Abstract

Analysis of patients with advanced non-Hodgkin’s lymphoma (NHL) suggests unique clinical presentations and outcome according to histologic subtype. Little is known of outcome as it relates to histologic subytpe in patients with limited disease. In a previous report (

NEJM
1998
;
339
:
21
–6
), 401 patients with limited disease (Stage I or non-bulky II) intermediate or high grade NHL, enrolled in SWOG study 8736, were randomized to chemotherapy or chemotherapy plus radiotherapy. Results at 5 years showed superior survival and less toxicity for those treated with 3 cycles of CHOP chemotherapy plus radiotherapy. These 401 patients, with additional followup and reclassification of histology according to World Health Organization (WHO) criteria, form the basis of the current report. Of the 401 pts, 2 were excluded because of clinical findings and 34 patients were excluded for insufficient pathology material. 365 pts were evaluable. On the basis of hematoxylin-eosin and immunohistochemistry results, pt cases were classified as diffuse large B cell (174pts), follicular, Grade 3 (36), Burkitt-like (27), peripheral T cell, unspecified (9), anaplastic large T cell (4), morphologically consistent with mantle cell (4), morphologically consistent with MALToma (3), morphologically diffuse small cleaved cell (2), unclassifiable (1), suggesting anaplastic large cell CD30+ (1), diffuse large cell without immunohistochemical results (104). At 10 years, there was no significant difference in overall survival (OS) or failure free survival (FFS) between the 2 treatments (OS, p=0.48; FFS, p=0.77) (
Blood
2001
;
98
:
724a
). When analyzed by histology, including T lineage, neither OS nor FFS were different for any histologic subytpe (OS, p=0.94; FFS, p=0.99). In addition, the estimated shapes of the survival curves were similar for all histologic subtypes among these 365 evaluable pts. On the basis of these findings it does not appear that either the WHO or the Working Formulation (WF) classification system is able to predict outcome for limited stage disease pts treated with CHOP +/− radiotherapy. Therefore, histologic type should not be a criterion for exclusion for limited stage studies of lymphoma. Further, it does not appear that any histologic subtype presenting as early stage disease needs CNS prophylaxis or a unique chemotherapy treatment strategy. There was only one central nervous system (CNS) relapse (in a patient with testis involvement), and none among the 27 Burkitt-like pts. The lack of an observed survival plateau in the first 10 years of followup for these pts is in contrast to advanced stage pts who achieve a plateau within 6 years. The biology of limited stage lymphoma may be fundamentally different from that of advanced stage disease and more significanct in determining outcome than histologic type.

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