To investigatethe clinical features and prognostic factors, compare the treatment efficiency of chemotherapy and hematopoietic stem celltransplantation (HSCT) in Chinese patients with lymphoblastic lymphoma (LBL).
We retrospectively analyzed clinical features, outcomes and prognosis of fifty-two patients with LBL who underwent chemotherapy (n=31) or HSCT (n=21) from January 1998 to December 2010 in our hospital.
The median age was 19.5years (12–75 years). There was a male predominance with a ratio of 2.7:1. At presentation, 76.9% were T-cell immunophenotype, 90.4% were Ann Arbor stage III/‡W, 71.2% had mediastinal tumor, 30.8% presented with bone marrow involvement, and 7.7% had central nervous system (CNS) disease.
Of the 52 patients, the overall response rate (ORR) was 90.4% and complete remission (CR) rate was 75.0%. The ORR rates in patients treated with ALL-like regimens and those treated with NHL-like regimens were 94.7% and 78.6%(P=0.221), CR rates were 81.6% and 57.2%(P=0.149), respectively.
With a median follow-up of 19 months, the overall survival (OS) for all patients was 41.5% at two years and 29.0% at five years, and progression-free survival (PFS) was 33.2% and 25.3%, respectively. The 5-year OS rate was53.6% for the HSCT group and 12.1% for the chemotherapy group (P=0.001).
For transplanted patients, 5-year PFS rate for patients who were in CR1 or not in CR1 before transplantation were 65.5% and 33.3%, respectively (P=0.036).
Multivariate analyses showed that immunophenotype, lactatedehydrogenase (LDH), response to induction therapy and transplantation were independent prognostic factors (P<0.05). T-cell immunophenotype, elevated LDH, disease status more advanced than CR and patients without HSCT were associated with inferior outcomes.
LBL is more common in young men and most patients had advanced diease at diagnosis. Clinically, it often presents with mediastinal, bone marrow and CNS involvement. More intensive ALL-like regimens appear superior to NHL-like regimens. Compared with chemotherapy, HSCT may improve overall survival. The use of HSCT in CR1 produces a trend for improved PFS. T-cell immunophenotype, elevated LDH, disease status more advanced than CR and patients without HSCT are independently associated with inferior outcomes.
No relevant conflicts of interest to declare.
Asterisk with author names denotes non-ASH members.