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Sun J, He S, Cen H, Zhou D, Li Z, Wang MY, Ke Q, Guo BP, Liao CC, Rong C, Zhong DN, Tan XH. A novel prognostic model for angioimmunoblastic T-cell lymphoma: A retrospective study of 55 cases. J Int Med Res 2021; 49:3000605211013274. [PMID: 34034561 PMCID: PMC8161901 DOI: 10.1177/03000605211013274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To explore prognostic factors and develop an accurate prognostic prediction model for angioimmunoblastic T-cell lymphoma (AITL). Methods Clinical data from Chinese patients with newly diagnosed AITL were retrospectively analysed. Overall survival (OS) and progression-free survival (PFS) were estimated using Kaplan-Meier method survival curves; prognostic factors were determined using a Cox proportional hazards model. The sensitivity and specificity of the predicted survival rates were compared using area under the curve (AUC) of receiver operating characteristic (ROC) curves. Results The estimated 5-year OS and PFS of 55 eligible patients with AITL were 22% and 3%, respectively. Multivariate analysis showed that the presence of pneumonia, and serous cavity effusions at initial diagnosis were significant prognostic factors for OS. Based on AUC ROC values, our novel prognostic model was superior to IPI and PIT based models and suggested better diagnostic accuracy. Conclusions Our prognostic model based on pneumonia, and serous cavity effusions at initial diagnosis enabled a balanced classification of AITL patients into different risk groups.
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Affiliation(s)
- Jie Sun
- Department of Haematology/Oncology and Paediatric Oncology, Guangxi Medical University Affiliated Cancer Hospital, Nanning, Guangxi, China
| | - Sha He
- Department of Haematology/Oncology and Paediatric Oncology, Guangxi Medical University Affiliated Cancer Hospital, Nanning, Guangxi, China
| | - Hong Cen
- Department of Haematology/Oncology and Paediatric Oncology, Guangxi Medical University Affiliated Cancer Hospital, Nanning, Guangxi, China
| | - Da Zhou
- Department of Haematology/Oncology and Paediatric Oncology, Guangxi Medical University Affiliated Cancer Hospital, Nanning, Guangxi, China
| | - Zhe Li
- Department of Haematology/Oncology and Paediatric Oncology, Guangxi Medical University Affiliated Cancer Hospital, Nanning, Guangxi, China
| | - Ming-Yue Wang
- Department of Haematology/Oncology and Paediatric Oncology, Guangxi Medical University Affiliated Cancer Hospital, Nanning, Guangxi, China
| | - Qing Ke
- Department of Haematology/Oncology and Paediatric Oncology, Guangxi Medical University Affiliated Cancer Hospital, Nanning, Guangxi, China
| | - Bao-Ping Guo
- Department of Haematology/Oncology and Paediatric Oncology, Guangxi Medical University Affiliated Cancer Hospital, Nanning, Guangxi, China
| | - Cheng-Cheng Liao
- Department of Haematology/Oncology and Paediatric Oncology, Guangxi Medical University Affiliated Cancer Hospital, Nanning, Guangxi, China
| | - Chao Rong
- Department of Haematology/Oncology and Paediatric Oncology, Guangxi Medical University Affiliated Cancer Hospital, Nanning, Guangxi, China
| | - Da-Ni Zhong
- Department of Haematology/Oncology and Paediatric Oncology, Guangxi Medical University Affiliated Cancer Hospital, Nanning, Guangxi, China
| | - Xiao-Hong Tan
- Department of Haematology/Oncology and Paediatric Oncology, Guangxi Medical University Affiliated Cancer Hospital, Nanning, Guangxi, China
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Huang C, Zhang H, Gao Y, Diao L, Liu L. Development of a Novel Clinical Prognostic Model for Patients With Angioimmunoblastic T-Cell Lymphoma. Technol Cancer Res Treat 2020; 19:1533033820964231. [PMID: 33073702 PMCID: PMC7592312 DOI: 10.1177/1533033820964231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In this study we aimed to identify a set of prognostic factors for angioimmunoblastic T-cell lymphoma (AITL) and establish a novel prognostic model. The clinical data of 64 AITL patients enrolled to the Fourth Hospital of Hebei Medical University (from 2012 Jan to 2017 May) were retrospectively analyzed. The estimated 5-year overall survival and progression-free survival of this cohort of patients were 45.8% and 30.8%, respectively. Univariate analysis showed that age > 60 years, performance status ≥2, Ann Arbor stage III/IV, lactate dehydrogenase > 250 U/L, serum albumin (ALB) < 30 g/l, Coombs test positive, and Ki-67 rate ≥ 70% were significantly associated with poor prognosis. Multivariate analysis demonstrated that age > 60 years, ALB < 30 g/l, Ki-67 rate ≥ 70%, and Coombs test positive were independent prognosis factors for AITL. Here a new prognostic model, named as AITLI, was constructed using the top 5 significant prognostic factors for AITL prognostic prediction. The AITL patients were stratified into 3 risk groups: low, intermediate, and high risk groups. The new prognostic model AITLI showed better performance in predicting prognosis than the International Prognostic Index (IPI) and the prognostic index for PTCL, not otherwise specified (PIT) that were wisely used to predict the outcome for patients with other subtypes of lymphoma.
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Affiliation(s)
- Chen Huang
- Department of Hematology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Huichao Zhang
- Department of Clinic Laboratory, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Yuhuan Gao
- Department of Hematology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Lanping Diao
- Department of Hematology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Lihong Liu
- Department of Hematology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
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Qian J, Meng H, Lv B, Wang J, Lu Y, Su L, Zhao S, Li W. High expression levels of TLR9 and PD-L1 indicates a poor prognosis in patients with angioimmunoblastic T-cell lymphoma: a retrospective study of 88 cases in a single center. J Cancer 2020; 11:57-68. [PMID: 31892973 PMCID: PMC6930404 DOI: 10.7150/jca.37033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/22/2019] [Indexed: 12/28/2022] Open
Abstract
Background: The role of TLR9 expressed by tumor cells in evading immune surveillance was confirmed. PD-L1 expression in tumor cells plays a key role in tumor immune escape, which is associated with poor prognosis. However, the clinical relevance of TLR9 and PD-L1 expression in angioimmunoblastic T-cell lymphoma (AITL) has not been evaluated. Materials and methods: In this study, we identified differentially expressed genes in AITL samples by bioinformatic analysis, and we first examined TLR9 and PD-L1 expression by immunohistochemical staining in patients with AITL and compared these data with clinical features and survival time. Results: It was found that the expression of PD-L1 and multiple TLRs was higher in AITL than normal T-cell samples, and TLR9 and PD-L1 expression displayed complex interactions by bioinformatic analysis. The rates of TLR9 and PD-L1 high expression were 69% and 50%, respectively. High expression of either TLR9 or PD-L1 indicated a poor survival rate for patients with AITL. Multivariate analysis further confirmed that high expression levels of TLR9 and PD-L1 were unfavorable prognostic factors for AITL. We further found inferior overall survival in AITL with clinical features of ECOG status ≥ 2, advanced-stage, elevated serum LDH levels, elevated serum β2-MG levels, and high IPI score. Conclusion: TLR9 and PD-L1 expression may be a novel predictor of prognosis for patients with AITL and may serve as potential therapeutic strategy.
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Affiliation(s)
- Jingrong Qian
- Department of Clinical Laboratory, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150081, P. R. China
| | - Hongxue Meng
- Department of Pathology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150081, P. R. China
| | - Bowen Lv
- Department of Clinical Laboratory, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150081, P. R. China
| | - Jie Wang
- Department of Clinical Laboratory, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150081, P. R. China
| | - Yingying Lu
- Department of Clinical Laboratory, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150081, P. R. China
| | - Liju Su
- Department of Clinical Laboratory, The First Hospital of Harbin, Harbin, Heilongjiang 150010, P. R. China
| | - Shu Zhao
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150081, P. R. China
| | - Wenhui Li
- Department of Clinical Laboratory, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150081, P. R. China
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Hsu YT, Wang YC, Chen RY, Hung LY, Li SS, Yen CC, Chen TY, Medeiros LJ, Chang KC. Angioimmunoblastic T-cell lymphoma in Taiwan reveals worse progression-free survival for RHOA G17V mutated subtype. Leuk Lymphoma 2019; 61:1108-1118. [PMID: 31870198 DOI: 10.1080/10428194.2019.1702179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) carries genetic mutations of TET2, RHOA, and IDH2, but the prognostic impact of these mutations is not widely investigated. Although one study shows no difference in overall survival between patients with or without RHOA G17V mutation, a poor performance status is associated with RHOA G17V-mutated AITL, which is an independent adverse factor. We retrospectively investigated the prognostic impact of RHOA G17V mutation in AITL patients. A total of 31 cases were enrolled (male-to-female, 2.1; mean age: 62.8 years). RHOA G17V mutation was analyzed by deep sequencing. We found that in contrast to RHOA-wild type, patients with RHOA G17V-mutated AITL more frequently had B symptoms (p = .035), stronger PD1 expression (p = .045), ≥3 TFH markers (p = .011), higher blood vessel density (p<.001), and poorer progression-free survival (p = .046). These results support a role for RHOA genetic testing in AITL patients as ROHA G17V mutation carries a worse prognosis, probably associated with B symptoms and stage IV disease.
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Affiliation(s)
- Ya-Ting Hsu
- Department of Internal Medicine, Division of Hematology/Oncology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Chu Wang
- Department of Biotechnology and Bioindustry Sciences, College of Bioscience and Biotechnology, National Cheng Kung University, Tainan, Taiwan
| | - Ruo-Yu Chen
- Department of Biotechnology and Bioindustry Sciences, College of Bioscience and Biotechnology, National Cheng Kung University, Tainan, Taiwan
| | - Liang-Yi Hung
- Department of Biotechnology and Bioindustry Sciences, College of Bioscience and Biotechnology, National Cheng Kung University, Tainan, Taiwan
| | - Sin-Syue Li
- Department of Internal Medicine, Division of Hematology/Oncology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chi-Chieh Yen
- Department of Internal Medicine, Division of Hematology/Oncology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tsai-Yun Chen
- Department of Internal Medicine, Division of Hematology/Oncology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Kung-Chao Chang
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Pathology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
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Innovative analysis of predictors for overall survival from systemic non-Hodgkin T cell lymphoma using quantile regression analysis. Chin Med J (Engl) 2019; 132:294-301. [PMID: 30681495 PMCID: PMC6595814 DOI: 10.1097/cm9.0000000000000088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background: Non-Hodgkin T/NK cell lymphoma is a rare and widely variable type of lymphoma with the most dismal prognosis. This study aimed to investigate varied impact of the clinical indicators to the overall survival (OS). Methods: We conducted a retrospective study to identify the non-invasive clinical features of T cell lymphoma that can predict prognosis with an innovative analysis method using quantile regression. A total of 183 patients who visited a top-tier hospital in Beijing, China, were enrolled from January 2006 to December 2015. Demographic information and main clinical indicators were collected including age, erythrocyte sedimentation rate (ESR), survival status, and international prognostic index (IPI) score. Results: The median age of the patients at diagnosis was 45 years. Approximately 80% of patients were at an advanced stage, and the median survival time after diagnosis was 5.1 months. Multivariable analysis of the prognostic factors for inferior OS associated with advanced clinical staging [HR=3.16, 95%CI (1.39–7.2)], lower platelet count [HR = 2.57, 95%CI (1.57–4.19), P < 0.001] and higher IPI score [HR = 1.29, 95%CI (1.01–1.66), P = 0.043]. Meanwhile, T cell lymphoblastic lymphoma [HR = 0.40, 95%CI (0.20–0.80), P = 0.010], higher white blood cell counts [HR = 0.57, 95%CI (0.34–0.96), P = 0.033], higher serum albumin level [HR = 0.6, 95%CI (0.37–0.97), P = 0.039], and higher ESR [HR = 0.53, 95%CI (0.33–0.87), P = 0.011] were protective factors for OS when stratified by hemophagocytic lymphohistiocytosis (HLH). Multivariable quantile regression between the OS rate and each predictor at quartiles 0.25, 0.5, 0.75, and 0.95 showed that the coefficients of serum β2-microglobulin level and serum ESR were statistically significant in the middle of the coefficient curve (quartile 0.25–0.75). The coefficient of IPI was negatively associated with OS. The coefficients of hematopoietic stem cell transplantation (HSCT) and no clinical symptoms were higher at the middle of the quartile level curve but were not statistically significant. Conclusions: The IPI score is a comparatively robust indicator of prognosis at 3 quartiles, and serum ESR is stable at the middle 2 quartiles section when adjusted for HLH. Quantile regression can be used to observe detailed impacts of the predictors on OS.
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Hong H, Fang X, Wang Z, Huang H, Lam ST, Li F, Peng C, Tian Y, Lin S, Lin T. Angioimmunoblastic T-cell lymphoma: a prognostic model from a retrospective study. Leuk Lymphoma 2018; 59:2911-2916. [PMID: 29909754 DOI: 10.1080/10428194.2018.1459610] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) is a distinct subtype of peripheral T-cell lymphoma with unique clinical and pathological features. This study aim to design a prognostic model specifically for AITL, providing risk stratification in affected patients. A total of 115 newly diagnosed AITL patients were retrospectively analyzed. The estimated five-year overall survival (OS) rate for all patients was 45.4%. Multivariate analysis found prognostic factors for survival were bone marrow involvement, number of extranodal sites >1, and performance status >1. We categorized three risk groups: group 1, no adverse factor; group 2, one factor; and group 3, two or three factors. Five-year OS was 86.9% for Group 1, 46.3% for Group 2, and 16.2% for Group 3 (p < .0001). The novel prognostic model balanced the distribution of patients into different risk groups with better predictive discrimination as compared to the International Prognostic Index and Prognostic Index for PTCL, unless otherwise specified.
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Affiliation(s)
- Huangming Hong
- a Department of Medical Oncology, Sun Yat-sen University Cancer Center , State Key Laboratory of Oncology in Southern China, and Collaborative Innovation Center of Cancer Medicine , Guangzhou , China
| | - Xiaojie Fang
- a Department of Medical Oncology, Sun Yat-sen University Cancer Center , State Key Laboratory of Oncology in Southern China, and Collaborative Innovation Center of Cancer Medicine , Guangzhou , China
| | - Zhao Wang
- a Department of Medical Oncology, Sun Yat-sen University Cancer Center , State Key Laboratory of Oncology in Southern China, and Collaborative Innovation Center of Cancer Medicine , Guangzhou , China
| | - He Huang
- a Department of Medical Oncology, Sun Yat-sen University Cancer Center , State Key Laboratory of Oncology in Southern China, and Collaborative Innovation Center of Cancer Medicine , Guangzhou , China
| | - Sio Teng Lam
- b Centro Hospitalar Conde de Sao Januario , Macau , China
| | - Fangfang Li
- a Department of Medical Oncology, Sun Yat-sen University Cancer Center , State Key Laboratory of Oncology in Southern China, and Collaborative Innovation Center of Cancer Medicine , Guangzhou , China
| | - Chen Peng
- a Department of Medical Oncology, Sun Yat-sen University Cancer Center , State Key Laboratory of Oncology in Southern China, and Collaborative Innovation Center of Cancer Medicine , Guangzhou , China
| | - Ying Tian
- a Department of Medical Oncology, Sun Yat-sen University Cancer Center , State Key Laboratory of Oncology in Southern China, and Collaborative Innovation Center of Cancer Medicine , Guangzhou , China
| | - Suxia Lin
- a Department of Medical Oncology, Sun Yat-sen University Cancer Center , State Key Laboratory of Oncology in Southern China, and Collaborative Innovation Center of Cancer Medicine , Guangzhou , China
| | - Tongyu Lin
- a Department of Medical Oncology, Sun Yat-sen University Cancer Center , State Key Laboratory of Oncology in Southern China, and Collaborative Innovation Center of Cancer Medicine , Guangzhou , China
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Nishimura K, Ota R, Mikajiri Y, Takahashi K, Sugishima S, Eto T. Useful laboratory markers for the diagnosis of bone marrow involvement by malignant lymphoma. Int J Lab Hematol 2017; 40:34-40. [PMID: 28876549 DOI: 10.1111/ijlh.12725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 07/03/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION This study aimed to investigate the effect of bone marrow involvement by malignant lymphoma (BMI) on laboratory data and to determine the useful laboratory markers for diagnosing BMI. METHODS We compared laboratory data between patients with and without BMI. We performed multivariate logistic regression and receiver operating characteristic (ROC) analyses to evaluate the diagnostic values of independent predictors. RESULTS In the BMI group, platelets in peripheral blood (PLT) and megakaryocyte count in bone marrow (MgK) were significantly lower than those in the non-BMI group (PLT, P < .0001; MgK, P = .0384). The rate of peripheral blood involvement by malignant lymphoma (PBI), red blood cell distribution width (RDW), D-dimer (DD), soluble interleukin-2 receptor (sIL2R), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) was significantly higher in the BMI group than in the non-BMI group (PBI, P < .0001; RDW, P = .0190; DD, P = .0006; sIL2R, P < .0001; AST, P = .0256; LDH, P = .0002). In multivariate analysis, PBI, PLT, sIL2R, and MgK levels were independent predictors of BMI. CONCLUSION PBI, PLT, sIL2R, and MgK may be the useful laboratory markers for BMI diagnosis.
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Affiliation(s)
- K Nishimura
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Clinical Laboratory, Hamanomachi Hospital, Fukuoka, Japan
| | - R Ota
- Department of Clinical Laboratory, Hamanomachi Hospital, Fukuoka, Japan
| | - Y Mikajiri
- Department of Clinical Laboratory, Hamanomachi Hospital, Fukuoka, Japan
| | - K Takahashi
- Department of Clinical Laboratory, Hamanomachi Hospital, Fukuoka, Japan
| | - S Sugishima
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - T Eto
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
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Li Y, Yang C, Mao L, Wang J, Li C, Qian W. Clinical characteristics of angioimmunoblastic T-cell lymphoma in China and C-reactive protein as an independent prognostic factor. Medicine (Baltimore) 2017; 96:e8091. [PMID: 28953629 PMCID: PMC5626272 DOI: 10.1097/md.0000000000008091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) is a major subtype of peripheral T-cell lymphoma (PTCL). Due to its low incidence, the characteristics of AITL are still not well understood. The prognostic evaluation of this disease has not been established.We retrospectively analyzed 52 patients with newly diagnosed AITL in China between January 2008 and September 2016.Among these patients, the median age at diagnosis was 62 (40-83) and 58% (30/52) of the patients were older than 60 years. Thirty-five patients were male, accounting for 67.3% of the whole. Among these, 90% (47/52) of the diagnoses were estimated at advanced stage. A total of 25 (48%) patients were scored >1 by the ECOG performance status. Systemic B symptoms were described in 34 (65%) patients. When evaluated by International Prognostic Index (IPI), 81% were scored >2, and 77% got >1 score according to the prognostic index for PTCL (PIT) upon diagnosis. The 3-year progression-free survival (PFS) was 44% and the 3-year overall survival (OS) rate was 52%. IPI and PIT scores could not be effectively applied to stratify those AITL patients into subgroups. Our multivariate analysis results found that the elevated serum C-reactive protein (CRP) level was an independent adverse factor to the OS of the AITL patients.Patients with AITL had a poor outcome. The serum level of CRP may be applied as an independent prognostic factor for AITL.
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Affiliation(s)
- Ying Li
- Department of Hematology, the First Affiliated Hospital of Zhejiang University
- Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Chunmei Yang
- Department of Hematology, the First Affiliated Hospital of Zhejiang University
- Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Liping Mao
- Department of Hematology, the First Affiliated Hospital of Zhejiang University
- Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Jinghan Wang
- Department of Hematology, the First Affiliated Hospital of Zhejiang University
- Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Chenying Li
- Department of Hematology, the First Affiliated Hospital of Zhejiang University
- Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Wenbin Qian
- Department of Hematology, the First Affiliated Hospital of Zhejiang University
- Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
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