with ALK+ ALCL. The median age at diagnosis was 57 years (range 14–92 years); 47% of patients were >60 years. The male-to-female ratio was 1:1. ECOG performance status >1 was seen in 51%, LDH was elevated in 67%, advanced stage was seen in 73%, and >1 extranodal sites were seen in 22% of the patients. Bone marrow involvement was reported in 30% and B symptoms in 64% of patients. An International Prognostic Index (IPI) score 3–5 was seen in 55%, and a Prognostic Index for PTCLU (PIT) score of 2–4 in 63%. The median overall survival (OS) for the whole group was 10 months. The IPI score, the PIT score, ALC <1000/uL and AMC >800/uL (Figure) showed statistical significance in the univariate survival analysis (p<0.001, p<0.001, p=0.001 and p=0.001, respectively). In the multivariate analysis, PIT score and AMC >800/uL showed statistical significance (p=0.006, p=0.046, respectively). Conclusions: Monocytosis, defined as AMC >800/uL, and the PIT score were independent prognostic factors for OS in patients with aggressive, non-primary cutaneous PTCL. Disclosures: No relevant conflicts of interest to declare.

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Nodal Peripheral T-Cell Lymphoma – a Clinical and Epidemiological Analysis at Medicine School of Sao Paulo University

Blood ◽

10.1182/blood.v124.21.1706.1706 ◽

2014 ◽

Vol 124 (21) ◽

pp. 1706-1706

Author(s):

Luis Alberto de Padua Covas Lage ◽

Marianne Castro Goncalves ◽

Rodrigo Santucci ◽

Renata Oliveira Costa ◽

Debora Levy ◽

...

Keyword(s):

Overall Survival ◽

T Cell ◽

High Risk ◽

Cell Lymphoma ◽

Progression Free Survival ◽

Large Cell ◽

T Cell Lymphoma ◽

Peripheral T Cell Lymphoma ◽

Free Survival ◽

Large Cell Lymphoma

Abstract Background: Peripheral T-cell lymphoma (PTCL) are a biologically and clinically heterogeneous group of rare diseases arising from mature or activated post-thymic T lymphocytes. Correspond to 10% to 15% of lymphoid malignancies with marked geographical variation in incidence. According to the WHO classification they are divided into nodal, extranodal, primary cutaneous and leukemic or disseminated and encompass 18 distinct entities. The nodal group involves the peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS), angioimmunoblastic lymphoma (AITL), anaplastic large cell lymphoma ALK positive (ALCL-ALK+) and anaplastic large cell lymphoma ALK negative (ALCL-ALK-). The literature of PTCL is scarce, especially in our country where data of epidemiology, clinical features and outcomes are usually rarely available. So, to better understand PTCL we performed a retrospective study with patients treated in a reference service for cancer treatment in Brazil. Methods: Eight-seven nodal PTCL patients treated with anthracyclne-based regimen (CHOP or, CHOEP) from January 2000 to June 2014 were evaluated retrospectively at the Medicine School of Sao Paulo University, Brazil. All patients lower than 60 years were consolidated with autologous hematopoietic stem cell transplantation (ASCT) in first CR or PR except that with ALCL-ALK+ diagnosis. Refractory and relapsed patients were salvaged with 3-4 cycles of IVAC (Ifosphamide 1.5 g/m2 i.v D1-D5, etoposide 100mg/m2 i.v D1-D5, aracytin 2g/m2 i.v twice a day D1-D2) regimen and submitted to ASCT. It was performed a central histopathological review and clinical and epidemiological data were obtained from medical records. Patients were evaluated for overall response (OR) including complete response (CR) and partial response (PR), overall survival (OS) and progression free survival (PFS). Statistical analysis was performed using the STATA-3 program using and a p-value ≤ 0.05 was considered statistically significant. Results: Of the 87 patients, 34 (39.08%) cases were classified as ALCL-ALK-, 27 (31.03%) as PTCL-NOS, 16 (18.39%) as ALCL-ALK+, 6 (6.89%) as AITL and in 4 (4.1%) cases the diagnosis could not be performed and an expansion of the immunohistochemical is ongoing. Thirty-six (45.38%) cases were female and 51(54.62%) were male, 59(67.81%) patients were lower than 60 years. Seventy-six (87.35%) patients presented in advanced stage (III or IV) at diagnosis but 73(83.90%) patients presented an ECOG < 2 and 14(16.10%) ≥ 2. Eighteen (20.70%) patients were of low-risk, 26 (29.88%) of low-intermediate risk and 43(49.42%) of high-intermediate and high-risk of international prognostic index (IPI). The CR and PR was obtained for 44(50.57%) and 8(9.19%), respectively with 59.76% OR. Thirty (34.48%) patients were primary refractory and five remain under treatment. In a median of follow of 30 months, ALCL-ALK+ show higher OS (median 140.98 months) than ALCL-ALK- (44.20 months), PTCL-NOS (median 20.62 months) and AITL (median 7.24 months) (p=0.41) (Figure 1A). The median of PFS was 3.84 months for AITL, 23.44 months for ALCL-ALK+, 40.03 months for PTCL-NOS and was not yet reached for ALCL-ALK- (p=0.0006) (Figure 1B). Figure 1: Overall survival (1A) and Progression Free Survival (1B) of nodal PTCL Figure 1:. Overall survival (1A) and Progression Free Survival (1B) of nodal PTCL Figure 2 Figure 2. Conclusion: In this study we showed that ALCL-ALK+ as well as found in the literature presented a better OS in comparison to others nodal T-cell lymphoma as AITL, PTCL-NOS and ALCL-ALK-. Surprisingly the PFS of ALCL-ALK+ was statistically significant lower than of ALCL-ALK-. We thought that this result may be explained because in our service until to perform this analysis we did not indicate ASCT in first CR for ALCL-ALK+, but for all ALCL-ALK-. This hypothesis may be reinforced as the most of our cases presented high-intermediate and high-risk of IPI and that could equalize the favorable effect of ALK expression. In addition, we changed our approach and we are also indicating ASCT in first line for patients with ALCL-ALK+ with intermediate-high and high-risk of IPI . Disclosures No relevant conflicts of interest to declare.

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Perifollicular Variant of Peripheral T-Cell Lymphoma, UNS: A Distinct Lymphoma Type with Cytogenetic andcytogenetic and Clinical Findings Different from Those of Angio-Immunoblastic Lymphoma

Blood ◽

10.1182/blood.v124.21.3013.3013 ◽

2014 ◽

Vol 124 (21) ◽

pp. 3013-3013

Author(s):

Assia Bassarova ◽

Francesca Micci ◽

Gunhild Trøen ◽

Harald Holte ◽

Jan Delabie

Keyword(s):

Overall Survival ◽

T Cell ◽

Cell Lymphoma ◽

Early Stage ◽

Clinical Findings ◽

T Cell Lymphoma ◽

Peripheral T Cell Lymphoma ◽

Schematic Representation ◽

Bulky Disease ◽

Cytogenetic Data

Abstract Perifollicular variant of peripheral T-cell lymphoma, UNS: a distinct lymphoma type with cytogenetic and clinical findings different from those of angio-immunoblastic lymphoma. A. Bassarova, F. Micci, G. Trzen, H. Holte, J. Delabie Peripheral T-cell lymphoma, unspecified (PTCL-U), represents approximately 30% of all peripheral T-cell lymphomas (PTCL) in adults, excluding primary cutaneous lymphomas. PTCL-U represents approximately 12–15% of lymphomas in the Western population. The disease has a five-year overall survival of about 30%. PTCL-U is currently an amalgam of T-cell lymphomas with a mature immunophenotype that cannot be classified into other well-characterized types of PTCL. However, within PTCL-U several variants are tentatively recognized, among which the follicular or perifollicular variant. This entity is histologically characterized by its localization within the B-cell area of the lymph node and by its T follicular helper cell immunophenotype. In view of the latter, it has been argued that the follicular variant of PTCL-U is an early stage of angio-immunoblastic T-cell lymphoma, a well-characterized type of PTCL of T follicular helper cell origin. To better study perifollicar T-cell lymphoma as compared to AITL, we retrieved 47 cases of PTCL with these diagnoses from the archive of the Department of Pathology at Oslo University Hospital collected in a time period from 1999 to 2013 and reviewed the morphological, immunophenotypic, cytogenetic and clinical findings. Immunophenotypic analysis was completed when necessary. Diagnoses were made according to the W.H.O. criteria that included those published by our group previously. Cytogenetic data were available for 39 cases. Nineteen cases of perifollicular TCL and 23 cases of AITL were retrieved and 4 cases with features between perifollicular TCL and AITL were identified. By cytogenetic analysis, perifollicular TCL showed a complex karyotype with structural and numerical abnormalities. The most frequently observed aberrations were loss of 4p16 and 6q22 as well as gains of 1q21 and 3q11q12 (Fig. 1). AITL was characterized by predominantly numerical chromosomal aberrations and less structural abnormalities. The most frequent detected abnormalities were gains of chromosome 3, 5, 7, 9 and 19 (Fig. 2). The patients with perifollicular TCL had normal to high lymphocytic counts (p<0.05), platelet counts greater than 145 (p<0.001), normal LDH levels, albumin levels above the median (p<0.05) normal or slightly elevated sedimentation ratios (p<0.05), normal or above median hemoglobin levels (p<0.001) and infrequent bone marrow involvement at presentation. The majority of patients had international prognostic index (IPI) scores of 0, 1 or 2 (p<0.05) and a W.H.O. performance status between 0 and 2. Bulky disease as well as extranodal involvement at presentation was rare in this group of patients. By contrast patients with AITL presented with B-symptoms, high sedimentation ratios (p<0.05), lymphopenia (p<0.05), thrombocytopenia (p<0.001), elevated LDH and low hemoglobin levels (p<0.001) and hypoalbuminemia (p<0.05). The patients had IPI scores between 3 and 5 at presentation (p<0.05). All patients with AITL had bulky disease and 40 % had multiple extranodal localizations at presentation. Importantly, patients with perifollicular TCL showed better response to therapy and had significantly longer overall survival when compared with AILT (Fig. 3). In conclusion, the cytogenetic findings showing a complex karyotype with predominantly structural alterations, the less severe symptoms and signs at presentation and the longer overall survival are features that distinguish perifollicular TCL from AITL. Together these features do not favor the hypothesis that perifollicular TCL is an early stage of AITL but indicate that perifollicular TCL is a distinct type of PTCL. The identification of four cases with histological features between those of perifollicular TCL and AITL in our series may indicate that better methods are needed to reliably separate these entities. Therefore, detailed genetic characterization of perifollicular TCL in comparison with AITL is currently being undertaken. Fig. 1 Schematic representation of the cytogenetic data of PTCL-perifollicular Fig. 1. Schematic representation of the cytogenetic data of PTCL-perifollicular Fig. 2 Schematic representation of the cytogenetic data of AITL Fig. 2. Schematic representation of the cytogenetic data of AITL Fig. 3 The overall survival of PTCL-perifollicular vs. AITL Fig. 3. The overall survival of PTCL-perifollicular vs. AITL Disclosures No relevant conflicts of interest to declare.

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The NCCN-IPI Score Is Prognostic of Survival in Patients with Peripheral T-Cell Lymphoma, Not Otherwise Specified

Blood ◽

10.1182/blood-2018-99-113187 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 5363-5363

Author(s):

Brady E. Beltrán ◽

Denisse A. Castro ◽

Yesenia M. Huerta- Collado ◽

Eduardo Sotomayor ◽

Jorge J. Castillo

Keyword(s):

Overall Survival ◽

T Cell ◽

High Risk ◽

Research Funding ◽

Cell Lymphoma ◽

Low Risk ◽

T Cell Lymphoma ◽

Score Distribution ◽

Peripheral T Cell Lymphoma ◽

Not Otherwise Specified

Abstract Introduction: Peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) accounts for 15-20% of NHL and is characterized by a poor survival. The IPI and PIT scores are prognostic factors in survival in B-cell and T-cell lymphomas, but not without limitations. The aim of this study is to evaluate the prognostic value of the NCCN-IPI score in patients with PTCL-NOS. Methods: We included patients with a pathological diagnosis of PTCL-NOS who were diagnosed and treated at our institution between 1997 and 2017. IRB approval was obtained prior to research. Pathological samples were reviewed by hematopathologists at our institution to confirm the diagnosis. Pertinent clinicopathological data were collected through chart review and are presented using descriptive statistics. Survival curves were estimated using the Kaplan-Meier method and compared using the log-rank test. Univariate and multivariate Cox proportional-hazard regression models were fitted to evaluate hazard ratios (HR) for overall survival (OS). Results: A total of 173 patients with diagnosis of PTCL-NOS were included in this analysis. The median age at diagnosis was 58 years (range 18-91 years) with a male predominance (58%). Clinically, 47% of patients were 60 or older, 52% presented with ECOG >1, 82% had elevated serum LDH, 74% had extranodal disease, and 34% had stage I/II and 66% had stage III/IV. IPI score distribution was low-risk in 55% of patients, low-intermediate in 36%, high-intermediate in 48% and high-risk in 33%. PIT score distribution was low-risk in 53%, low-intermediate in 67%, high-intermediate in 38% and high-risk in 14%. NCCN-IPI score distribution was low risk in 40%, low-intermediate in 56%, high- intermediate in 63% and high risk in 11%. 22% of patients received CHOEP, 23% received CHOP, and 55% received other regimens. The overall response rate was 59%; 47% had a complete response and 12% had a partial response. The 5-year overall survival (OS) rate was 32% with a median OS of 12 months. PTCL-NOS patients with low, low-intermediate, high-intermediate and high-risk NCCN-IPI had 5-year OS rates of 46%, 36%, 26% and 0%, respectively (p<0.001). When compared with patients with low-risk NCCN-IPI, patients with low-intermediate (HR 3.2, 95% CI,1.1-9.5; p=0.044) and high-intermediate /high risk NCCN-IPI (HR 6.0, 95% CI 2.1-17; p=0.001) had worse OS. Conclusions: We have validated the NCCN-IPI score as a prognostic tool in patients with PTCL-NOS. This work can serve to address future prospective designs that allow selection of groups of patients at greater risk and thus lead to more individualized therapy. Figure. Figure. Disclosures Castillo: Janssen: Consultancy, Research Funding; Genentech: Consultancy; Abbvie: Consultancy, Research Funding; Pharmacyclics: Consultancy, Research Funding; Millennium: Research Funding; Beigene: Consultancy, Research Funding.

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Associations between low body mass index and mortality in patients with sepsis: A retrospective analysis of a cohort study in Japan

PLoS ONE ◽

10.1371/journal.pone.0252955 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0252955

Author(s):

Tetsuya Sato ◽

Daisuke Kudo ◽

Shigeki Kushimoto ◽

Masatsugu Hasegawa ◽

Fumihito Ito ◽

...

Keyword(s):

Older Adults ◽

Body Mass Index ◽

Body Mass ◽

East Asian ◽

High Body Mass Index ◽

Body Mass Index Group ◽

Asian Countries ◽

High Body ◽

Index Group ◽

Low Body Mass Index

Background The distribution of body mass in populations of Western countries differs from that of populations of East Asian countries. In East Asian countries, fewer people have a high body mass index than those in Western countries. In Japan, the country with the highest number of older adults worldwide, many people have a low body mass index. Therefore, this study aimed to determine the association between a low body mass index and mortality in patients with sepsis in Japan. Methods We conducted this retrospective analysis of 548 patients with severe sepsis from a multicenter prospective observational study. Multivariate logistic regression analyses determined the association between body mass index and 28-day mortality adjusted for age, sex, pre-existing conditions, the occurrence of septic shock, Acute Physiology and Chronic Health Evaluation II scores, and Sequential Organ Failure Assessment scores. Furthermore, the association between a low body mass index and 28-day mortality was analyzed. Results The low body mass index group represented 18.8% of the study population (103/548); the normal body mass index group, 57.3% (314/548); and the high body mass index group, 23.9% (131/548), with the 28-day mortality rates being 21.4% (22/103), 11.2% (35/314), and 14.5% (19/131), respectively. In the low body mass index group, the crude and adjusted odds ratios (95% confidence intervals) for 28-day mortality relative to the non-low body mass index (normal and high body mass index groups combined) group were 2.0 (1.1–3.4) and 2.3 (1.2–4.2), respectively. Conclusion A low body mass index was found to be associated with a higher 28-day mortality than the non-low body mass index in patients with sepsis in Japan. Given that older adults often have a low body mass index, these patients should be monitored closely to reduce the occurrence of negative outcomes.

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Prognostic Value of NCCN-IPI and Interim PET/CT Based on Visual Assessment in the Treatment of Peripheral T Cell Lymphomas

Blood ◽

10.1182/blood.v128.22.1822.1822 ◽

2016 ◽

Vol 128 (22) ◽

pp. 1822-1822

Author(s):

Seo-Yeon Ahn ◽

Ho-Young Yhim ◽

Young Rok Do ◽

Sung-Hoon Jung ◽

Jae-Sook Ahn ◽

...

Keyword(s):

Overall Survival ◽

T Cell ◽

High Risk ◽

Cell Lymphoma ◽

Prognostic Index ◽

Visual Assessment ◽

T Cell Lymphoma ◽

Peripheral T Cell Lymphoma ◽

Interim Pet ◽

Pet Ct

Abstract Background It has been well known that peripheral T cell lymphoma (PTCL) has undergone poor prognosis compared with other non-Hodgkin lymphomas (NHL). Although the National Comprehensive Cancer Network-International Prognostic Index (NCCN-IPI) has been proposed to determining prognosis for patients with diffuse large B-cell lymphoma (DLBCL) at 2014, there is no study examines whether NCCN-IPI could apply to the T-cell NHLs. In addition, a few studies suggest prognostic utility of interim PET/CT in PTCL, but the role of interim PET/CT is not clear. Purpose We evaluate the predictive efficacy of the NCCN-IPI and interim PET/CT based on visual assessment in patients with newly diagnosed PTCLs. Methods This study included 153 patients with de novo peripheral PTCLs, diagnosed from January 2010 to August 2015. The NCCN-IPI was calculated as following the original references. Survival outcomes were compared with a matched result of IPI and/or Prognostic Index for peripheral T cell lymphoma, unspecified (PIT). Visual assessment of interim PET/CT based on Deauville five point scales was performed at the time of diagnosis, mid-treatment and completion of CHOP/CHOP-like or other non-anthracycline chemotherapy. Results The subtypes of PTCLs included PTCL, not otherwise specified (PTCL-NOS) (26%), angioimmunoblastic T cell lymphoma (20%), anaplastic large cell lymphoma (13%), extranodal NK/T cell lymphoma, nasal type (35%), and the others (6%). The NCCN-IPI showed better risk-based prognostic discrimination than IPI and PIT, especially between high-intermediate and high risk subgroups (3-year overall survival 40% vs. 27% vs. 26% among the high-intermediate risk group, respectively; 3-year overall survival 15% vs. 33% vs. 32% among the high risk group, respectively) with a median follow-up of 25.1 months (Figure 1). The absolute difference of survival rates between the low and high risk groups was 75% based on the NCCN-IPI stratification compared with 45% on the IPI stratification or 54% on the PIT stratification, respectively. When divided into two histologic subgroups (nodal vs. extra-nodal type), the NCCN-IPI showed considerable discriminatory capacity in both histologic groups. However, the IPI or PIT classification could not have discrimination in extra-nodal PTCLs. The interim PET-CT was significantly predicting for progression free survival in all PTCL patients, however, it also showed no predictive value in the patients with extranodal PTCLs, especially NK/T cell lymphoma. Conclusions The NCCN-IPI is a powerful prognostic model in PTCLs predicting overall survival among high-intermediate and high risk patients. Also, interim PET/CT response based on visual assessment could be a valuable prediction tool in nodal PTCLs, however, it should be carefully interpreted in the treatment of extranodal subtypes. Disclosures No relevant conflicts of interest to declare.

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Radiation Therapy In Peripheral T-Cell Lymphoma Of The Head and Neck

Blood ◽

10.1182/blood.v122.21.1795.1795 ◽

2013 ◽

Vol 122 (21) ◽

pp. 1795-1795 ◽

Cited By ~ 2

Author(s):

Annemarie T. Fernandes ◽

Jakub Svoboda ◽

Sunita D. Nasta ◽

Lynn D. Wilson ◽

John P. Plastaras

Keyword(s):

Overall Survival ◽

Radiation Therapy ◽

T Cell ◽

Marital Status ◽

Head And Neck ◽

Cell Lymphoma ◽

T Cell Lymphoma ◽

Stage I ◽

Peripheral T Cell Lymphoma ◽

Stage Disease

Abstract Introduction The role of radiation therapy in peripheral T-cell lymphoma (PTCL) is not well established. While the NCCN guidelines recommend combined modality treatment with consolidative radiation therapy after chemotherapy for localized (stage I and II) disease, the data supporting this recommendation is lacking and is extrapolated from B-cell lymphoma. Methods This is a retrospective analysis of outcome in patients with non-cutaneous peripheral T-cell lymphoma of the head and neck from the Surveillance, Epidemiology and End Results (SEER) database diagnosed between 1981-2010. Survival was estimated by Kaplan-Meier estimates using the log-rank test. Univariate and multivariable analyses were performed using Cox regression analysis. Results Of the 307 patients analyzed, 130 (43%) underwent radiation therapy. The median age was 59 years old, 60.3% were male, 73.9% were Caucasian and the median year of diagnosis was 2004. The majority of patients had PTCL, Not Otherwise Specified (74.3%), followed by anaplastic large cell histology (22.2%). Patients were grouped as stage I (47.2%), stage II (29.9%) and stage III/IV (22.8%). Head and neck sites included the nasal cavity (28.3%), oropharynx (25.7%), oral cavity (21.2%), salivary gland (11.7%), nasopharynx (7.8%) and larynx/hypopharynx (5.2%). The median follow-up was 54 months for survivors. Radiation therapy was associated with a higher 5-year overall survival in all patients (56.7% vs. 38.4%, p=0.001), patients with stage I disease (63.4% vs. 53.4%, p=0.036) and patients with stage II disease (60.8% vs. 36.3%, p=0.034), see Figure 1. Radiation therapy was not associated with a difference in overall survival in patients with stage III/IV disease (p=0.91). Univariate analysis demonstrated that age, stage, radiation therapy and marital status were predictive of overall survival, but sex, and race were not. The year (p=0.93) or decade of treatment (p=0.67) did not impact overall survival. On multivariable analysis, increasing age (HR: 1.02, p<0.001), increasing stage (HR: 1.42, p=0.004), radiation therapy (HR: 0.60, p=0.011) and marital status of not married (HR: 1.49, p=0.035) remained statistically significant predictors of overall survival. An additional analysis was performed excluding patients who survived less than 3 months to account for mortality related to disease progression or chemotherapy toxicity. After excluding these 45 patients, radiation therapy was still associated with increased overall survival in all patients (p<0.001) and in patient with limited stage disease (p=0.021). Conclusions The integration of local radiation therapy to the treatment of PTCL of the head and neck may improve overall survival in patients with limited stage disease. Disclosures: No relevant conflicts of interest to declare.

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Peripheral T-cell lymphoma, not otherwise specified: a report of 340 cases from the International Peripheral T-cell Lymphoma Project

Blood ◽

10.1182/blood-2010-09-310342 ◽

2011 ◽

Vol 117 (12) ◽

pp. 3402-3408 ◽

Cited By ~ 228

Author(s):

Dennis D. Weisenburger ◽

Kerry J. Savage ◽

Nancy Lee Harris ◽

Randy D. Gascoyne ◽

Elaine S. Jaffe ◽

...

Keyword(s):

Overall Survival ◽

T Cell ◽

Cell Lymphoma ◽

International Prognostic Index ◽

T Cell Lymphoma ◽

Peripheral T Cell Lymphoma ◽

Bulky Disease ◽

Free Survival ◽

Not Otherwise Specified ◽

Pathologic Features

Abstract The International Peripheral T-cell Lymphoma Project is a collaborative effort to better understand peripheral T-cell lymphoma (PTCL). A total of 22 institutions submitted clinical and pathologic material on 1314 cases. One objective was to analyze the clinical and pathologic features of 340 cases of PTCL, not otherwise specified. The median age of the patients was 60 years, and the majority (69%) presented with advanced stage disease. Most patients (87%) presented with nodal disease, but extranodal disease was present in 62%. The 5-year overall survival was 32%, and the 5-year failure-free survival was only 20%. The majority of patients (80%) were treated with combination chemotherapy that included an anthracycline, but there was no survival advantage. The International Prognostic Index (IPI) was predictive of both overall survival and failure-free survival (P < .001). Multivariate analysis of clinical and pathologic prognostic factors, respectively, when controlling for the IPI, identified bulky disease (≥ 10 cm), thrombocytopenia (< 150 × 109/L), and a high number of transformed tumor cells (> 70%) as adverse predictors of survival, but only the latter was significant in final analysis. Thus, the IPI and a single pathologic feature could be used to stratify patients with PTCL-not otherwise specified for novel and risk-adapted therapies.

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Bone Marrow Involvement Detected By Multi-Parameter Flow Cytometry Predicts Poor Outcome after Autologous Stem Cell Transplantation for Peripheral T-Cell Lymphoma

Blood ◽

10.1182/blood.v126.23.1972.1972 ◽

2015 ◽

Vol 126 (23) ◽

pp. 1972-1972

Author(s):

Jordan Gauthier ◽

Leona Holmberg ◽

David Wu ◽

William I. Bensinger ◽

Ajay K. Gopal ◽

...

Keyword(s):

Flow Cytometry ◽

Overall Survival ◽

T Cell ◽

Cumulative Incidence ◽

Research Funding ◽

Residual Disease ◽

Cell Lymphoma ◽

Multivariable Analysis ◽

T Cell Lymphoma ◽

Peripheral T Cell Lymphoma

Abstract BACKGROUND: Peripheral T-cell lymphomas (PTCL) encompass a heterogeneous group of neoplasms accounting for 10 to 15% of non-Hodgkin lymphomas worldwide. Prognosis for PTCL patients is poor and consolidation in first remission with autologous stem cell transplantation (ASCT) is widely used. Most patients though still relapse after transplant. We hypothesized that pre-ASCT bone marrow (BM) involvement detected by multi-parameter flow cytometry (FC) would identify patients with inferior outcome after ASCT. METHODS: We retrospectively analyzed the outcome of 29 consecutive PTCL patients who underwent ASCT at the Fred Hutchinson Cancer Research Center from April 2004 through July 2014. Pre-ASCT BM involvement by flow cytometry (FC) was defined as the presence of an abnormal T-cell population detected by multi-parameter FC analysis in a BM aspirate obtained within 30 days prior to ASCT. An abnormal T-cell population accounting for a percentage equal or greater than 0.01% of total leukocytes after red blood cell lysis was considered significant. RESULTS: Ten patients (34%) with angioimmunoblastic T cell lymphoma (AITCL), 8 (27%) with ALK-negative anaplastic large cell lymphoma (ALCL), 8 (27%) with peripheral T cell lymphoma, not otherwise specified (PTCL-NOS) and 3 (12%) with other PTCL sub-types were included. Median age at transplant was 54 (range: 29-71). Twenty patients (76%) presented at ASCT in complete remission (CR) per 1999 Cheson criteria and 9 (31%) were in first CR (CR1). Fifteen patients (50%) underwent ASCT upfront. Pre-ASCT BM involvement was detected by FC analysis in 7 patients (24%, 3 patients with AITCL, 1 patient with ALCL and 3 patients with PTCL-NOS) and by morphology in 2 patients (7%, 2 patients with AITCL). The 7 patients with pre-ASCT BM involvement detected by FC experienced a significantly higher 4-year cumulative incidence of relapse (CIR) (85% versus 36%, p < 0.001) and lower overall survival (OS) (19% versus 89%, p < 0.001) with a median follow-up of 51 months. These findings were confirmed in multivariable analysis for CIR (HR = 7.37, CI = 1.14 - 47.61, p = 0.03) and OS (HR = 7.04, CI = 1.29 - 38, p = 0.024). The IPI score, absence or presence of CR1 and the number of prior therapies were included in a multivariable model for CIR, while age and the IPI score at diagnosis were taken into account for OS. ASCT performed in CR1 was associated with lower CIR (HR = 0.11, CI = 0.03-0.041, p < 0.001). Histologic subtypes did not impact CIR (p = 0.97) nor OS (p = 0.91) and they did not significantly differ between the groups with and without pre-ASCT BM involvement detected by FC (p = 0.60) after applying Fisher's exact test. Further analysis of the 22 patients presenting in CR at ASCT revealed that in this subgroup, pre-ASCT BM involvement by FC (n = 4) was also associated with higher CIR (75% versus 32%, p = 0.002) and lower OS (25 versus 94%, p <0.001). The prognostic impact of pre-ASCT BM involvement by FC persisted in multivariable analysis for CIR (HR = 16, CI = 1.11-228.70, p = 0.042, IPI score at diagnosis and number of prior therapies considered as covariables) but not for OS (HR = 0.15, CI = 0.65-65.40, p = 0.10, multivariable model including age and the IPI score at diagnosis). CONCLUSION: Pre-ASCT BM involvement by FC correlated with dramatically higher relapse rates and an inferior OS in PTCL patients after ASCT. Furthermore, we demonstrate that residual disease, detected only in patients meeting Cheson 1999 criteria for CR at ASCT is capable of predicting a higher risk for relapse. These findings should encourage further evaluation of minimal residual disease in PTCL patients achieving complete remission as defined per Cheson 1999 and 2007 criteria. Figure 1. Cumulative incidence of relapse Figure 1. Cumulative incidence of relapse Figure 2. Overall survival Figure 2. Overall survival Disclosures Gopal: Merck: Research Funding; Emergent/Abbott: Research Funding; Cephalon/Teva: Research Funding; BioMarin: Research Funding; Sanofi-Aventis: Honoraria; Millenium: Honoraria, Research Funding; Seattle Genetics: Consultancy, Honoraria, Research Funding; Janssen: Consultancy, Research Funding; Pfizer: Consultancy, Research Funding; Spectrum: Consultancy, Research Funding; Gilead: Consultancy, Research Funding; Piramal: Research Funding; Biogen Idec, BMS: Research Funding. Maloney:Juno Therapeutics: Research Funding; Roche/Genentech: Honoraria; Janssen Scientific Affairs: Honoraria; Seattle Genetics: Honoraria. Till:Roche-Genentech: Research Funding.

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