Subcutaneous Panniculitis-Like T-Cell Lymphoma With Bone Marrow Involvement

Abstract T-cell lymphoma is the special malignant type of non-Hodgkin’s lymphoma. The diagnosis and the treatment were usually troublesome for physician in clinical practice. We retrospectively reviewed 63 cases of T-cell lymphomas from 360 cases of lymphomas in our hospital during the period from January 2000 to July 2006. This study is to determine the clinicopathological characteristics of T cell lymphomas. The patients were reclassified according to the World Health Organization classification system. Clinical data, including age, gender, clinical staging, and follow-up, were scrutinized. The median follow-up duration was 5 months (range 21days to 36 months). There were slightly more males than females (36 versus 27), and the median age at the onset were 40 years (range 13 to 77 years). The major subtype was peripheral T-cell lymphoma, which accounted for 78% (49/63). Besides, there were 5 cases of anaplastic T large cell lymphoma, 3 lymphoblastic lymphoma, 2 T/NK-cell lymphoma, 2 angioimmunoblastic lymphoma, 1 mycosis fungoides and 1 pre-T cell lymphoma. The most common manifestation was fever, which accounted for 60% (38/63). 27% (17/63) patients presented with obvious enlargement of lymphonodes. Other manifestation included skin rash or phymata, pruritus, jaundice, abdominal pain, rhinorrhagia, puffiness, diarrhea, hoarseness and ulcus. Interestingly, we found that only 32% obvious enlarged lymphonodes could be confirmed by physical examination, hepatomegaly 33% and Splenomegaly 44% respectively. Besides, there were several significant laboratory findings: 40% cases had cytopenia of at least 2 cell lines, 68% had high level of LDH, 70% had elevated β2-microglobulin and 68% were detected T-cell receptor (TCR) and immunoglobulin heavy chain (IgH) gene rearrangement. Furthermore, 53% (33/63) patients had bone marrow involvement at the onset and 27% were diagnosed only by bone marrow biopsy. We also observed 20 cases of lymphoma associated hemophagocytic syndromes (LAHS). The median age for this disease was 37 year. The median life span was 39 days (range 21days to 10 months). The initial manifestations included fever (19/20), splenohepatomegaly (18/20), and cytopenias in all patients. Only 15% patients had enlargement of lymphonodes, which was suggested to be infrequent in LAHS. Immatural T-cell infiltration in bone marrow was detected in 75% (15/20) cases. Chromosome disorder of [der(21)(p11), −22] was detected in 3 cases. We also found that 2 cases which underwent plasmapheresis got much better after chemotherapy. 19 cases were under our follow-up. 17 patients could not survival longer than 6 months. The 6-month overall survival (OS) for LAHS was merely 2 of all 20. Furthermore, nobody survived more than 1 year, which indicated the poor prognosis of LAHS. There were 11 out of 63 cases had received trial chemotherapy including liposomal Doxorubicin, L-asparaginase, velcade, autologous bone marrow transplantation, or plasmapheresis before chemotherapy. The median survival time prolonged obviously from 2 months up to 8 months, which suggested the encouraging efficiency of these methods.

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Evaluation of bone marrow involvement in extranodal NK/T cell lymphoma by FDG-PET/CT

Annals of Hematology ◽

10.1007/s00277-014-2289-4 ◽

2014 ◽

Vol 94 (6) ◽

pp. 963-967 ◽

Cited By ~ 7

Author(s):

Zhiyuan Zhou ◽

Changying Chen ◽

Xiang Li ◽

Zhaoming Li ◽

Xudong Zhang ◽

...

Keyword(s):

Bone Marrow ◽

T Cell ◽

Fdg Pet ◽

Cell Lymphoma ◽

Bone Marrow Involvement ◽

T Cell Lymphoma ◽

Pet Ct ◽

Nk T Cell ◽

Fdg Pet Ct

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Bone marrow involvement of primary cutaneous γ/δ T-cell lymphoma

Blood ◽

10.1182/blood-2016-07-730002 ◽

2016 ◽

Vol 128 (18) ◽

pp. 2274-2274

Author(s):

Hiromichi Matsushita ◽

Dai Maruyama

Keyword(s):

Bone Marrow ◽

T Cell ◽

Cell Lymphoma ◽

Bone Marrow Involvement ◽

T Cell Lymphoma

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Bone marrow involvement as initial presentation of CD8 cytotoxic peripheral T-cell lymphoma with CD20 coexpression and relatively indolent clinical course

Leukemia & Lymphoma ◽

10.3109/10428194.2012.724533 ◽

2012 ◽

Vol 54 (5) ◽

pp. 1113-1116 ◽

Cited By ~ 1

Author(s):

Yizhuo Zhang ◽

Ling Zhang ◽

Xin Jin ◽

Haifeng Zhao ◽

Xishan Hao ◽

...

Keyword(s):

Bone Marrow ◽

T Cell ◽

Clinical Course ◽

Cell Lymphoma ◽

Bone Marrow Involvement ◽

T Cell Lymphoma ◽

Initial Presentation ◽

Peripheral T Cell Lymphoma

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The Prognostic Value of the Neutrophil to Lymphocyte Ratio in 209 Patients with Peripheral T-Cell Lymphoma

Blood ◽

10.1182/blood.v124.21.1675.1675 ◽

2014 ◽

Vol 124 (21) ◽

pp. 1675-1675

Author(s):

Brady E Beltran ◽

Denisse Castro ◽

Julio C Chavez ◽

Eduardo M. Sotomayor ◽

Jorge J. Castillo

Keyword(s):

Bone Marrow ◽

T Cell ◽

Prognostic Value ◽

Cell Lymphoma ◽

Performance Status ◽

Bone Marrow Involvement ◽

T Cell Lymphoma ◽

Neutrophil To Lymphocyte Ratio ◽

Advanced Stage ◽

Lymphocyte Ratio

Abstract Introduction: Peripheral T-cell lymphomas (PTCL) are rare hematologic malignancies with a poor prognosis when treated with current standard therapies. Several factors have been developed to prognosticate survival in PTCL patients; however, more refined, easy to use and reliable prognostic tools are needed. The neutrophil to lymphocyte ratio (NLR) has been reported prognostic in patients with diffuse large B-cell lymphoma (Troppan et al. BJC 2014). We have investigated the prognostic value of the NLR in the overall survival (OS) of patients with untreated PTCL. Methods: We included patients with a pathological diagnosis of PTCL who were diagnosed and treated at our institution between 2001-2013. We excluded cases with primary cutaneous PTCL, CNS involvement, and patients with >50% incomplete data. IRB approval was obtained prior to research. Pathological samples were reviewed by expert hematopathologists to confirm a diagnosis of PTCL. Pertinent clinicopathological data such as age, sex, performance status, LDH levels, stage, bone marrow involvement, extranodal sites of disease, PTCL subtype, and absolute neutrophil and lymphocyte countswere collected through chart review, and are presented using descriptive statistics. The NLR was calculated by dividing the absolute neutrophil by the lymphocyte count, and dichotomized in NLR>=4 and NLR<4. The Prognostic Index for PTCL (PIT) was estimated using the clinical data above. Survival curves were estimated using the Kaplan-Meier method and compared using the log-rank test. Multivariate analyses were performed using Cox proportional-hazard regression models. Results: A total of 209 patients were included in our analysis from which 93 (44.5%) were PTCL, not otherwise specified (NOS), 83 (40%) were adult T-cell leukemia/lymphoma (ATLL), 22 (10.5%) were anaplastic large cell lymphoma (ALCL), 7 (3%) were extranodal NK/T-cell lymphoma (NKTCL), and 4 (2%) angioimmunoblastic T-cell lymphoma (AITL). The median age was 57 years (range 3-87 years) with equal distribution among men (52%) and women (48%). Poor performance status (ECOG >1) was seen in 85 (49%), elevated LDH levels in 116 (64%), >1 extranodal site in 31 (19%), bone marrow involvement in 64 (31%), and advanced stage (stage 3 and 4) in 151 (74%) of patients. Based on the NLR, 91 patients (59%) had NLR<4 and 62 (n=41%) had NLR>=4. Patients with NLR >=4 were more likely men (67% vs. 44%, p=0.005), and tended to present with elevated LDH (73% vs. 47%, p=0.002), advanced stage (87% vs. 61%, p=0.001) but lower bone marrow involvement (19% vs. 37%, p=0.02). There were no differences in age, performance status and number of extranodal sites. NLR>=4 was associated with a worse OS (HR 2.27, 95% CI 1.40-3.69; p=0.001). Specifically, NLR>=4 was associated with a worse OS in patients with non-ATLL PTCL (HR 2.99, 95% CI 1.67-5.37; p<0.001) but not in patients with ATLL (HR 1.16, 0.48-2.81; p=0.75). In the multivariate analysis, NLR>=4 was independently associated with worse OS when adjusting for the PIT score in non-ATLL PTCL patients (HR 2.12, 95% CI 1.06-4.26; p=0.03). Conclusion: The NLR appears as a novel and easy to use prognostic factor for OS in patients with untreated non-ATLL PTCL, independent of the PIT score. The NLR did not seem to be prognostic in ATLL patients. Our findings support the need for validation of the NLR in larger retrospective or prospective studies in patients with PTCL. Disclosures No relevant conflicts of interest to declare.

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Peripheral Blood Involvement By Flow Cytometry As a Prognostic Factor in Aggressive T Cell Lymphomas Following Autologous Stem Cell Transplantation

Blood ◽

10.1182/blood-2019-128888 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 4055-4055

Author(s):

Namrata S Chandhok ◽

Scott F. Huntington ◽

Iris Isufi ◽

Lohith Gowda ◽

Mina L Xu ◽

...

Keyword(s):

Bone Marrow ◽

Flow Cytometry ◽

T Cell ◽

Peripheral Blood ◽

Cell Lymphoma ◽

Bone Marrow Involvement ◽

T Cell Lymphoma ◽

T Cell Lymphomas ◽

First Remission ◽

Peripheral Blood Involvement

Introduction: Aggressive T cell lymphomas (TCL) are a heterogenous group of lymphomas that are frequently associated with poor outcomes. Autologous stem cell transplantation (ASCT) is recommended according to the NCCN guidelines and by practice standards for most subtypes as a consolidation for patients in first remission. A large prospective study of up-front ASCT by the Nordic Lymphoma group identified age, ECOG performance status <2, and bone marrow involvement as important prognostic factors. We have identified peripheral blood involvement by flow cytometry at diagnosis in up to one third of patients with aggressive TCL and analyzed whether this was a prognostic factor for outcomes after ASCT. Methods: We retrospectively analyzed data from consecutively treated patients (pts) with aggressive T-cell lymphomas who underwent ASCT at our institution from July 2009 to February 2019. Patient and disease characteristics were summarized using descriptive statistics. Kaplan-Meier analysis was used to estimate progression free survival (PFS) that was defined as the time from SCT to the first evidence of recurrence, and overall survival (OS) that was defined as the time from SCT to death or last institutional follow up with a hematologist. We collected data on age, co-morbidities, disease subtype, stage, response to therapy and treatment both pre and post SCT. Flow cytometry was obtained at diagnosis and phenotype of atypical circulating cells was compared with immunophenotype from tumor biopsy specimens. Results: 50 pts with TCL who received ASCT were identified for this analysis. Of this population, 41 (80%) of pts had peripheral blood flow available at the time of initial diagnosis. T-cell lymphoma types included peripheral T cell lymphoma not otherwise specified (PTCL NOS, 17 pts), angioimmunoblastic T cell lymphoma (AITCL, 15pts), ALK negative anaplastic large cell lymphoma (ALCL, 1pt), enteropathy-type T-cell lymphoma (EATL, 2pts), extranodal natural killer T-cell lymphoma (NKTCL, 2pts) and panniculitis like T cell lymphoma (2 pts) (Table 1). Median age of the cohort was 62 years (range 20-75 years) and all patients included had an ECOG PS 0-1 at the time of diagnosis. The majority had stage 4 disease (36/41, 87.8%), but analysis included a small number of patients with stage 2 (1/41, 2.4%) and stage 3 (4/41,9.7%) disease. Bone marrow involvement by morphologic criteria was noted on bone marrow biopsy in 8/41 (19.5%) pts; bone marrow was negative in 28/41 or 61% pts and not evaluated in 8/41 or 19.5% pts. Flow cytometry of peripheral blood performed as part of initial staging was positive for circulating malignant cells in 13/41 pts (31.7%) at the time of diagnosis. All patients underwent ASCT in first remission. The median PFS and OS were 15.2 and 29.9 months respectively in the flow positive group, while neither median PFS nor OS were reached in the flow negative group (Figures 1 and 2). Flow cytometry results from time of diagnosis was not strongly associated with PFS (log rank, p = 0.39), however, it was associated with overall survival (log rank, p = 0.012). There were 11 deaths in the cohort- 4 in the flow negative group and 7 in the flow positive group. Further, when bone marrow involvement was evaluated, 7 of 13 pts with positive flow cytometry (53.8%) and 5 of 28 (17.8%) pts with negative flow cytometry had BM involvement, suggesting a correlation between positive bone marrow and detection of lymphoma cells in the peripheral blood at the time of diagnosis. Conclusions: We demonstrate in our cohort of patients that detection of circulating lymphoma cells at diagnosis by flow cytometry was associated with a worse outcome in patients with aggressive T cell lymphomas undergoing ASCT as a consolidation in first remission. Larger cohorts will be needed to validate these findings, but these results suggest peripheral blood involvement by sensitive flow cytometry may identify patients with worse outcomes who might benefit from a more aggressive strategy such as allogeneic stem cell transplantation or alternative consolidation strategies. Disclosures Huntington: Bayer: Consultancy, Honoraria; Pharmacyclics: Honoraria; Celgene: Consultancy, Research Funding; DTRM Biopharm: Research Funding; Genentech: Consultancy; AbbVie: Consultancy. Isufi:Celgene: Consultancy; Novartis: Consultancy; Astra Zeneca: Consultancy. Foss:Seattle Genetics: Consultancy, Other: fees for non-CME/CE services ; Mallinckrodt: Consultancy; miRagen: Consultancy; Spectrum: Other: fees for non-CME/CE services ; Eisai: Consultancy; Acrotech: Consultancy.

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BONE MARROW INVOLVEMENT, BUT NO BLOOD INVOLVEMENT, IMPAIRS SURVIVAL IN ANGIOIMMUNOBLASTIC T CELL LYMPHOMA: AN ANCILLARY STUDY OF THE REVAIL TRIAL

Hematological Oncology ◽

10.1002/hon.89_2630 ◽

2019 ◽

Vol 37 ◽

pp. 278-279

Author(s):

F. Lemonnier ◽

V. Safar ◽

A. Ferchiou ◽

A. Cottereau ◽

E. Bachy ◽

...

Keyword(s):

Bone Marrow ◽

T Cell ◽

Cell Lymphoma ◽

Bone Marrow Involvement ◽

T Cell Lymphoma ◽

Angioimmunoblastic T Cell Lymphoma ◽

Ancillary Study

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Peripheral T-Cell Lymphoma Simulating Hodgkin's Disease With Initial Bone Marrow Involvement

Mayo Clinic Proceedings ◽

10.1016/s0025-6196(12)61400-1 ◽

1986 ◽

Vol 61 (1) ◽

pp. 68-71 ◽

Cited By ~ 11

Author(s):

GERARDO COLON-OTERO ◽

STEPHEN P. McCLURE ◽

ROBERT L. PHYLIKY ◽

WILLIAM L. WHITE ◽

PETER M. BANKS

Keyword(s):

Bone Marrow ◽

T Cell ◽

Hodgkin's Disease ◽

Cell Lymphoma ◽

Hodgkin’S Disease ◽

Bone Marrow Involvement ◽

T Cell Lymphoma ◽

Peripheral T Cell Lymphoma

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Angioimmunoblastic T-Cell Lymphoma: A Clinicopathologic Study of 158 Patients Treated in GELA (Groupe d’ Etude des Lymphomes de l’ Adulte) Trials.

Blood ◽

10.1182/blood.v108.11.397.397 ◽

2006 ◽

Vol 108 (11) ◽

pp. 397-397 ◽

Cited By ~ 2

Author(s):

Nathalie Mourad ◽

Nicolas Mounier ◽

Josette Brière ◽

Emmanue Raffoux ◽

Thierry Molina ◽

...

Keyword(s):

Bone Marrow ◽

Overall Survival ◽

T Cell ◽

Clinical Presentation ◽

Cell Lymphoma ◽

Bone Marrow Involvement ◽

Germinal Centers ◽

Lymphoid Cells ◽

T Cell Lymphoma ◽

Angioimmunoblastic T Cell Lymphoma

Abstract Background: Angioimmunoblastic T-cell lymphoma (AITL), the second most frequent peripheral T-cell lymphoma, is characterized by a distinct clinical presentation and a spectrum of biological and morphologic features with little available data on prognostic factors in the literature. Objective: to evaluate the prognostic significance of clinical, biological and pathological features in AITL. Methods: between 1987 and 1998, 158 AITL patients were retrieved from the GELA LNH87 and LNH93 trials. Most patients received an anthracycline based polychemotherapy. Histologically, cases were reviewed by a panel of expert hematopathologists. For each case, at least 2 hematoxylin eosin slides were available for review together with an appropriate immunohistochemical staining including CD3, CD20 and CD21/CNA42. Cases were classified as “transformed” (>10% large B and/or T cells) and “classic” (including cases rich in clear cells, rich in epithelioid cells and with hyperplastic germinal centers). 62 cases were evaluated for CD10 and CXCL13 expression and scored according to the number of positive lymphoid cells. Results: there was a slight male predominance (M/F=1.53). Median age was 62 years. 81%, 50%, 67% and 39% of patients had respectively an advanced stage, a non ambulatory PS, an IPI>2 and a PIT>2 (age>60y, PS>=2, LDH>=normal and bone marrow involvement). Anemia, positive coombs test and bone marrow involvement were observed in 65%, 33% and 47% of cases respectively. Hypergammaglobulinemia, elevated LDH levels and skin rash were observed in 15%, 66% and 44% of patients respectively. 41 cases were classified as transformed and 117 as classic including 20 epithelioid-cell rich, 14 clear-cell rich and 4 with hyperplastic germinal centers. CD10 and CXCL13 were clearly positive, in a fraction of the lymphoid infiltrate, in 71% and 73% of cases respectively. CR/CRu remission was observed in 46% of patients after induction therapy. With a median follow-up of 69 months, the 5y overall survival rate was 33%, reaching a plateau level around 6 years. Concerning PIT, patients with 0–1 factors and 3–4 factors had a 5y OS of 37% and 38% respectively. In univariate analysis, absence of CR/CRu (p<0.0001), hepatomegaly (p=0.0004), male gender (p=0.004), and anemia (p=0.05) were poor prognostic indicators for overall survival. Classic and transformed AITL were not different regarding clinical presentation, biological findings, and outcome except for a higher frequency of elevated serum LDH (p=0.0266) and b2 microglobulin levels (p=0.0456) within the transformed group. IPI and PIT were not predictive of survival. Conclusion: despite of various intensive regimens with an anthracycline based chemotherapy, AITL pursues an aggressive clinical course and carries a poor prognosis. Our large series emphasizes the morphologic heterogeneity of AITL, without any clinical impact, and further confirms the common expression of CD10 and CXCL13.

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