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Prognostic Significance of T-Cell Phenotype in Aggressive
Non-Hodgkin's Lymphomas
Christian Gisselbrecht,
Philippe Gaulard,
Eric Lepage,
Bertrand Coiffier,
Josette Brière,
Corinne Haioun,
Dominique Cazals-Hatem,
André Bosly,
Luc Xerri,
Hervé Tilly,
Françoise Berger,
Reda Bouhabdallah, and
Jacques Diebold for
the Groupe d'Etudes des Lymphomes de l'Adulte (GELA)
From the Institut d'Hématologie, Hôpital Saint-Louis,
Paris; Département de Pathologie, Hôpital Henri-Mondor,
Créteil; Unité d'Information Médicale, Hôpital
Henri-Mondor, Paris; Service d'Hématologie Clinique, Centre
Hospitalier Lyon Sud, Pierre-Bénite; Service d'Anatomie
Pathologique, Hôpital Necker, Paris; Hôpital de jour
d'Hématologie, Hôpital Henri-Mondor, Créteil;
Service d'Anatomie Pathologique, Hôpital Saint-Louis, Paris;
Institut Paoli-Calmette, Marseille; Centre Henri-Becquerel, Rouen;
Hôpital Edouard-Herriot, Lyon; Institut Paoli-Calmette,
Marseille; Service d'Anatomie Pathologique, Hôtel Dieu, Paris,
France; and Clinique Universitaire de Mont Godinne, Yvoir, Belgium.
Peripheral T-cell lymphomas (PTCL) have been generally reported to
have a worse prognosis than B-cell lymphomas (BCL). Because of their
heterogeneity and scarcity, the outcomes of the different histological
subtypes have not been compared. From October 1987 to March 1993, 1,883 patients with diffuse aggressive non-Hodgkin's lymphomas (NHL)
included in the LNH87 protocol could be assessed for both morphology
and immunophenotyping. Among them, 288 (15%) had PTCL and 1,595 (85%)
had BCL. According to the Kiel classification, most PTCL were
classified as angioimmunoblastic (AIL; 23%), pleomorphic medium and
large T-cell (PML; 49%), or anaplastic large cell (ALCL; 20%)
lymphomas. Comparing PTCL with BCL patients, the former had more
disseminated disease (78% v 58%), B symptoms (57% v
40%), bone marrow involvement (31% v 17%), skin involvement
(21% v 4%), and increased
 2-microglobulin (50% v 34%),
whereas BCL patients had more bulky disease (41% v 26%).
According to the International Prognostic Index (IPI), PTCL and BCL
scores were, respectively: 0 factors, 13% and 15%; 1 factor, 17% and
22%; 2 factors, 24% and 25%;  3 factors, 45% and 37%
(P = .09). For BCL and PTCL, respectively, complete
remission rates were 63% and 54% (P = .004); the 5-year
overall survival (OS) rates were 53% and 41% (P = .0004) and event-free survival (EFS) rates were 42% and 33%
(P < .0001). Comparison of the different histological
subtypes of lymphoma showed that the 5-year OS rate for T-ALCL (64%)
was superior to those of other PTCL (35%) as well as diffuse large
B-cell (53%) NHL. When multivariate analysis was applied using the IPI
score as one factor, nonanaplastic PTCL remained an independent
parameter (P = .0004). Although the poor prognosis of
non-ALCL PTCL could be due in part to the presence of adverse
prognostic factors at diagnosis, this study shows that the T-cell
phenotype is an independent significant factor, which should be
incorporated into the definition of prognostic groups.
Blood, Vol. 92 No. 1 (July 1), 1998:
pp. 76-82
© 1998 by The American Society of Hematology.
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