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Prepublished online as a Blood First Edition Paper on May 13, 2002; DOI 10.1182/blood-2002-01-0110.
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Blood, 15 June 2002, Vol. 99, No. 12, pp. 4379-4385
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Outcome of adult patients with T-lymphoblastic lymphoma treated
according to protocols for acute lymphoblastic leukemia
Dieter Hoelzer,
Nicola Gökbuget,
Werner Digel,
Thomas Faak,
Michael Kneba,
Regina Reutzel,
Joanna Romejko-Jarosinska,
Jacek Zwolinski, and
Jan Walewski for
the German Multicenter Study Group for Adult Acute
Lymphoblastic Leukemia
From the Medical Clinic III, Department of Hematology,
University of Frankfurt, Germany; the Department of Lymphoma, Maria
Sklodowska-Curie Memorial Cancer Center and Institute of Oncology,
Warsaw, Poland; the Department of Hematology, University of Freiburg,
Germany; and the Department of Hematology, General Hospital St Georg,
Hamburg, Germany.
We treated 45 adult patients with T-lymphoblastic
lymphoma (T-LBL) (age range 15-61 years) with 2 protocols designed for
adult acute lymphoblastic leukemia (ALL). An encouraging cure rate of 90% was recently reported for T-LBL in children treated with a similar
approach. In our study, an 8-drug standard induction was administered
over 8 weeks including prophylactic cranial (24 Gy) and mediastinal
irradiation (24 Gy) followed by consolidation and reinduction therapy.
At diagnosis, 91% of the 45 patients showed a mediastinal tumor and
40% had pleural/pericardial effusions; 73% of the patients had stage
III/IV disease. Overall, 42 patients (93%) achieved a complete
remission (CR), 2 patients (4%) achieved a partial remission, and 1 patient (2%) died during induction. In patients with stage I-III
disease (n = 18) the CR rate was 100% compared with 89% in stage IV
(n = 27). There were 15 patients who relapsed (36%) within 12 months. The majority of relapses (47%) occurred in the mediastinum
(n = 7) despite mediastinal irradiation with 24 Gy in 6 out of 7 patients. The estimates for overall survival, continuous CR, and
disease-free survival at 7 years are 51%, 65%, and 62%,
respectively. Stage, age, lactate dehydrogenase, and all other
parameters had no influence on achievement of CR or outcome. This study
demonstrates in a large cohort of patients with adult T-LBL that a high
CR rate and a favorable outcome can be achieved with an ALL-type
regimen. Mediastinal recurrence was the major obstacle and further
improvement by intensification of chemotherapy, increased dose of
mediastinal irradiation (36 Gy), and extended indications for stem cell
transplantation seem to be required.
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