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Ohmoto A, Fuji S. Cyclosporine for angioimmunoblastic T-cell lymphoma: a literature review. Expert Rev Hematol 2019; 12:975-981. [DOI: 10.1080/17474086.2019.1652590] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Akihiro Ohmoto
- Division of Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shigeo Fuji
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
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Townsend W, Johnson RJ, Pottinger BT, Counsell N, Smith P, Chadwick H, Evans K, Wickham C, Rudin CE. A phase II clinical trial of fludarabine and cyclophosphamide followed by thalidomide for angioimmunoblastic T-cell lymphoma. An NCRI clinical trial. CRUK number C17050/A5320. Leuk Lymphoma 2016; 57:2232-4. [PMID: 27001186 DOI: 10.3109/10428194.2015.1133814] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- William Townsend
- a Cancer Research UK and University College London Cancer Trials Centre , London , UK
| | - Rod J Johnson
- b The Leeds Teaching Hospitals NHS Trust , Leeds , UK
| | | | - Nicholas Counsell
- a Cancer Research UK and University College London Cancer Trials Centre , London , UK
| | - Paul Smith
- a Cancer Research UK and University College London Cancer Trials Centre , London , UK
| | - Humra Chadwick
- a Cancer Research UK and University College London Cancer Trials Centre , London , UK
| | - Katy Evans
- d Department of Haematology , Royal Devon and Exeter NHS Foundation Trust , Exeter , Devon EX2 5AD , UK
| | - Caroline Wickham
- d Department of Haematology , Royal Devon and Exeter NHS Foundation Trust , Exeter , Devon EX2 5AD , UK
| | - Claudius E Rudin
- d Department of Haematology , Royal Devon and Exeter NHS Foundation Trust , Exeter , Devon EX2 5AD , UK
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Kameoka Y, Takahashi N, Itou S, Kume M, Noji H, Kato Y, Ichikawa Y, Sasaki O, Motegi M, Ishiguro A, Tagawa H, Ishizawa K, Ishida Y, Ichinohasama R, Harigae H, Sawada K. Analysis of clinical characteristics and prognostic factors for angioimmunoblastic T-cell lymphoma. Int J Hematol 2015; 101:536-42. [PMID: 25739382 DOI: 10.1007/s12185-015-1763-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 02/23/2015] [Accepted: 02/23/2015] [Indexed: 12/31/2022]
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) is a distinct peripheral T-cell lymphoma entity exhibiting peculiar clinical features and poor prognosis. Its clinical characteristics and prognostic factors are not well established. To clarify the clinical characteristics and prognostic features of AITL, we conducted a multicenter, retrospective study. Fifty-six patients were enrolled. The median patient age was 68 years. Immunohistochemical examinations of tumor cells showed positivity for CD10 and T-cell markers, and chromosomal examination detected several types of abnormalities. More than 80 % of patients show advanced disease at diagnosis and poor prognostic scores. A high proportion of patients showed accompanying B symptoms, splenomegaly, and hepatomegaly at diagnosis. The 5-year overall survival (OS) rate was 48 % and progression-free survival was 25 %. Univariate analysis revealed higher age, fever, poor performance status, anemia, and low albumin level to be poor prognostic factors for OS. In addition to these factors, both IPI and PIT were also predictive of OS. Multivariate analysis indicated only a low level of serum albumin to be a significant prognostic factor for OS. Serum albumin may be one of the important prognostic factors for AITL. Further investigation is needed to confirm these results.
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Chen XG, Huang H, Tian Y, Guo CC, Liang CY, Gong YL, Zou BY, Cai RQ, Lin TY. Cyclosporine, prednisone, and high-dose immunoglobulin treatment of angioimmunoblastic T-cell lymphoma refractory to prior CHOP or CHOP-like regimen. CHINESE JOURNAL OF CANCER 2013; 30:731-8. [PMID: 21959050 PMCID: PMC4012273 DOI: 10.5732/cjc.011.10071] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) is a rare, distinct subtype of peripheral T-cell lymphoma, possessing an aggressive course and poor prognosis with no standard therapy. Twelve patients who have failed at least two initial CHOP or CHOP-like regimens were enrolled in this study and treated with individualized cyclosporine (CsA), prednisone (PDN), and monthly, high-dose intravenous immunoglobulin (HDIVIG). The dose of CsA was adjusted individually based on the blood trough concentration of CsA and renal function. All patients were examined for response, toxicity and survival. The most significant toxicities (≥ grade 2) were infection (16.7%), renal insufficiency (8.3%), hypertension (8.3%), diabetes (8.3%) and insomnia (16.7%). Discontinuation of treatment occurred in one patient (8.3%) due to grade 3 renal toxicity and subsequent grade 4 pulmonary infection. Treatment-related death was not observed. The overall response rate was 75.0% (complete response, 33.3%; partial response, 41.7%). With a median follow-up of 25.5 months, the median duration of response was 20 months (range, 12 to 49 months) and the median progression-free survival (PFS) was 25.5 months (range, 10 to 56 months). The 2-year PFS rate was 81.5%. Our findings indicate the combination of CsA, PDN and HDIVIG is an effective salvage regimen for refractory or relapsed AITL with predictable and manageable toxicity.
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Affiliation(s)
- Xing-Gui Chen
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
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Federico M, Rudiger T, Bellei M, Nathwani BN, Luminari S, Coiffier B, Harris NL, Jaffe ES, Pileri SA, Savage KJ, Weisenburger DD, Armitage JO, Mounier N, Vose JM. Clinicopathologic characteristics of angioimmunoblastic T-cell lymphoma: analysis of the international peripheral T-cell lymphoma project. J Clin Oncol 2013; 31:240-6. [PMID: 22869878 PMCID: PMC3532394 DOI: 10.1200/jco.2011.37.3647] [Citation(s) in RCA: 232] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The International Peripheral T-Cell Lymphoma Project was undertaken to better understand the subtypes of T-cell and natural killer (NK) -cell lymphomas. PATIENTS AND METHODS Angioimmunoblastic T-cell lymphoma (AITL) was diagnosed according to the 2001 WHO criteria by a central review process consisting of panels of expert hematopathologists. Clinical, pathologic, immunophenotyping, treatment, and survival data were correlated. RESULTS Of 1,314 patients, 243 (18.5%) were diagnosed with AITL. At presentation, generalized lymphadenopathy was noted in 76% of patients, and 89% had stages III to IV disease. Skin rash was observed in 21% of patients. Hemolytic anemia and hypergammoglobulinemia occurred in 13% and 30% of patients, respectively. Five-year overall and failure-free survivals were 33% and 18%, respectively. At presentation, prognostic models were evaluated, including the standard International Prognostic Index, which comprised the following factors: age ≥ 60 years, stages III to IV disease, lactic dehydrogenase (LDH) > normal, extranodal sites (ENSs) > one, and performance status (PS) ≥ 2; the Prognostic Index for Peripheral T-Cell Lymphoma, comprising: age ≥ 60 years, PS ≥ 2, LDH > normal, and bone marrow involvement; and the alternative Prognostic Index for AITL (PIAI), comprising: age > 60 years, PS ≥ 2, ENSs > one, B symptoms, and platelet count < 150 × 10(9)/L. The simplified PIAI had a low-risk group (zero to one factors), with 5-year survival of 44%, and a high-risk group (two to five factors), with 5-year survival of 24% (P = .0065). CONCLUSION AITL is a rare clinicopathologic entity characterized by an aggressive course and dismal outcome with current therapies.
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Affiliation(s)
- Massimo Federico
- Massimo Federico, Monica Bellei, and Stefano Luminari, Università di Modena e Reggio Emilia, Modena; Stefano A. Pileri, Università di Bologna, Bologna, Italy; Thomas Rudiger, Stadisches Klinikum Karlsruhe, Karlsruhe, Germany; Bharat N. Nathwani, Ceders-Sinai Medical Center and University of Southern California Keck School of Medicine, Los Angeles, CA; Bertrand Coiffier, Hospices Civils de Lyon, Lyon; Nicholas Mounier, Hospital l'Archet, Nice, France; Nancy L. Harris, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Elaine S. Jaffe, National Cancer Institute, Bethesda, MD; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Dennis D. Weisenburger, James O. Armitage, and Julie M. Vose, University of Nebraska Medical Center, Omaha, NE
| | - Thomas Rudiger
- Massimo Federico, Monica Bellei, and Stefano Luminari, Università di Modena e Reggio Emilia, Modena; Stefano A. Pileri, Università di Bologna, Bologna, Italy; Thomas Rudiger, Stadisches Klinikum Karlsruhe, Karlsruhe, Germany; Bharat N. Nathwani, Ceders-Sinai Medical Center and University of Southern California Keck School of Medicine, Los Angeles, CA; Bertrand Coiffier, Hospices Civils de Lyon, Lyon; Nicholas Mounier, Hospital l'Archet, Nice, France; Nancy L. Harris, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Elaine S. Jaffe, National Cancer Institute, Bethesda, MD; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Dennis D. Weisenburger, James O. Armitage, and Julie M. Vose, University of Nebraska Medical Center, Omaha, NE
| | - Monica Bellei
- Massimo Federico, Monica Bellei, and Stefano Luminari, Università di Modena e Reggio Emilia, Modena; Stefano A. Pileri, Università di Bologna, Bologna, Italy; Thomas Rudiger, Stadisches Klinikum Karlsruhe, Karlsruhe, Germany; Bharat N. Nathwani, Ceders-Sinai Medical Center and University of Southern California Keck School of Medicine, Los Angeles, CA; Bertrand Coiffier, Hospices Civils de Lyon, Lyon; Nicholas Mounier, Hospital l'Archet, Nice, France; Nancy L. Harris, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Elaine S. Jaffe, National Cancer Institute, Bethesda, MD; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Dennis D. Weisenburger, James O. Armitage, and Julie M. Vose, University of Nebraska Medical Center, Omaha, NE
| | - Bharat N. Nathwani
- Massimo Federico, Monica Bellei, and Stefano Luminari, Università di Modena e Reggio Emilia, Modena; Stefano A. Pileri, Università di Bologna, Bologna, Italy; Thomas Rudiger, Stadisches Klinikum Karlsruhe, Karlsruhe, Germany; Bharat N. Nathwani, Ceders-Sinai Medical Center and University of Southern California Keck School of Medicine, Los Angeles, CA; Bertrand Coiffier, Hospices Civils de Lyon, Lyon; Nicholas Mounier, Hospital l'Archet, Nice, France; Nancy L. Harris, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Elaine S. Jaffe, National Cancer Institute, Bethesda, MD; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Dennis D. Weisenburger, James O. Armitage, and Julie M. Vose, University of Nebraska Medical Center, Omaha, NE
| | - Stefano Luminari
- Massimo Federico, Monica Bellei, and Stefano Luminari, Università di Modena e Reggio Emilia, Modena; Stefano A. Pileri, Università di Bologna, Bologna, Italy; Thomas Rudiger, Stadisches Klinikum Karlsruhe, Karlsruhe, Germany; Bharat N. Nathwani, Ceders-Sinai Medical Center and University of Southern California Keck School of Medicine, Los Angeles, CA; Bertrand Coiffier, Hospices Civils de Lyon, Lyon; Nicholas Mounier, Hospital l'Archet, Nice, France; Nancy L. Harris, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Elaine S. Jaffe, National Cancer Institute, Bethesda, MD; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Dennis D. Weisenburger, James O. Armitage, and Julie M. Vose, University of Nebraska Medical Center, Omaha, NE
| | - Bertrand Coiffier
- Massimo Federico, Monica Bellei, and Stefano Luminari, Università di Modena e Reggio Emilia, Modena; Stefano A. Pileri, Università di Bologna, Bologna, Italy; Thomas Rudiger, Stadisches Klinikum Karlsruhe, Karlsruhe, Germany; Bharat N. Nathwani, Ceders-Sinai Medical Center and University of Southern California Keck School of Medicine, Los Angeles, CA; Bertrand Coiffier, Hospices Civils de Lyon, Lyon; Nicholas Mounier, Hospital l'Archet, Nice, France; Nancy L. Harris, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Elaine S. Jaffe, National Cancer Institute, Bethesda, MD; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Dennis D. Weisenburger, James O. Armitage, and Julie M. Vose, University of Nebraska Medical Center, Omaha, NE
| | - Nancy L. Harris
- Massimo Federico, Monica Bellei, and Stefano Luminari, Università di Modena e Reggio Emilia, Modena; Stefano A. Pileri, Università di Bologna, Bologna, Italy; Thomas Rudiger, Stadisches Klinikum Karlsruhe, Karlsruhe, Germany; Bharat N. Nathwani, Ceders-Sinai Medical Center and University of Southern California Keck School of Medicine, Los Angeles, CA; Bertrand Coiffier, Hospices Civils de Lyon, Lyon; Nicholas Mounier, Hospital l'Archet, Nice, France; Nancy L. Harris, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Elaine S. Jaffe, National Cancer Institute, Bethesda, MD; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Dennis D. Weisenburger, James O. Armitage, and Julie M. Vose, University of Nebraska Medical Center, Omaha, NE
| | - Elaine S. Jaffe
- Massimo Federico, Monica Bellei, and Stefano Luminari, Università di Modena e Reggio Emilia, Modena; Stefano A. Pileri, Università di Bologna, Bologna, Italy; Thomas Rudiger, Stadisches Klinikum Karlsruhe, Karlsruhe, Germany; Bharat N. Nathwani, Ceders-Sinai Medical Center and University of Southern California Keck School of Medicine, Los Angeles, CA; Bertrand Coiffier, Hospices Civils de Lyon, Lyon; Nicholas Mounier, Hospital l'Archet, Nice, France; Nancy L. Harris, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Elaine S. Jaffe, National Cancer Institute, Bethesda, MD; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Dennis D. Weisenburger, James O. Armitage, and Julie M. Vose, University of Nebraska Medical Center, Omaha, NE
| | - Stefano A. Pileri
- Massimo Federico, Monica Bellei, and Stefano Luminari, Università di Modena e Reggio Emilia, Modena; Stefano A. Pileri, Università di Bologna, Bologna, Italy; Thomas Rudiger, Stadisches Klinikum Karlsruhe, Karlsruhe, Germany; Bharat N. Nathwani, Ceders-Sinai Medical Center and University of Southern California Keck School of Medicine, Los Angeles, CA; Bertrand Coiffier, Hospices Civils de Lyon, Lyon; Nicholas Mounier, Hospital l'Archet, Nice, France; Nancy L. Harris, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Elaine S. Jaffe, National Cancer Institute, Bethesda, MD; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Dennis D. Weisenburger, James O. Armitage, and Julie M. Vose, University of Nebraska Medical Center, Omaha, NE
| | - Kerry J. Savage
- Massimo Federico, Monica Bellei, and Stefano Luminari, Università di Modena e Reggio Emilia, Modena; Stefano A. Pileri, Università di Bologna, Bologna, Italy; Thomas Rudiger, Stadisches Klinikum Karlsruhe, Karlsruhe, Germany; Bharat N. Nathwani, Ceders-Sinai Medical Center and University of Southern California Keck School of Medicine, Los Angeles, CA; Bertrand Coiffier, Hospices Civils de Lyon, Lyon; Nicholas Mounier, Hospital l'Archet, Nice, France; Nancy L. Harris, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Elaine S. Jaffe, National Cancer Institute, Bethesda, MD; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Dennis D. Weisenburger, James O. Armitage, and Julie M. Vose, University of Nebraska Medical Center, Omaha, NE
| | - Dennis D. Weisenburger
- Massimo Federico, Monica Bellei, and Stefano Luminari, Università di Modena e Reggio Emilia, Modena; Stefano A. Pileri, Università di Bologna, Bologna, Italy; Thomas Rudiger, Stadisches Klinikum Karlsruhe, Karlsruhe, Germany; Bharat N. Nathwani, Ceders-Sinai Medical Center and University of Southern California Keck School of Medicine, Los Angeles, CA; Bertrand Coiffier, Hospices Civils de Lyon, Lyon; Nicholas Mounier, Hospital l'Archet, Nice, France; Nancy L. Harris, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Elaine S. Jaffe, National Cancer Institute, Bethesda, MD; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Dennis D. Weisenburger, James O. Armitage, and Julie M. Vose, University of Nebraska Medical Center, Omaha, NE
| | - James O. Armitage
- Massimo Federico, Monica Bellei, and Stefano Luminari, Università di Modena e Reggio Emilia, Modena; Stefano A. Pileri, Università di Bologna, Bologna, Italy; Thomas Rudiger, Stadisches Klinikum Karlsruhe, Karlsruhe, Germany; Bharat N. Nathwani, Ceders-Sinai Medical Center and University of Southern California Keck School of Medicine, Los Angeles, CA; Bertrand Coiffier, Hospices Civils de Lyon, Lyon; Nicholas Mounier, Hospital l'Archet, Nice, France; Nancy L. Harris, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Elaine S. Jaffe, National Cancer Institute, Bethesda, MD; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Dennis D. Weisenburger, James O. Armitage, and Julie M. Vose, University of Nebraska Medical Center, Omaha, NE
| | - Nicholas Mounier
- Massimo Federico, Monica Bellei, and Stefano Luminari, Università di Modena e Reggio Emilia, Modena; Stefano A. Pileri, Università di Bologna, Bologna, Italy; Thomas Rudiger, Stadisches Klinikum Karlsruhe, Karlsruhe, Germany; Bharat N. Nathwani, Ceders-Sinai Medical Center and University of Southern California Keck School of Medicine, Los Angeles, CA; Bertrand Coiffier, Hospices Civils de Lyon, Lyon; Nicholas Mounier, Hospital l'Archet, Nice, France; Nancy L. Harris, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Elaine S. Jaffe, National Cancer Institute, Bethesda, MD; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Dennis D. Weisenburger, James O. Armitage, and Julie M. Vose, University of Nebraska Medical Center, Omaha, NE
| | - Julie M. Vose
- Massimo Federico, Monica Bellei, and Stefano Luminari, Università di Modena e Reggio Emilia, Modena; Stefano A. Pileri, Università di Bologna, Bologna, Italy; Thomas Rudiger, Stadisches Klinikum Karlsruhe, Karlsruhe, Germany; Bharat N. Nathwani, Ceders-Sinai Medical Center and University of Southern California Keck School of Medicine, Los Angeles, CA; Bertrand Coiffier, Hospices Civils de Lyon, Lyon; Nicholas Mounier, Hospital l'Archet, Nice, France; Nancy L. Harris, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Elaine S. Jaffe, National Cancer Institute, Bethesda, MD; Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Dennis D. Weisenburger, James O. Armitage, and Julie M. Vose, University of Nebraska Medical Center, Omaha, NE
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Lin HN, Liu CY, Hong YC, Pai JT, Yang CF, Yu YB, Hsiao LT, Chiou TJ, Liu JH, Gau JP, Tzeng CH, Chen PM. Clinical features and prognostic factors of angioimmunoblastic T-cell lymphoma in Taiwan: a single-institution experience. Leuk Lymphoma 2010; 51:2208-14. [PMID: 21054150 DOI: 10.3109/10428194.2010.525270] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) is a rare subtype of peripheral T-cell lymphoma that carries a poor prognosis. This study retrospectively analyzed patients with AITL from a single institution in Taiwan, aiming to define the clinical features and prognostic factors. Patients with AITL treated at our institution from February 1988 through January 2010 were enrolled. Factors associated with overall survival (OS) were determined by statistical methods. A total of 31 Taiwanese patients (21 males) were identified. The median age was 74 years (range, 27-90). Among all patients, 67.7% were Ann Arbor stage III or IV, 58.1% presented with B symptoms, 48.4% had hypoalbuminenia (<35 g/L), and 63.3% had elevated lactate dehydrogenase (LDH) at diagnosis. First-line chemotherapy was mostly CHOP (cyclophosphamide, vincristine, doxorubicin, and prednisolone)-based and complete response (CR) was achieved in 25% of patients. The actuarial 2-year survival rate was 38.7%, and the median OS was 14.9 months. In multivariate analysis, initial presentation with fever (p = 0.035), advanced stage (p = 0.024), and failure to achieve CR (p = 0.029) were independent adverse factors associated with poorer OS. Interestingly, OS did not differ whether chemotherapy regimens contained anthracycline or not. Taiwanese patients with AITL were usually elderly. Despite the prognosis being generally poor, patients with AITL should be treated with the goal of achieving CR, regardless of anthracycline- or non-anthracycline-based chemotherapy.
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Affiliation(s)
- Han-Nan Lin
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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de Leval L, Gisselbrecht C, Gaulard P. Advances in the understanding and management of angioimmunoblastic T-cell lymphoma. Br J Haematol 2010; 148:673-89. [DOI: 10.1111/j.1365-2141.2009.08003.x] [Citation(s) in RCA: 183] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Rodríguez J, Gutiérrez A, Martínez-Delgado B, Perez-Manga G. Current and future aggressive peripheral T-cell lymphoma treatment paradigms, biological features and therapeutic molecular targets. Crit Rev Oncol Hematol 2009; 71:181-98. [DOI: 10.1016/j.critrevonc.2008.10.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Revised: 10/06/2008] [Accepted: 10/15/2008] [Indexed: 10/21/2022] Open
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9
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Gottardi M, Danesin C, Canal F, Tos APD, Stefani PM, Calistri E, Salvadori U, Gherlinzoni F. Complete remission induced by thalidomide in a case of angioimmunoblastic T-cell lymphoma refractory to autologous stem cell transplantation. Leuk Lymphoma 2009; 49:1836-8. [DOI: 10.1080/10428190802233165] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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10
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Advani R, Horwitz S, Zelenetz A, Horning SJ. Angioimmunoblastic T cell lymphoma: Treatment experience with cyclosporine. Leuk Lymphoma 2009; 48:521-5. [PMID: 17454592 DOI: 10.1080/10428190601137658] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Angioimmunoblastic T cell lymphoma is a distinct entity for which there is no standard therapy. On the basis of the rationale that CsA may represent a novel drug for AITL, a disease with considerable immune dysregulation, and encouraging case reports, the authors have treated 12 patients with this agent. Ten had failed prior steroids and/or chemotherapy and two had no prior therapy. CsA was administered at a dose of 3 - 5 mg/kg PO bid for 6 - 8 weeks and gradually tapered by 50 mg every 1 - 3 weeks. Responding patients received a maintenance dose of 50 - 100 mg, with a gradual taper after a maximal response was achieved as tolerated. Doses were titrated for renal dysfunction or hypertension. CsA levels were not monitored. Eight of 12 patients responded (three complete and five partial remissions). Dose reductions were required in six patients; renal insufficiency (n = 3), fatigue (n = 2), and hypertension (n = 1). Two patients developed acute infections and one patient died shortly after active treatment. These results suggest that CsA deserves further testing as a novel therapy for AITL. By interrupting T-cell activation, CsA may alter the immune dysregulation that characterizes AILT. The efficacy of CsA is being explored in patients with recurrent AILT in a prospective trial (ECOG 2402).
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Affiliation(s)
- Ranjana Advani
- Stanford University Medical Center, Stanford, CA 94305-5821, USA.
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11
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Rojnuckarin P, Nakorn TN, Assanasen T, Wannakrairot P, Intragumtornchai T. Cyclosporin in subcutaneous panniculitis-like T-cell lymphoma. Leuk Lymphoma 2009; 48:560-3. [PMID: 17454599 DOI: 10.1080/10428190601078456] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare form of hematologic malignancy characterized by lesions in subcutaneous fat associated with systemic symptoms. The standard treatment of the disease, currently, is not established, but CHOP or CHOP-like regimens are usually given. We report, herein, 4 cases of SPTCL diagnosed by histopathology and immunohistochemistry who were refractory to CHOP and/or ESHAP and/or fludarabine-based regimen, but showed rapid improvement within weeks after oral cyclosporin 4 mg/kg/day. Three sustained complete remission for the durations of 8 - 9 months off-treatments. T-cell receptor gene rearrangement revealed polyclonality in 3 cases and monoclonality in 1 case. Our data suggest the benefit of incorporating cyclosporin into the treatment regimen for SPTCL.
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Affiliation(s)
- Ponlapat Rojnuckarin
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailland
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12
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Iannitto E, Ferreri AJM, Minardi V, Tripodo C, Kreipe HH. Angioimmunoblastic T-cell lymphoma. Crit Rev Oncol Hematol 2008; 68:264-71. [PMID: 18684638 DOI: 10.1016/j.critrevonc.2008.06.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Revised: 05/28/2008] [Accepted: 06/27/2008] [Indexed: 02/01/2023] Open
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) is a rare and aggressive neoplasm clinically characterized by sudden onset of constitutional symptoms, lymphadenopathy, hepatosplenomegaly, frequent autoimmune phenomena, particularly hemolytic anemia and thrombocytopenia, and polyclonal hypergammaglobulinemia. The lymph node histological picture is also distinctive, constituted by a polymorphic infiltrate, a marked proliferation of high endothelial venules, and a dense meshwork of dentritic cells. The neoplastic CD4+ T-cells represent a minority of the lymph node cell population; its detection is facilitated by the aberrant expression of CD10. Almost all cases arbor an EBV infected B-cell population. Patients with AITL have a poor prognosis with conventional treatment, with a median overall survival of less than 3 years. Patients achieving a good clinical response seem beneficiate from a consolidation with high-dose therapy and autologous stem cell transplantation. Constitutional symptoms and autoimmune phenomena, and some times also the neoplastic masses may respond to immunosuppressive or immunomodulatory agents such as thalidomide.
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Affiliation(s)
- Emilio Iannitto
- Division of Hematology, High Dose Therapy Unit, Policlinico Paolo Giaccone, Palermo, Italy
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13
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Mourad N, Mounier N, Brière J, Raffoux E, Delmer A, Feller A, Meijer CJLM, Emile JF, Bouabdallah R, Bosly A, Diebold J, Haioun C, Coiffier B, Gisselbrecht C, Gaulard P. Clinical, biologic, and pathologic features in 157 patients with angioimmunoblastic T-cell lymphoma treated within the Groupe d'Etude des Lymphomes de l'Adulte (GELA) trials. Blood 2008; 111:4463-70. [PMID: 18292286 PMCID: PMC2343588 DOI: 10.1182/blood-2007-08-105759] [Citation(s) in RCA: 225] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Accepted: 02/13/2008] [Indexed: 12/11/2022] Open
Abstract
To evaluate the prognostic significance of clinicobiologic and pathological features in angioimmunoblastic T-cell lymphoma (AITL), 157 AITL patients were retrieved from the GELA LNH87-LNH93 randomized clinical trials. One hundred forty-seven patients received a cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP)-like regimen with intensified courses in half of them. Histologically, 41 cases were classified as "rich in large cells" and 116 as "classic" (including 19 rich in epithelioid cells, 14 rich in clear cells, and 4 with hyperplastic germinal centers). Sixty-two cases were scored for CD10 and CXCL13 expression according to the abundance of positive lymphoid cells. Median age was 62 years, with 81% advanced stage, 72% B symptoms, 65% anemia, 50% hypergammaglobulinemia, and 66% elevated LDH. Overall 7-year survival was 30%. In multivariate analysis, only male sex (P = .004), mediastinal lymphadenopathy (P = .041), and anemia (P = .042) adversely affected overall survival. Increase in large cells and high level of CD10 and CXCL13 did not affect survival. Intensive regimen did not improve survival. In conclusion, AITL is a morphologically heterogeneous T-cell lymphoma commonly expressing CXCL13 and CD10 and carrying few prognostic factors. It portends a poor prognosis even when treated intensively. However, AITL is not always lethal with 30% of patients alive at 7 years.
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14
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Kyriakou C, Canals C, Goldstone A, Caballero D, Metzner B, Kobbe G, Kolb HJ, Kienast J, Reimer P, Finke J, Oberg G, Hunter A, Theorin N, Sureda A, Schmitz N. High-Dose Therapy and Autologous Stem-Cell Transplantation in Angioimmunoblastic Lymphoma: Complete Remission at Transplantation Is the Major Determinant of Outcome—Lymphoma Working Party of the European Group for Blood and Marrow Transplantation. J Clin Oncol 2008; 26:218-24. [DOI: 10.1200/jco.2008.12.6219] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposePatients with angioimmunoblastic T-cell lymphoma (AITL) have poor prognoses with current conventional chemotherapy. The aim of this study was to evaluate the effect of high-dose therapy (HDT) followed by autologous stem-cell transplantation (ASCT) on patients with AITL.Patients and MethodsWe report a retrospective, multicenter study of 146 patients with AITL who received ASCT. The source of the stem cells was peripheral blood in 143 patients. The conditioning regimen varied, and 74% of the patients received carmustine and 1,3-bis(2-chloroethyl)-1-nitrosourea; etoposide; ara-C; and melphalan chemotherapy.ResultsAfter a median follow-up of 31 months (range, 3 to 174 months), 95 patients (65%) remained alive, and 51 patients (35%) died. Forty-two patients died as a result of disease progression, and nine died as a result of regimen-related toxicity. The cumulative incidence of nonrelapse mortality was 5% and 7% at 12 and 24 months, respectively. The actuarial overall survival (OS) was 67% at 24 months and 59% at 48 months. The cumulative incidence of relapse was estimated at 40% and 51% at 24 and 48 months, respectively. Disease status at transplantation was the major factor that impacted outcome. Patients who received a transplant during first complete remission (CR) had significantly superior progression-free survival and OS. The estimated PFS rates for patients who received their transplants in CR were 70% and 56% at 24 and 48 months, respectively; 42% and 30% for patients with chemotherapy-sensitive disease at those time points, respectively; and 23% at both time points for patients with chemotherapy-refractory disease.ConclusionThis study shows that HDT and ASCT offers the possibility of long-term disease-free survival to patients with AITL. Early transplantation is necessary to achieve optimal results.
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Affiliation(s)
- Charalampia Kyriakou
- From the University College London; European Bone Marrow Transplantation Group, London; and Leicester Royal Infirmary, Leicester, United Kingdom; Hospital Clínico Servicio de Hematología, Salamanca; and Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; University Hospital, Dept. of Hematology; and University Hospital, Department of Medicine, Uppsala, Sweden; University of Freiburg, Department of Medicine -Hematology, Oncology, Freiburg; Medical Klinik, Wurzburg; University of Münster, Department of
| | - Carmen Canals
- From the University College London; European Bone Marrow Transplantation Group, London; and Leicester Royal Infirmary, Leicester, United Kingdom; Hospital Clínico Servicio de Hematología, Salamanca; and Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; University Hospital, Dept. of Hematology; and University Hospital, Department of Medicine, Uppsala, Sweden; University of Freiburg, Department of Medicine -Hematology, Oncology, Freiburg; Medical Klinik, Wurzburg; University of Münster, Department of
| | - Anthony Goldstone
- From the University College London; European Bone Marrow Transplantation Group, London; and Leicester Royal Infirmary, Leicester, United Kingdom; Hospital Clínico Servicio de Hematología, Salamanca; and Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; University Hospital, Dept. of Hematology; and University Hospital, Department of Medicine, Uppsala, Sweden; University of Freiburg, Department of Medicine -Hematology, Oncology, Freiburg; Medical Klinik, Wurzburg; University of Münster, Department of
| | - Dolores Caballero
- From the University College London; European Bone Marrow Transplantation Group, London; and Leicester Royal Infirmary, Leicester, United Kingdom; Hospital Clínico Servicio de Hematología, Salamanca; and Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; University Hospital, Dept. of Hematology; and University Hospital, Department of Medicine, Uppsala, Sweden; University of Freiburg, Department of Medicine -Hematology, Oncology, Freiburg; Medical Klinik, Wurzburg; University of Münster, Department of
| | - Bernd Metzner
- From the University College London; European Bone Marrow Transplantation Group, London; and Leicester Royal Infirmary, Leicester, United Kingdom; Hospital Clínico Servicio de Hematología, Salamanca; and Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; University Hospital, Dept. of Hematology; and University Hospital, Department of Medicine, Uppsala, Sweden; University of Freiburg, Department of Medicine -Hematology, Oncology, Freiburg; Medical Klinik, Wurzburg; University of Münster, Department of
| | - Guido Kobbe
- From the University College London; European Bone Marrow Transplantation Group, London; and Leicester Royal Infirmary, Leicester, United Kingdom; Hospital Clínico Servicio de Hematología, Salamanca; and Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; University Hospital, Dept. of Hematology; and University Hospital, Department of Medicine, Uppsala, Sweden; University of Freiburg, Department of Medicine -Hematology, Oncology, Freiburg; Medical Klinik, Wurzburg; University of Münster, Department of
| | - Hans-Jochem Kolb
- From the University College London; European Bone Marrow Transplantation Group, London; and Leicester Royal Infirmary, Leicester, United Kingdom; Hospital Clínico Servicio de Hematología, Salamanca; and Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; University Hospital, Dept. of Hematology; and University Hospital, Department of Medicine, Uppsala, Sweden; University of Freiburg, Department of Medicine -Hematology, Oncology, Freiburg; Medical Klinik, Wurzburg; University of Münster, Department of
| | - Joachim Kienast
- From the University College London; European Bone Marrow Transplantation Group, London; and Leicester Royal Infirmary, Leicester, United Kingdom; Hospital Clínico Servicio de Hematología, Salamanca; and Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; University Hospital, Dept. of Hematology; and University Hospital, Department of Medicine, Uppsala, Sweden; University of Freiburg, Department of Medicine -Hematology, Oncology, Freiburg; Medical Klinik, Wurzburg; University of Münster, Department of
| | - Peter Reimer
- From the University College London; European Bone Marrow Transplantation Group, London; and Leicester Royal Infirmary, Leicester, United Kingdom; Hospital Clínico Servicio de Hematología, Salamanca; and Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; University Hospital, Dept. of Hematology; and University Hospital, Department of Medicine, Uppsala, Sweden; University of Freiburg, Department of Medicine -Hematology, Oncology, Freiburg; Medical Klinik, Wurzburg; University of Münster, Department of
| | - Jurgen Finke
- From the University College London; European Bone Marrow Transplantation Group, London; and Leicester Royal Infirmary, Leicester, United Kingdom; Hospital Clínico Servicio de Hematología, Salamanca; and Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; University Hospital, Dept. of Hematology; and University Hospital, Department of Medicine, Uppsala, Sweden; University of Freiburg, Department of Medicine -Hematology, Oncology, Freiburg; Medical Klinik, Wurzburg; University of Münster, Department of
| | - Gunnar Oberg
- From the University College London; European Bone Marrow Transplantation Group, London; and Leicester Royal Infirmary, Leicester, United Kingdom; Hospital Clínico Servicio de Hematología, Salamanca; and Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; University Hospital, Dept. of Hematology; and University Hospital, Department of Medicine, Uppsala, Sweden; University of Freiburg, Department of Medicine -Hematology, Oncology, Freiburg; Medical Klinik, Wurzburg; University of Münster, Department of
| | - Ann Hunter
- From the University College London; European Bone Marrow Transplantation Group, London; and Leicester Royal Infirmary, Leicester, United Kingdom; Hospital Clínico Servicio de Hematología, Salamanca; and Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; University Hospital, Dept. of Hematology; and University Hospital, Department of Medicine, Uppsala, Sweden; University of Freiburg, Department of Medicine -Hematology, Oncology, Freiburg; Medical Klinik, Wurzburg; University of Münster, Department of
| | - Niklas Theorin
- From the University College London; European Bone Marrow Transplantation Group, London; and Leicester Royal Infirmary, Leicester, United Kingdom; Hospital Clínico Servicio de Hematología, Salamanca; and Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; University Hospital, Dept. of Hematology; and University Hospital, Department of Medicine, Uppsala, Sweden; University of Freiburg, Department of Medicine -Hematology, Oncology, Freiburg; Medical Klinik, Wurzburg; University of Münster, Department of
| | - Anna Sureda
- From the University College London; European Bone Marrow Transplantation Group, London; and Leicester Royal Infirmary, Leicester, United Kingdom; Hospital Clínico Servicio de Hematología, Salamanca; and Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; University Hospital, Dept. of Hematology; and University Hospital, Department of Medicine, Uppsala, Sweden; University of Freiburg, Department of Medicine -Hematology, Oncology, Freiburg; Medical Klinik, Wurzburg; University of Münster, Department of
| | - Norbert Schmitz
- From the University College London; European Bone Marrow Transplantation Group, London; and Leicester Royal Infirmary, Leicester, United Kingdom; Hospital Clínico Servicio de Hematología, Salamanca; and Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; University Hospital, Dept. of Hematology; and University Hospital, Department of Medicine, Uppsala, Sweden; University of Freiburg, Department of Medicine -Hematology, Oncology, Freiburg; Medical Klinik, Wurzburg; University of Münster, Department of
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15
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Abstract
Angioimmunoblastic T-cell lymphoma most often affects the elderly. Patients present with generalized lymphadenopathy and systemic symptoms; half also have hepatomegaly, splenomegaly and a rash. Polyclonal hypergammaglobulinemia, elevated lactate dehydrogenase, and anemia are the main laboratory abnormalities. Autoimmune phenomena (including autoimmune hemolytic anemia, immunologic thrombocytopenia, and autoantibodies) are common. Lymph node biopsy is needed to confirm this diagnosis. Genetic analysis that reveals a monoclonal T-cell population is also relevant. The underlying immune deficiency explains the frequency of infections. Most patients are treated with combination chemotherapy. Autologous stem cell transplantation is proposed to the youngest. Immunosuppressive drugs may be appropriate for elderly or relapsing patients. The overall 5-year survival rate is 30%.
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Affiliation(s)
- Florence Lachenal
- Service de médecine interne, Centre hospitalier Lyon Sud, Pierre-Bénite.
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16
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Stern M, Buser AS, Lohri A, Tichelli A, Nissen-Druey C. Autoimmunity and malignancy in hematology—More than an association. Crit Rev Oncol Hematol 2007; 63:100-10. [PMID: 17391977 DOI: 10.1016/j.critrevonc.2007.02.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Revised: 01/02/2007] [Accepted: 02/06/2007] [Indexed: 02/01/2023] Open
Abstract
Several associations between hematological malignancies and autoimmunity directed against hematopoietic cells exist. Antibody mediated elimination of mature blood cells such as autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP) are frequent complications of non-Hodgkin lymphomas, most prominently chronic lymphocytic leukemia. Autoimmunity directed against hematopoietic precursor cells is the hallmark of aplastic anemia, but many features of this disease are shared by two related disorders, paroxysmal nocturnal hemoglobinuria (PNH) and myelodysplastic syndrome (MDS). While the clinical associations between hematological malignancy and autoimmunity have been described many decades ago, only in the last several years have the common pathogenetic mechanisms been elucidated. We summarize the recent progress made in understanding how hematological malignancy gives rise to autoimmunity directed against blood cells and vice versa, and illustrate parallels in the etiology of malignant and autoimmune hematological disorders. Specifically, recent progress in the recognition of the association of lymphoproliferative disorders and autoimmunity against mature blood cells, and common pathogenetic background of aplastic anemia, paroxysmal nocturnal hemoglobinuria, and myelodysplastic syndrome are discussed.
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Affiliation(s)
- Martin Stern
- Division of Experimental Hematology and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Perugia, Policlinico Monteluce, Perugia, Italy
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17
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Panwalkar AW, Armitage JO. T-cell/NK-cell lymphomas: A review. Cancer Lett 2007; 253:1-13. [PMID: 17196327 DOI: 10.1016/j.canlet.2006.11.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2006] [Revised: 11/17/2006] [Accepted: 11/21/2006] [Indexed: 11/26/2022]
Abstract
T-cell neoplasms are a group of heterogeneous neoplasms that present a challenge in management. Accurate diagnosis and classification are necessary for proper treatment. This dilemma is exemplified by continuous upgrading of classification systems in an effort to better understand these diseases. The spectrum of management varies from observation and monitoring to prompt aggressive multimodality treatment to achieve optimal outcomes. Allogeneic transplant has been successful in a minority of cases with the possibility of cure; however this approach is still largely experimental. Molecular studies such as gene expression profiling are expected to offer exciting insight into the biology of these diseases. Novel therapeutic approaches continue to be explored, however will probably require larger clinical trials to establish their utility over the current standard.
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Affiliation(s)
- Amit W Panwalkar
- University of Nebraska Medical Center, Department of Oncology/Hematology, 987680 Nebraska Medical Center, Omaha, NE 68198-7680, United States.
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18
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Rodríguez J, Conde E, Gutiérrez A, Arranz R, Gandarillas M, Leon A, Ojanguren J, Sureda A, Carrera D, Bendandi M, Moraleda J, Ribera JM, Albo C, Morales A, García JC, Fernández P, Cañigral G, Bergua J, Caballero MD. Prolonged survival of patients with angioimmunoblastic T-cell lymphoma after high-dose chemotherapy and autologous stem cell transplantation. The GELTAMO experience. Eur J Haematol 2007; 78:290-6. [PMID: 17378891 DOI: 10.1111/j.1600-0609.2007.00815.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Angioimmunoblastic T-cell lymphoma (AIL) is a rare lymphoma with a poor prognosis and no standard treatment. Here, we report our experiences with 19 patients treated with high-dose chemotherapy and autologous stem cell transplantation (HDC/ASCT) within the GELTAMO co-operative group between 1992 and 2004. METHODS The median age at transplantation was 46 yr. Fifteen patients underwent the procedure as front-line therapy and four patients as salvage therapy. Most patients received peripheral stem cells (90%) coupled with BEAM or BEAC as conditioning regimen (79%). RESULTS A 79% of patients achieved complete response, 5% partial response and 16% failed the procedure. After a median follow-up of 25 months, eight patients died (seven of progressive disease and secondary neoplasia), while actuarial overall survival and progression-free survival at 3 yr was 60% and 55%. Prognostic factors associated with a poor outcome included bone marrow involvement, transplantation in refractory disease state, attributing more than one factor of the age-adjusted-International Prognostic Index, Pretransplant peripheral T-cell lymphoma (PTCL) Score or Prognostic Index for PTCL. CONCLUSIONS More than half of the patients with AIL that display unfavourable prognostic factors at diagnosis or relapse would be expected to be alive and disease-free after 3 yr when treated with HDC/ASCT. Patients who are transplanted in a refractory disease state do not benefit from this procedure.
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Affiliation(s)
- José Rodríguez
- Hospital Universitario Son Dureta, Palma de Mallorca, Spain.
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19
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Jayaraman AG, Cassarino D, Advani R, Kim YH, Tsai E, Kohler S. Cutaneous involvement by angioimmunoblastic T-cell lymphoma: a unique histologic presentation, mimicking an infectious etiology. J Cutan Pathol 2006; 33 Suppl 2:6-11. [PMID: 16972945 DOI: 10.1111/j.1600-0560.2006.00489.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Angioimmunoblastic T-cell lymphoma (AILT) is an aggressive peripheral T-cell lymphoma that is frequently accompanied by a cutaneous eruption. The cutaneous findings most commonly consist of a maculopapular eruption on the trunk. However, purpura, infiltrated or urticarial plaques, papulovesicular lesions, nodules, and erythroderma have also been reported. Histologic findings in the lymph node are characteristic, while those in the skin may show one of four patterns. Here, we review the previously reported histologic patterns and present a case of AILT involving the skin with a unique histologic appearance of necrotizing granulomas with abundant histiocytes and eosinophils, mimicking an infectious etiology.
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Affiliation(s)
- Anu G Jayaraman
- Department of Pathology, Stanford University Medical Center, Stanford, California 94305-5324, USA
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20
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Grogg KL, Attygalle AD, Attygale AD, Macon WR, Remstein ED, Kurtin PJ, Dogan A. Expression of CXCL13, a chemokine highly upregulated in germinal center T-helper cells, distinguishes angioimmunoblastic T-cell lymphoma from peripheral T-cell lymphoma, unspecified. Mod Pathol 2006; 19:1101-7. [PMID: 16680156 DOI: 10.1038/modpathol.3800625] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The germinal center T-helper cell has been proposed as the cell of origin for angioimmunoblastic T-cell lymphoma. Our recent report of expression of CXCL13, a chemokine critical for germinal center formation and one of the most highly upregulated genes in the germinal center T-helper cell subset, in the majority of angioimmunoblastic T-cell lymphoma cases, provided further support for this theory. To determine the specifity of this marker for angioimmunoblastic T-cell lymphoma, we evaluated CXCL13 expression in 26 nodal-based peripheral T-cell lymphomas and 14 lymph nodes showing paracortical lymphoid hyperplasia. No significant paracortical CXCL13 staining was seen in the reactive lymph nodes. By WHO classification criteria, 20 of the lymphoma cases were considered peripheral T-cell lymphoma, unspecified, and six were reclassified as angioimmunoblastic T-cell lymphoma after immunohistochemical detection of disorganized follicular dendritic cell meshworks. Combining the results of our studies, 31 of 35 angioimmunoblastic T-cell lymphoma cases (89%) showed CXCL13 expression, in contrast to two out of 20 peripheral T-cell lymphoma, unspecified cases (10%). The two peripheral T-cell lymphoma, unspecified cases that were positive for CXCL13 showed a Lennert lymphoma-like histology. While these cases did not meet all histologic criteria for angioimmunoblastic T-cell lymphoma, they did show an increase in EBV-positive B cells, suggesting they may be histologic variants of angioimmunoblastic T-cell lymphoma. In conclusion, CXCL13 expression is a distinctive feature of angioimmunoblastic T-cell lymphoma, providing further support for the germinal center T-helper cell as the cell of origin for this neoplasm. Given its specificity when compared to cases of peripheral T-cell lymphoma, unspecified as well as paracortical lymphoid hyperplasia, it may be a useful marker in the diagnosis of angioimmunoblastic T-cell lymphoma.
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Affiliation(s)
- Karen L Grogg
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA.
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21
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Grogg KL, Attygalle AD, Macon WR, Remstein ED, Kurtin PJ, Dogan A. Angioimmunoblastic T-cell lymphoma: a neoplasm of germinal-center T-helper cells? Blood 2005; 106:1501-2. [PMID: 16079436 PMCID: PMC1895208 DOI: 10.1182/blood-2005-03-1083] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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22
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Dogan A, Ngu LSP, Ng SH, Cervi PL. Pathology and clinical features of angioimmunoblastic T-cell lymphoma after successful treatment with thalidomide. Leukemia 2005; 19:873-5. [PMID: 15744336 DOI: 10.1038/sj.leu.2403710] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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23
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Affiliation(s)
- Ahmet Dogan
- Department of Histopathology, University College London, London, UK.
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24
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Attygalle A, Al-Jehani R, Diss TC, Munson P, Liu H, Du MQ, Isaacson PG, Dogan A. Neoplastic T cells in angioimmunoblastic T-cell lymphoma express CD10. Blood 2002; 99:627-33. [PMID: 11781247 DOI: 10.1182/blood.v99.2.627] [Citation(s) in RCA: 233] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) is a systemic disease involving lymph nodes, spleen, and bone marrow. Although the histologic features have been well described, the diagnosis is often challenging, as there are no specific phenotypic or molecular markers available. This study shows that the neoplastic cells of AITL can be identified by aberrant CD10 expression. Archival material from 30 cases of AITL, 10 cases of peripheral T-cell lymphoma unspecified (PTL), and 10 cases of reactive lymphoid hyperplasia were reviewed. Single and double immunostaining for CD3, CD4, CD8, CD20, CD21, CD10, BCL6, Ki67, and LMP-1 in situ hybridization for Epstein-Barr early region and polymerase chain reaction (PCR) for T-cell receptor gamma chain gene and immunoglobulin heavy chain gene were performed. Three overlapping histologic patterns with hyperplastic follicles, depleted follicles, or without follicles were identified in AITL. Of the 30 cases of AITL, 27 contained CD10(+) T cells. No CD10(+) T cells were present in the cases of PTL or reactive hyperplasia. PCR confirmed a monoclonal or oligoclonal T-cell population in 29 of 30 cases of AITL and a monoclonal B-cell population in 6 cases. Analysis of microdissected CD10(+) single cells showed that they belonged to the neoplastic clone. In conclusion CD10 is a phenotypic marker that specifically identifies the tumor cells in 90% of AITL, including the early cases. The presence of these cells distinguishes AITL from other PTLs. This finding provides an objective criterion for accurate and early diagnosis of AITL.
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MESH Headings
- Adaptor Proteins, Signal Transducing
- Adult
- Aged
- Aged, 80 and over
- Antigens, CD/analysis
- Biomarkers, Tumor/analysis
- Biopsy
- Carrier Proteins/analysis
- Cell Separation/methods
- Clone Cells/metabolism
- Clone Cells/pathology
- Cytoskeletal Proteins
- DNA, Viral/analysis
- DNA-Binding Proteins/analysis
- Epstein-Barr Virus Infections/metabolism
- Epstein-Barr Virus Infections/pathology
- Female
- Gene Rearrangement, B-Lymphocyte, Heavy Chain
- Gene Rearrangement, T-Lymphocyte
- Herpesvirus 4, Human/isolation & purification
- Humans
- Immunoblastic Lymphadenopathy/metabolism
- Immunoblastic Lymphadenopathy/pathology
- Immunoblastic Lymphadenopathy/virology
- Immunoenzyme Techniques
- In Situ Hybridization
- Intracellular Signaling Peptides and Proteins
- Ki-67 Antigen/analysis
- LIM Domain Proteins
- Lymph Nodes/chemistry
- Lymph Nodes/pathology
- Lymphoma, T-Cell/metabolism
- Lymphoma, T-Cell/pathology
- Lymphoma, T-Cell, Peripheral/classification
- Lymphoma, T-Cell, Peripheral/metabolism
- Lymphoma, T-Cell, Peripheral/pathology
- Male
- Micromanipulation
- Middle Aged
- Neoplasm Proteins/analysis
- Neoplastic Stem Cells/metabolism
- Neprilysin/analysis
- Polymerase Chain Reaction
- Proto-Oncogene Proteins/analysis
- Proto-Oncogene Proteins c-bcl-6
- Pseudolymphoma/metabolism
- Pseudolymphoma/pathology
- T-Lymphocytes/metabolism
- Transcription Factors/analysis
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Affiliation(s)
- Ayoma Attygalle
- Department of Histopathology, Royal Free and University College Medical School, London, United Kingdom
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25
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Sezer O, Schweigert M, Naujokat C, Mai I, Mergenthaler HG, Possinger K. In vitro and in vivo correlation of cyclosporin A-induced apoptosis in acute lymphoblastic leukemia. Eur J Haematol 1999; 63:207-9. [PMID: 10485277 DOI: 10.1111/j.1600-0609.1999.tb01770.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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