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Evaluation of the Revised European-American Lymphoma classification
confirms the clinical relevance of immunophenotype in 560 cases of
aggressive non-Hodgkin's lymphoma
A Melnyk, A Rodriguez, WC Pugh and F Cabannillas
Department of Hematology, M.D. Anderson Cancer Center, Houston, TX 77030,
USA.
The Revised European-American Lymphoma (REAL) classification has been
criticized for its emphasis on the unproven clinical relevance of
immunophenotype. A worse prognosis for peripheral T-cell non-Hodgkin's
lymphomas (PTCLs) has been inconsistently reported in part because the
definition of PTCL has been imprecise (eg, T-cell-rich B-cell non-
Hodgkin's lymphomas [TCRBCLs] have been misdiagnosed as PTCLs in the past)
and because its correlation with other known prognostic factors has not
been studied by multivariate analysis. We analyzed six protocols from 1984
to 1995 with Working Formulation intermediate grade and immunoblastic
lymphomas (exclusive of mantle cell) and selected only those cases in which
immunophenotyping was performed and was conclusive. Of a total of 560
evaluable patients, 68 were PTCLs (12%) and the remaining 492 (88%) were
B-cell non-Hodgkin's lymphomas, including 16 TCRBCLs (3% of total). The
5-year failure-free survival (FFS) for PTCLs and B-cell large-cell
lymphomas (BCLCLs) is 38% and 55%, respectively (P < .0001) and the
5-year overall survival (OS) is 39% and 262%, respectively (P < .001).
The M.D. Anderson prognostic tumor score (MDATS) and International
Prognostic Index (IPI) for all patients was calculated. With MDATS of less
than 3 (good prognosis), the 5-year FFS for PTCL and BCLCL is 56% and 69%,
respectively (P = .01), and the 5-year OS is 64% and 77%, respectively (P =
.06). With MDATS of greater than 2 (poor prognosis), 5-year FFS for PTCL
and BCLCL is 26% and 38%, respectively (P = .03), and the 5-year OS is 24%
and 41%, respectively (P = .02). With an IPI of less than 3 (good
prognosis), the 5-year FFS for PTCL and BCLCL is 49% and 64%, respectively
(P = .001), and the 5-year OS is 55% and 71%, respectively (P = .013). With
an IPI greater than 2 (poor prognosis), the 5-year FFS for PTCL and BCLCL
is 11% and 35%, respectively (P = .044), and the 5- year OS is 10% and 40%,
respectively (P = .011). Multivariate analysis shows that MDATS, IPI, and
T-cell phenotype are totally independent and are the most significant
predictors of FFS and OS. The 68 PTCLs include 45 PTCLs unspecified, 10
Ki-1 anaplastic (ALCL), 8 angioimmunoblastic, and 5 angiocentric lymphomas.
Angiocentrics were usually refractory (1 of 5 remissions only). ALCL rarely
relapsed late. We conclude that the immunophenotypic basis of the REAL
classification is clinically relevant and that, although other prognostic
features also influence outcome, the T-cell phenotype still remains an
independent and significant prognostic factor.
Volume 89,
Issue 12,
pp. 4514-4520,
06/15/1997
Copyright © 1997 by The American Society of Hematology
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