Clinical Features, Treatment Outcomes And Prognosis Of Lymphoblastic Lymphoma: A Report On52Patients From A Single Center In China

Objective: To investigate the clinical features and prognostic factors, comparethe treatment efficiency of chemotherapy and hematopoietic stem celltransplantation(HSCT) in Chinese patients with lymphoblastic lymphoma(LBL).Methods: We retrospectively analyzed clinical features, outcomes andprognosis of fifty-two patients with LBL who underwent chemotherapy(n=31) orHSCT(n=21) from January1998to December2010in our hospital.Results:(1) The median age was19.5years(12-75years). There was a male predominancewith a ratio of2.7:1. At presentation,76.9%were T-cell immunophenotype,90.4%were Ann Arbor stage Ⅲ/Ⅳ,71.2%had mediastinal tumor,30.8%presented withbone marrow involvement, and7.7%had central nervous system(CNS) disease.(2) Of the52patients, the overall response rate(ORR) was90.4%and completeremission(CR) rate was75.0%． The ORR rates in patients treated with ALL-likeregimens and those treated with NHL-like regimens were94.7%and78.6%(P=0.221),CR rates were81.6%and57.2%(P=0.149), respectively.(3) With a median follow-up of19months, the overall survival(OS) for allpatients was41.5%at two years and29.0%at five years, and progression-freesurvival(PFS) was33.2%and25.3%, respectively. The5-year OS rate was53.6%forthe HSCT group and12.1%for the chemotherapy group(P=0.001).(4) For transplanted patients,5-year PFS rate for patients who were in CR1or notin CR1before transplantation were65.5%and33.3%, respectively(P=0.036).(5) Univariate analysis showed that T-cell immunophenotype, elevated LDH, disease status more advanced than CR and patients without HSCT were associatedwith inferior outcomes. Multivariate analysis indicated that immunophenotype, lactatedehydrogenase (LDH), response to induction therapy and transplantation wereindependent prognostic factors.Conclusion: LBL is more common in young men and most patients had advanceddiease at diagnosis. Clinically, it often presents with mediastinal, bone marrow andCNS involvement. More intensive ALL-like regimens appear superior to NHL-likeregimens. Compared with chemotherapy, HSCT may improve overall survival. The useof HSCT in CR1produces a trend for improved PFS. T-cell immunophenotype,elevated LDH, disease status more advanced than CR and patients without HSCT areindependently associated with inferior outcomes.