Prognostic Factors in Patients With Aggressive Non-Hodgkin's Lymphoma Treated by Front-Line Autotransplantation After Complete Remission: A Cohort Study by the Groupe d'Etude des Lymphomes de l'Adulte

Purpose Improved survival has been observed in aggressive non-Hodgkin's lymphoma (NHL) patients with adverse prognostic factors when autotransplantation (ASCT) was performed after complete remission. However, there is no agreement on the prognostic factors for patients treated with ASCT. We aimed to estimate the prognostic effect of clinical and biologic variables on relapse and survival rates by pooling the data from two trials. Patients and Methods Of the patients treated in the LNH87 and LNH93 trials, 330 under age 60 years achieved complete remission after high-dose cyclophosphamide, doxorubicin, vincristine, and prednisone, and received consolidative ASCT; 16% of patients had T-cell NHL. The International Prognostic Index (IPI) score was 0 for 11%, 1 for 23%, 2 for 51%, and 3 for 15%. Univariate and Cox multivariate survival analyses were retrospectively performed on this population. Results Overall survival was 75 ± 5% at 5 years and disease-free survival (DFS) 67 ± 5%. For T-cell NHL, these scores were 54% and 44%, respectively. The IPI score had no prognostic value and only the following parameters adversely affected overall survival and DFS (P < .05): marrow involvement; more than one extranodal site; histology (nonanaplastic T-cell v others); and type of anthracycline (mitoxantrone v doxorubicin, for DFS only). Conclusion These results suggest that ASCT can prevent relapse in patients with adverse IPI factors. However, patients presenting with a nonanaplastic T-cell phenotype, more than one extranodal site, or marrow involvement still have a higher risk of relapse. These factors should be taken into account when designing post-ASCT maintenance studies.

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T-cell Non-Hodgkin's Lymphoma in Adults: Clinicopathological Characteristics, Response to Treatment and Prognostic Factors

Leukemia & Lymphoma ◽

10.1080/10428190290016926 ◽

2002 ◽

Vol 43 (4) ◽

pp. 805-811 ◽

Cited By ~ 43

Author(s):

M. Reiser ◽

A. Josting ◽

M. Soltani ◽

P. Staib ◽

B. Salzberger ◽

...

Keyword(s):

Prognostic Factors ◽

T Cell ◽

Hodgkin’S Lymphoma ◽

Clinicopathological Characteristics ◽

Hodgkin's Lymphoma ◽

Response To Treatment ◽

Non Hodgkin’S Lymphoma ◽

Non Hodgkin's Lymphoma

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T-Cell Phenotype Is Associated with Decreased Survival in Non-Hodgkin's Lymphoma

Japanese Journal of Cancer Research ◽

10.1111/j.1349-7006.1989.tb01704.x ◽

1989 ◽

Vol 80 (8) ◽

pp. 720-726 ◽

Cited By ~ 14

Author(s):

Kazuyuki Shimizu ◽

Nobuyuki Hamajima ◽

Kazunori Ohnishi ◽

Kazuo Hara ◽

Akira Kunii

Keyword(s):

T Cell ◽

Hodgkin’S Lymphoma ◽

Hodgkin's Lymphoma ◽

Cell Phenotype ◽

Non Hodgkin’S Lymphoma ◽

Non Hodgkin's Lymphoma

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Primary non-Hodgkin's lymphoma of bone: A rare disorder with high frequency of T-cell phenotype in southern Taiwan

Leukemia & Lymphoma ◽

10.1080/10428190500272705 ◽

2006 ◽

Vol 47 (1) ◽

pp. 65-70 ◽

Cited By ~ 14

Author(s):

Pin-Pen Hsieh ◽

Hui-Hwa Tseng ◽

Sheng-Tsung Chang ◽

Ting-Ying Fu ◽

Chin-Li Lu ◽

...

Keyword(s):

T Cell ◽

High Frequency ◽

Hodgkin’S Lymphoma ◽

Rare Disorder ◽

Hodgkin's Lymphoma ◽

Cell Phenotype ◽

Non Hodgkin’S Lymphoma ◽

Non Hodgkin's Lymphoma ◽

Southern Taiwan

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Primary Central Nervous System Lymphoma of T-Cell Phenotype: A Rare Variant of Non-Hodgkin’s Lymphoma Treated with CNS Directed Therapy

Blood ◽

10.1182/blood.v112.11.4965.4965 ◽

2008 ◽

Vol 112 (11) ◽

pp. 4965-4965

Author(s):

Nancy D Doolittle ◽

Edward A Neuwelt

Keyword(s):

Central Nervous System ◽

Nervous System ◽

T Cell ◽

Rare Variant ◽

Hodgkin’S Lymphoma ◽

Central Nervous System Lymphoma ◽

Hodgkin's Lymphoma ◽

Cell Phenotype ◽

Non Hodgkin’S Lymphoma ◽

Non Hodgkin's Lymphoma

Abstract Primary central nervous system lymphoma (PCNSL) is a non-Hodgkin’s lymphoma confined to the craniospinal axis and/or eyes, without evidence of systemic spread. Almost all PCNSL’s are classified as large B-cell lymphoma. A rare variant of PCNSL includes lymphomas of the T-cell phenotype. Until the publication of a large retrospective series of patients (pts) (n = 45) with T-cell PCNSL (Shenkier TN, et al. J Clin Oncol2005;23:2233–2239),only case reports of T-PCNSL and literature reviews were available. The large retrospective series reported that ECOG Performance Status (PS) (0 or 1 versus 2, 3 or 4) at diagnosis was significantly associated with better outcome (Log rank P <.0001), as was primary treatment with high-dose methotrexate (MTX) (yes versus no) (Log rank P = .002). Median survival in the large series was 25 months (95% CI: 11 to 38 months). We reviewed our brain tumor database for pts seen between January 1980 and July 2008. Of 159 pts diagnosed with PCNSL, 3 (2M/1F) had histopathologically confirmed large T-cell phenotype. At diagnosis, the pts’ ages were 10, 23, and 64 years; in each case ECOG PS at diagnosis was 0. Brain parenchyma disease location was periventricular (1 pt), parietal (1 pt), and corpus callosum (1 pt); one pt had both brain and ocular lymphoma. First-line treatment was IA MTX-based chemotherapy with osmotic blood-brain barrier disruption (BBBD), without brain irradiation. The dose of MTX was 2.5 grams/day for 2 consecutive days, every 4 weeks for up to one year. A comprehensive neuropsychological test battery was administered at baseline prior to MTX-based BBBD treatment. Followup neuropsychological testing was conducted within 6 months after the final BBBD treatment. All patients attained CR and are alive 15.8, 8.9 and 1.2 years after diagnosis, with excellent PS and no evidence of disease progression to date. The 3 pts showed stable or improved neuropsychological function in all cognitive domains at follow-up testing. Side effects during BBBD treatment included focal seizures (1 pt) and atrial fibrillation (1 pt). In these 3 cases of T-cell PCNSL, encouraging tumor responses and survival were seen, with stable or improved neurocognitive functioning to date, warranting further investigation of CNS directed therapy in this rare variant of non-Hodgkin’s lymphoma.

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Prognostic factors in patients with T-cell non-Hodgkin's lymphoma

Journal of Clinical Oncology ◽

10.1200/jco.2004.22.90140.6603 ◽

2004 ◽

Vol 22 (14_suppl) ◽

pp. 6603-6603

Author(s):

N. S. Liu ◽

M. Escalon ◽

Y. Yang ◽

T. A. Smith ◽

N. H. Dang

Keyword(s):

Prognostic Factors ◽

T Cell ◽

Hodgkin’S Lymphoma ◽

Hodgkin's Lymphoma ◽

Non Hodgkin’S Lymphoma ◽

Non Hodgkin's Lymphoma

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High-dose intense doxorubicin-based regimens in aggressive non-Hodgkin's lymphoma: A systematic overview

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e19528 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e19528-e19528

Author(s):

H. A. Azim ◽

R. A. Malek ◽

L. Santoro ◽

S. Gandini ◽

R. G. Bociek ◽

...

Keyword(s):

Overall Survival ◽

T Cell ◽

B Cell ◽

Hodgkin’S Lymphoma ◽

Randomized Trials ◽

Outcome Measure ◽

Chemotherapy Regimen ◽

Hodgkin's Lymphoma ◽

Non Hodgkin’S Lymphoma ◽

Non Hodgkin's Lymphoma

e19528 Background: Aggressive non-Hodgkin's lymphoma represents around 60% of lymphomas in the Western world and even more in Egypt. CHOP has been long been recognized as the standard chemotherapy regimen in this disease. The addition of rituximab (R) to CHOP in the treatment of B-cell subtypes has resulted in a significant improvement in all treatment endpoints. Nevertheless, still a significant fraction of patients in the developing world are not offered R due to economical reasons. Thus CHOP is still offered to these patients as well as those with T-cell subtypes. Data from the early 1990s have suggested that the dose intensity (DI) of doxorubicin may have a prognostic value. Hence we conducted a metaanalysis on chemotherapy regimens incorporating higher DI doxorubicin and compare them to CHOP in terms of complete response (CR) rate, event free survival (EFS) and overall survival (OAS). Methods: A MEDLINE and COCHRANE library search was performed using the search terms ‘CHOP‘, ‘lymphoma‘ and ‘randomized trials‘. Eligible trials were randomized trials, having CHOP as a control arm and any chemotherapy regimen administering doxorubicin at a higher DI than that of CHOP (16mg/m2/week) as the investigational arm. Pooling of data was performed using the mixed effect model. The outcome measure for pooling the CR rate was the odds ratio (OR) while the hazard ratio (HR) was the outcome measure for EFS and OAS. Confidence intervals were estimated according to the method developed by Parmar. Results: Eight trials published until February 2008 met the inclusion criteria. They included 3,668 patients randomly assigned to either CHOP (1,660 patients) or DI doxorubicin-based regimen (2008 patients). Patients receiving DI doxorubicin-based regimen had a significantly better overall survival (HR; 0.79; 95% CI: 0.66–0.94). As for the EFS and CR analyses, there was a trend in favor of patients who received the DI regimens; however the difference was not statistically significant (HR: 0.86; 95% CI: 0.71–1.03 & OR: 0.8; 95% CI: 0.63–1.02 respectively). Conclusions: High DI doxorubicin-based regimens are associated with a better OAS compared to CHOP. Such approach should be considered in patients with aggressive B-cell lymphomas not offered R as well as those with T-cell lymphomas. No significant financial relationships to disclose.

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Prognostic Implications of the Differentiation Inhibitory Factornm23-H1 Protein in the Plasma of Aggressive Non-Hodgkin’s Lymphoma

Blood ◽

10.1182/blood.v94.10.3541.422k15_3541_3550 ◽

1999 ◽

Vol 94 (10) ◽

pp. 3541-3550 ◽

Cited By ~ 41

Author(s):

Nozomi Niitsu ◽

Junko Okabe-Kado ◽

Takashi Kasukabe ◽

Yuri Yamamoto-Yamaguchi ◽

Masanori Umeda ◽

...

Keyword(s):

Overall Survival ◽

Complete Remission ◽

Hodgkin’S Lymphoma ◽

Progression Free Survival ◽

Hodgkin's Lymphoma ◽

Enzyme Linked Immunosorbent Assay ◽

Free Survival ◽

Non Hodgkin’S Lymphoma ◽

Response To Chemotherapy ◽

Non Hodgkin's Lymphoma

The outcome of patients with non-Hodgkin’s lymphoma has been improved by current approaches to treatment. Nevertheless, many patients either do not have a complete remission or ultimately relapse. To identify such patients, it is important to be able to predict the outcome. We previously found that the differentiation inhibitory factor/nm23 was correlated with the prognosis of acute myeloid leukemia. To examine the prognostic effect of nm23 on non-Hodgkin’s lymphoma, we established an enzyme-linked immunosorbent assay procedure to determine nm23-H1 protein levels in plasma and assessed the association of this protein level with the response to chemotherapy, overall survival, and progression-free survival in patients with aggressive non-Hodgkin’s lymphoma. The plasma concentration of nm23-H1 was significantly higher in patients with malignant lymphoma than in normal controls, especially in aggressive non-Hodgkin’s lymphoma. The complete remission rate in patients with higher nm23-H1 levels was significantly worse than that in patients with lower nm23-H1 levels. Overall survival and progression-free survival were also lower in patients with higher nm23-H1 levels than in those with lower levels. The 3-year survival rates in patients with low and high nm23-H1levels were 79.5% and 6.7% (P = .0001). A multivariate analysis of prognostic factors showed that the plasma nm23-H1level was independently associated with the survival and progression-free survival. An elevated plasma nm23-H1concentration predicts a poor outcome of advanced non-Hodgkin’s lymphoma. Therefore, nm23-H1 in plasma may be useful for identifying a distinct group of patients at very high risk.

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