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Meeuwes FO, Brink M, Plattel W, Van der Poel MWM, Kersten MJ, Wondergem M, Böhmer L, Woei-A-Jin FJSH, Visser O, Oostvogels R, Jansen PM, Neelis KJ, Crijns APG, Daniëls LA, Snijders TJF, Vermaat JSP, Huls GA, Nijland M. Outcome of combined modality treatment in first-line for stage I(E) peripheral T-cell lymphoma; a nationwide population-based cohort study from the Netherlands. Haematologica 2024; 109:1163-1170. [PMID: 37794805 PMCID: PMC10985449 DOI: 10.3324/haematol.2023.283174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Indexed: 10/06/2023] Open
Abstract
Peripheral T-cell lymphomas (PTCL) comprise a heterogeneous group of mature T-cell neoplasms with an unfavorable prognosis; presentation with stage I(E) disease is uncommon. In clinical practice, an abbreviated chemotherapy treatment regimen combined with radiotherapy (combined modality treatment [CMT]) is commonly used, although evidence from clinical trials is lacking. The aim of this nationwide population-based cohort study is to describe first-line treatment and outcome of patients with stage I(E) PTCL. All newly diagnosed patients ≥18 years with stage I(E) anaplastic large cell lymphoma (ALCL), angioimmunoblastic T-cell lymphoma (AITL) and peripheral T-cell lymphoma NOS (PTCL not otherise specified [NOS]) in 1989-2020 were identified in the Netherlands Cancer Registry. Patients were categorized according to treatment regimen, i.e., chemotherapy (CT), radiotherapy (RT), CMT, other therapy and no treatment. The primary endpoint was overall survival (OS). Patients with stage I(E) ALCL, AITL and PTCL NOS (n=576) were most commonly treated with CMT (28%) or CT (29%), 2% underwent SCT. RT only was given in 18%, and 8% received other therapy and 16% no treatment. Overall, the 5-year OS was 59%. According to subtype, 5-year OS was superior for ALCL as compared to PTCL NOS and AITL (68% vs. 55% and 52%, respectively; P=0.03). For patients treated with CMT, 5-year OS was significantly higher (72%) as compared to patients treated with either CT or RT alone (55% and 55%, respectively; P<0.01). In multivariable analysis, age per year increment (hazard ratio [HR] =1.06, 95% confidence interval [CI]: 1.05-1.07), male sex (HR=1.53, 95% CI: 1.23-1.90), and CT, or no treatment (HR=1.64, 95% CI: 1.21-2.21, and HR=1.55, 95% CI: 1.10-2.17, respectively) were associated with a higher risk of mortality. For stage I(E) ALCL, AITL and PTCL NOS, 5-year OS is 59%, comparing favorably to historical outcome in advanced-stage disease. Superior outcome estimates were observed in patients treated with CMT.
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Affiliation(s)
- Frederik O Meeuwes
- Department of Hematology, Treant Hospital, Emmen, The Netherlands; Department of Hematology, University Medical Center Groningen, Groningen
| | - Mirian Brink
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht
| | - Wouter Plattel
- Department of Hematology, University Medical Center Groningen, Groningen
| | - Marjolein W M Van der Poel
- Department of Hematology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht
| | - Marie José Kersten
- Department of Hematology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam
| | - Mariëlle Wondergem
- Department of Hematology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam
| | - Lara Böhmer
- Department of Hematology, Haga Hospital, The Hague
| | | | - Otto Visser
- Department of Hematology, Isala Hospital, Zwolle
| | - Rimke Oostvogels
- Department of Hematology, University Medical Center Utrecht, Utrecht
| | - Patty M Jansen
- Department of Pathology, Leiden University Medical Center, Leiden
| | - Karen J Neelis
- Department of Radiotherapy, Leiden University Medical Center, Leiden
| | - Anne P G Crijns
- Department of Radiotherapy, University Medical Center Groningen, Groningen
| | - Laurien A Daniëls
- Department of Radiotherapy, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam
| | | | | | - Gerwin A Huls
- Department of Hematology, University Medical Center Groningen, Groningen
| | - Marcel Nijland
- Department of Hematology, University Medical Center Groningen, Groningen.
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Gordon MJ, Duan Z, Zhao H, Nastoupil L, Ng S, Danilov AV, Iyer S, Giordano SH. Influence of treatment intensity and medical comorbidities in older adults with peripheral T cell lymphoma. Leuk Lymphoma 2023; 64:2258-2268. [PMID: 37706491 PMCID: PMC10841322 DOI: 10.1080/10428194.2023.2256908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/28/2023] [Accepted: 09/04/2023] [Indexed: 09/15/2023]
Abstract
We conducted a population-based study of patients >65 years, diagnosed 2008-2017, with peripheral T-cell lymphoma (PTCL) using SEER-Medicare. Associations between PTCL subtype, treatment regimen, comorbidity, and mortality were assessed using the Kaplan-Meier method and multivariable Cox regression. Amongst the 2,546 patients, the median age was 77 years (interquartile range, 71-83). 5-year overall survival (OS) ranged from 22.2% to 37.3% depending on PTCL subtype. The most common frontline regimen was cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). 5-year OS rate was 47.0% for patients treated with etoposide + CHOP (N = 67; CHOEP), 33.7% for those treated with CHOP (N = 732), and 23.8% for patients treated with non-anthracycline-containing regimens (N = 105; p < 0.001). In patients without comorbidities, CHOEP remained independently associated with improved OS (HR 0.52, 95% CI,0.30-0.91). Median OS was 1.2 years from initiation of second-line therapy (N = 228) independent of treatment regimen. Frontline but not second-line treatment regimen is associated with OS in older patients with PTCL.
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Affiliation(s)
- Max J. Gordon
- The University of Texas MD Anderson Cancer Center, Department of Cancer Medicine, Houston, TX, USA
| | - Zhigang Duan
- The University of Texas MD Anderson Cancer Center, Department of Health Services Research, Houston, TX, USA
| | - Hui Zhao
- The University of Texas MD Anderson Cancer Center, Department of Health Services Research, Houston, TX, USA
| | - Loretta Nastoupil
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma and Myeloma, Houston, TX, USA
| | - Samuel Ng
- National Cancer Institute, Lymphoid Malignancies Branch, Bethesda, MD, USA
| | - Alexey V. Danilov
- City of Hope National Medical Center, Department of Hematology & Hematopoietic Cell Transplantation, Duarte, CA, USA
| | - Swaminathan Iyer
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma and Myeloma, Houston, TX, USA
| | - Sharon H. Giordano
- The University of Texas MD Anderson Cancer Center, Department of Health Services Research, Houston, TX, USA
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3
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Petrilla AA, Shah A, Feliciano J, Woolery J, LeBlanc TW. Burden of illness and treatment patterns among patients with peripheral T-cell lymphoma in the US healthcare setting. Curr Med Res Opin 2021; 37:1189-1197. [PMID: 33944646 DOI: 10.1080/03007995.2021.1920380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Limited real-world information exists on the characteristics or treatment patterns of patients with peripheral T-cell lymphoma (PTCL). We reported demographics, treatments and direct healthcare resource utilization (HRU) in a large cohort of US patients newly diagnosed with PTCL. METHODS Patients aged ≥18 years with a PTCL diagnosis between January 2011 and December 2016 were identified from the Inovalon MORE2 Registry. Continuous medical/pharmacy enrollment 6-months prior to and ≥1-month after the first PTCL diagnosis was required. The main focus of this study was on newly diagnosed patients receiving cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) versus other chemotherapy. RESULTS A total 2971 patients with PTCL and chemotherapy information were included in the study; 1706 (57%) received CHOP and 1265 (43%) other chemotherapy. A majority of patients (51.7%) were female; mean (standard deviation) age at index was 61.0 (±16.0), Charlson score was 4.1 (±2.9), and follow-up time was 24.6 (±16.7) months. During the variable follow-up period, HRU was similar for the CHOP and other chemotherapy cohorts; 58.1% and 59.3% had ≥1 all-cause hospitalizations, respectively. The proportion of patients with ≥1 PTCL-related hospitalizations was higher in the CHOP than in the other chemotherapy cohort (40.3% vs. 9.7%, respectively) and mean length of stay was longer (4.6 vs. 3.7 days per patient per month, respectively). CONCLUSIONS This retrospective analysis of patients with PTCL revealed high levels of comorbidity and HRU; novel interventions that improve patient outcomes and reduce the HRU burden of PTCL are needed.
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Affiliation(s)
- Allison A Petrilla
- Health Economics and Outcomes Research, Avalere Health, Washington, DC, USA
| | - Anne Shah
- Health Economics and Outcomes Research, Avalere Health, Washington, DC, USA
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Abstract
PURPOSE This review will describe and update readers on the recent changes in the 2017 WHO classification regarding peripheral T-cell lymphomas. RECENT FINDINGS Signficant advances in molecular studies have resulted in revisions to the classification as well as introduction to provisional entities such as breast implant-associated ALCL and nodal PTCL with T-follicular helper phenotype. SUMMARY Major advances in molecular and gene expression profiling has expanded our knowledge of these rare and aggressive diseases.
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Affiliation(s)
- Parwiz J Siaghani
- Department of Pathology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Jerry T Wong
- Department of Pathology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - John Chan
- Department of Pathology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Dennis D Weisenburger
- Department of Pathology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Joo Y Song
- Department of Pathology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA.
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Chihara D, Fanale MA, Miranda RN, Noorani M, Westin JR, Nastoupil LJ, Hagemeister FB, Fayad LE, Romaguera JE, Samaniego F, Turturro F, Lee HJ, Neelapu SS, Rodriguez MA, Wang M, Fowler NH, Davis RE, Medeiros LJ, Oki Y. The risk of central nervous system relapses in patients with peripheral T-cell lymphoma. PLoS One 2018. [PMID: 29538376 PMCID: PMC5851529 DOI: 10.1371/journal.pone.0191461] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
We performed a retrospective analysis to identify risk factors and survival outcome for central nervous system (CNS) relapse of peripheral T-cell lymphoma (PTCL) by histologic type. Records of 600 PTCL patients diagnosed between 1999 and 2014 were analyzed including PTCL not otherwise specified (PTCL-NOS, 174 patients), angoimmunoblastic T-cell lymphoma (AITL, 144), ALK+anaplastic large cell lymphoma (ALCL, 74), ALK-ALCL (103), extranodal NK-cell lymphoma (ENKL, 54), or others (51). With a median follow up of 57 months, 13 patients (4 PTCL-NOS, 1 AITL, 4 ALK+ALCL, 2 ALK-ALCL, 2 ENKL) experienced CNS relapse. One-year and 5-year cumulative incidence of CNS relapse were 1.5% (95%CI: 0.7–2.8%) and 2.1% (95%CI: 1.1–3.5%), respectively. The 5-year cumulative incidence of CNS relapse was 1.8% in PTCL-NOS, 0.7% in AITL, 5.4% in ALK+ALCL, 2.1% in ALK-ALCL and 3.7% in ENKL. Extranodal involvement >1 site was the only significant factor associated with higher chance of CNS relapse (HR: 4.9, 95%CI: 1.6–15.0, p = 0.005). Patients with ALK+ALCL who had extranodal involvement >1 (N = 19) had very high risk of CNS relapse with one year cumulative incidence of 17% (95%CI: 4%-37%), all occurring within six months after diagnosis. All patients with CNS relapse eventually died (median, 1.5 months; range, 0.1–10.1 months). CNS relapse in patients with PTCL is rare event but the risk varies by subtype. ALK+ALCL patients with extranodal involvement >1 site have a very high risk of early CNS relapse, and thus evaluation of CNS involvement at the time of diagnosis and possible CNS-directed prophylaxis may be considered.
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Affiliation(s)
- Dai Chihara
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Michelle A. Fanale
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Roberto N. Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Mansoor Noorani
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Jason R. Westin
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Loretta J. Nastoupil
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Fredrick B. Hagemeister
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Luis E. Fayad
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Jorge E. Romaguera
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Felipe Samaniego
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Francesco Turturro
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Hun J. Lee
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Sattva S. Neelapu
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - M. Alma Rodriguez
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Michael Wang
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Nathan H. Fowler
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Richard E. Davis
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - L. Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Yasuhiro Oki
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
- * E-mail:
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Monabati A, Safaei A, Noori S, Mokhtari M, Vahedi A. Subtype distribution of lymphomas in South of Iran, analysis of 1085 cases based on World Health Organization classification. Ann Hematol 2016; 95:613-8. [PMID: 26754635 DOI: 10.1007/s00277-016-2590-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 12/30/2015] [Indexed: 01/13/2023]
Abstract
Lymphoma is one of the most common malignancies worldwide. Subtype distribution is different throughout the world. Some reports from the Middle East are in record. This article is trying to report the subtype distribution of lymphoma in Iran and compare it to that of Western, Far East Asian and Middle Eastern countries. A retrospective study was done on all lymphomas diagnosed in a large referral center in the South of Iran during a time period between 2009 and 2014. All diagnoses have been made according to 2008 WHO classification. A total number of 1085 cases with diagnoses of lymphoma retrieved. Twenty-nine cases (2.6 % of all) were precursor lymphoid neoplasm, 608 cases (56 % of all) were mature B cell neoplasm, 115 cases (10.5 % of all) were mature T and NK cell neoplasm, and 333 cases (30.6 % of all) were Hodgkin lymphoma. The six most frequent subtypes of mature B cell neoplasm were diffuse large B cell lymphoma, NOS (57 %), Burkitt lymphoma (7 %), small lymphocytic lymphoma (6.9 %), mantle cell lymphoma (5.7 %), extranodal marginal zone B cell lymphoma (5.2 %) and follicular lymphoma (3.6 %). Among mature T and NK cell neoplasm, mycosis fungoides was the most common type (43.4 %) followed by peripheral T cell lymphoma, NOS (20 %) and angioimmunoblastic T cell lymphoma (9.9 %). Of Hodgkin lymphoma cases, 90.6 % were classical type and 9.3 % were nodular lymphocyte predominant Hodgkin lymphoma. Extranodal involvement was seen in 42.2 % and GI tract was the most common site. Lymphoma frequencies were similar to that of Middle Eastern countries except for lower rate of follicular lymphoma and higher incidence of diffuse large B cell lymphoma, NOS and small lymphocytic lymphoma.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Child
- Child, Preschool
- Female
- Hodgkin Disease/classification
- Hodgkin Disease/diagnosis
- Hodgkin Disease/epidemiology
- Humans
- Iran/epidemiology
- Leukemia, Lymphocytic, Chronic, B-Cell/classification
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/epidemiology
- Lymphoma/classification
- Lymphoma/diagnosis
- Lymphoma/epidemiology
- Lymphoma, Follicular/classification
- Lymphoma, Follicular/diagnosis
- Lymphoma, Follicular/epidemiology
- Lymphoma, Large B-Cell, Diffuse/classification
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/epidemiology
- Lymphoma, T-Cell, Peripheral/classification
- Lymphoma, T-Cell, Peripheral/diagnosis
- Lymphoma, T-Cell, Peripheral/epidemiology
- Male
- Middle Aged
- Retrospective Studies
- World Health Organization
- Young Adult
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Affiliation(s)
- Ahmad Monabati
- Department of Pathology and Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Akbar Safaei
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sadat Noori
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maral Mokhtari
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Vahedi
- Department of Pathology, Tabriz University of Medical Sciences, Tabriz, Iran.
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Feng Y, Fu J, Yan S, Ling Y, Huang Y, Cai M, Rao H. [Analysis of mature T-cell and NK-cell lymphoma with CD30 expression based on latest WHO classification]. Zhonghua Bing Li Xue Za Zhi 2014; 43:508-511. [PMID: 25346118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the frequency of different types of mature T- and NK-cell lymphomas diagnosed in a 4-year period at Sun Yat-sen University Cancer Center, and to study baseline CD30 for potential anti-CD30 targeted therapy in mature T- and NK-cell lymphoma. METHODS All cases of mature T- and NK-cell lymphoma diagnosed at Sun Yat-sen University Cancer Center from September 1, 2009 to August 31, 2013, were reviewed. Paraffin-blocks of available 164 consecutive cases were stained for CD30 immunohistochemistry using EnVision protocol. RESULTS A total of 625 cases of mature T- and NK-cell lymphomas were diagnosed and the most common type was extranodal NK/T cell lymphoma (ENKTL), nasal type 319 (51.0%) cases, followed by angioimmunoblastic T-cell lymphoma (AITL) (119 cases, 19.0%), peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) (81 cases, 13.0%), and anaplastic large-cell lymphoma (ALCL), including 48 cases (7.7%) of systematic ALCL and 11 cases (1.8%) of primary cutaneous ALCL. Besides ALCL, ENKTL had the highest expression rate of CD30 among the 164 cases, with positivity observed in 41 cases (62.1%, 41/66). Only 1 case of PTCL-NOS was CD30 positive. CD30 was not expressed in all 28 cases of AITL and other rare types of mature T- and NK-cell lymphoma. CONCLUSIONS The frequency of different types of mature T- and NK-cell lymphoma encountered at Sun Yat-sen University Cancer Center was similar to that seen in other areas of China and other Asia countries. CD30 expression is different among several types of mature T- and NK-cell lymphoma. In addition to ALCL, ENKTL has the highest expression rate of CD30, which may be a candidate disease for anti-CD30 targeted therapy.
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MESH Headings
- China/epidemiology
- Humans
- Immunohistochemistry
- Killer Cells, Natural
- Lymphoma, Extranodal NK-T-Cell/epidemiology
- Lymphoma, Extranodal NK-T-Cell/pathology
- Lymphoma, Large-Cell, Anaplastic/epidemiology
- Lymphoma, Large-Cell, Anaplastic/pathology
- Lymphoma, Primary Cutaneous Anaplastic Large Cell/epidemiology
- Lymphoma, Primary Cutaneous Anaplastic Large Cell/pathology
- Lymphoma, T-Cell, Peripheral/epidemiology
- Lymphoma, T-Cell, Peripheral/pathology
- T-Lymphocytes
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Affiliation(s)
- Yanfen Feng
- Department of Pathology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Jia Fu
- Department of Pathology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Shumei Yan
- Department of Pathology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Yihong Ling
- Department of Pathology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Yili Huang
- Department of Pathology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Muyan Cai
- Department of Pathology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Huilan Rao
- Department of Pathology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China. E-mail:
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8
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Yasukawa M. Guest editorial: peripheral T-cell lymphomas: progress is not "peripheral", but "central". Int J Hematol 2014; 99:217-8. [PMID: 24504439 DOI: 10.1007/s12185-014-1526-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 01/26/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Masaki Yasukawa
- Department of Hematology, Clinical Immunology, and Infectious Diseases, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0295, Japan,
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9
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MESH Headings
- Aged
- Biomarkers, Tumor
- Clone Cells/virology
- Dendritic Cells, Follicular/pathology
- Diagnosis, Differential
- Epstein-Barr Virus Infections/pathology
- Female
- Gene Rearrangement, T-Lymphocyte
- Herpesvirus 4, Human/isolation & purification
- Hodgkin Disease/diagnosis
- Humans
- Hyperplasia
- Immunophenotyping
- Lymphoma, Large-Cell, Immunoblastic/diagnosis
- Lymphoma, T-Cell, Peripheral/diagnosis
- Lymphoma, T-Cell, Peripheral/epidemiology
- Lymphoma, T-Cell, Peripheral/genetics
- Lymphoma, T-Cell, Peripheral/pathology
- Lymphoma, T-Cell, Peripheral/virology
- Prognosis
- Pseudolymphoma/diagnosis
- Splenomegaly/etiology
- Venules/pathology
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Affiliation(s)
- Marie Parrens
- Département de pathologie, hôpital Haut-Lévêque, CHU et université de Bordeaux 2, avenue de Magellan, 33604 Pessac, France.
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Abstract
BACKGROUND T-cell lymphomas make up approximately 10-15% of lymphoid malignancies. The frequency of these lymphomas varies geographically, with the highest incidence in parts of Asia. DIAGNOSIS The diagnosis of aggressive peripheral T-cell lymphoma (PTCL) is usually made using the WHO classification. The ability of hematopathologists to reproducibly diagnose aggressive PTCL is lower than for aggressive B-cell lymphomas, with a range of 72-97% for the aggressive PTCLs. RISK STRATIFICATION Patients with aggressive PTCL are staged using the Ann Arbor Classification. Although somewhat controversial, positron emission tomography (PET) scans appear to be useful as they are in aggressive B-cell lymphomas. The most commonly used prognostic index is the International Prognostic Index. The specific subtype of aggressive PTCL is an important risk factor, with the best survival seen in anaplastic large-cell lymphoma-particularly young patients with the anaplastic lymphoma kinase positive subtype. RISK ADAPTED THERAPY Anaplastic large-cell lymphoma is the only subgroup to have a good response to a cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP)-like regimen. Angioimmunoblastic T-cell lymphoma has a prolonged disease-free survival in only ∼20% of patients, but younger patients who have an autotransplant in remission seem to do better. PTCL-not otherwise specified (NOS) is not one disease. Anthracycline containing regimens have disappointing results and a new approach is needed. NK/T-cell lymphoma localized to the nose and nasal sinuses seems to be best treated with radiotherapy containing regimens. Enteropathy associated PTCL and hepatosplenic PTCL are rare disorders with a generally poor response to therapy, although selected patients with enteropathy associated PTCL seem to benefit from intensive therapy.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bone Marrow Transplantation
- Combined Modality Therapy
- Disease Management
- Disease-Free Survival
- Gene Expression Profiling
- Humans
- Immunophenotyping
- Incidence
- Lymphoma, T-Cell, Peripheral/classification
- Lymphoma, T-Cell, Peripheral/diagnosis
- Lymphoma, T-Cell, Peripheral/drug therapy
- Lymphoma, T-Cell, Peripheral/epidemiology
- Lymphoma, T-Cell, Peripheral/radiotherapy
- Lymphoma, T-Cell, Peripheral/surgery
- Neoplasm Invasiveness
- Prognosis
- Severity of Illness Index
- Treatment Outcome
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11
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Niitsu N. [Peripheral T cell lymphoma]. Gan To Kagaku Ryoho 2009; 36:752-755. [PMID: 19496284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Nozomi Niitsu
- Department of Hematology, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Saitama, Japan
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12
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Shivarov V, Dimitrov J, Guenova M. Lymphoid neoplasms in Bulgaria according to the WHO classification (2001). The experience of the National Center of Haematology. Haematologica 2005; 90:ELT07. [PMID: 16464764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
The aim of the present study was to assess the incidence of lymphoma subtypes in the largest cohort of patients in Bulgaria, referred to the National Center of Haematology and Transfusiology between 01.01.2003 and 31.12.2004, applying the WHO classification criteria, including precursor and mature cell neoplasias, plasmacytoma and Hodgkin lymphomas. A total of 790 cases were newly diagnosed. Hodgkin lymphomas comprised 24.6% of the cases, B-cell neoplasias - 66.5% whereas T/NK-cell neoplasias - 6.9% of the total. Specimens were inadequate for subclassification in 2.2% of the cases. Detailed data on the subtypes are presented and compared to reported data from other geographic locations.
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Economopoulos T, Papageorgiou S, Dimopoulos MA, Pavlidis N, Tsatalas C, Symeonidis A, Foudoulakis A, Pectasides D, Rontogianni D, Rizos E, Chalkia P, Anagnostopoulos A, Melachrinou M, Papageorgiou E, Fountzilas G. Non-Hodgkin's lymphomas in Greece according to the WHO classification of lymphoid neoplasms. A retrospective analysis of 810 cases. Acta Haematol 2005; 113:97-103. [PMID: 15802887 DOI: 10.1159/000083446] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2003] [Accepted: 04/19/2004] [Indexed: 11/19/2022]
Abstract
The purpose of this retrospective study, the largest unselected series in our country, was to illustrate the clinicopathological features of non-Hodgkin's lymphoma (NHL) classified according to the World Health Organization (WHO) classification of lymphoid neoplasms. A retrospective analysis was conducted and clinical features of histological subtypes were established in 810 patients (age > or = 15 years) with NHL who were treated at 8 major centers representative of Greece. There were 435 males and 375 females 95% of them aged >30 years. B symptoms were present in 34% of the patients, while 45.3% had stages I-II and 54.6% had stages III-IV. LDH was increased in 37% of the patients. B cell lymphomas formed 88% of the cases whereas T cell lymphomas formed 12% of the total. Indolent lymphomas accounted for 31.1%, aggressive ones for 66.7% and very aggressive ones for 2.4% of all NHLs. Among indolent lymphomas extranodal ones (MALT B cell lymphoma) were the most common subset while follicular lymphoma grade I and II and small lymphocytic ones presented with equal frequency. Among the aggressive lymphomas diffuse large cell lymphoma (DLCL) was the most common subtype; this entity along with large-cell immunoblastic lymphomas accounted for 45.2% of all B cell lymphomas. Among the T cell lymphomas, peripheral T cell lymphomas and anaplastic large cell lymphomas of the T/null-cell type were the most common subtypes. The most common extranodal presentation was the gastrointestinal tract (GI). Next in frequency were primary extranodal NHL of the head and neck region. MALT B cell lymphomas were found in almost half of the patients with GI tract NHL, whereas in all other extranodal places DLCL was the predominant histological subtype. The median survival for indolent and aggressive NHL was 123.5 and 55.5 months, respectively. This is the first report of a large series of malignant lymphomas in Greece using the WHO classification. It appears that there are no significant differences between NHL in Greece and other large series as far as clinical and extranodal presentation is concerned. The frequency of follicular lymphoma in the current study is comparable to that reported from Asian countries and mainland Europe, but lower than that of US and Northern European series. There were no important differences in the incidence of the remaining histological subtypes between Greece and other European countries.
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MESH Headings
- Adolescent
- Adult
- Aged
- Child
- Child, Preschool
- Female
- Gastrointestinal Neoplasms/classification
- Gastrointestinal Neoplasms/epidemiology
- Gastrointestinal Neoplasms/mortality
- Gastrointestinal Neoplasms/pathology
- Greece/epidemiology
- Head and Neck Neoplasms/classification
- Head and Neck Neoplasms/epidemiology
- Head and Neck Neoplasms/mortality
- Head and Neck Neoplasms/pathology
- Humans
- Lymphoma, Large B-Cell, Diffuse/classification
- Lymphoma, Large B-Cell, Diffuse/epidemiology
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, T-Cell, Peripheral/classification
- Lymphoma, T-Cell, Peripheral/epidemiology
- Lymphoma, T-Cell, Peripheral/mortality
- Lymphoma, T-Cell, Peripheral/pathology
- Male
- Middle Aged
- Neoplasm Staging
- Retrospective Studies
- World Health Organization
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14
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Zucca E, Zinzani PL. Understanding the group of peripheral T-cell lymphomas, unspecified. Curr Hematol Rep 2005; 4:23-30. [PMID: 15610656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Presumably diverse cases are at present lumped under the heading peripheral T-cell lymphoma, not otherwise categorized, or unspecified (PTCL-U), which comprise the largest group of T-cell neoplasms in Western countries. Although a variety of morphologic subtypes have been described, no consistent immunophenotypic, genetic, or clinical features have been associated with most of them. Hopefully, some progress can be expected from the novel sophisticated and powerful genomic and proteomics technologies, which may uncover the group of T-cell neoplasms, and perhaps identify some specific disease entities. An improved understanding of their biology may improve our ability to develop better treatments for these disorders. Indeed, these disorders are among the most aggressive lymphomas, representing a wide variety of infrequent clinicopathologic syndromes that share a dismal prognosis. The treatments used for diffuse large B-cell lymphoma have produced disappointing results in peripheral T-cell lymphoma. Clinical trials focusing specifically on these subtypes are therefore warranted. Novel strategies need to be developed and specific regimens including active agents in peripheral T-cell lymphoma should be investigated. This effort will be successful only if a large international collaboration can be set up because of the rarity of most subtypes.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bone Marrow Transplantation
- Case Management
- Female
- Gene Rearrangement, T-Lymphocyte
- Humans
- Immunophenotyping
- Killer Cells, Natural/pathology
- Lymphoma, T-Cell, Cutaneous/classification
- Lymphoma, T-Cell, Peripheral/classification
- Lymphoma, T-Cell, Peripheral/epidemiology
- Lymphoma, T-Cell, Peripheral/genetics
- Lymphoma, T-Cell, Peripheral/pathology
- Lymphoma, T-Cell, Peripheral/therapy
- Male
- Middle Aged
- Receptors, Antigen, T-Cell, alpha-beta/genetics
- Receptors, Antigen, T-Cell, gamma-delta/genetics
- Survival Analysis
- T-Lymphocyte Subsets/pathology
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Affiliation(s)
- Emanuele Zucca
- International Extranodal Lymphoma Study Group, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, CH-6500, Bellinzona, Switzerland
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15
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Mitarnun W, Saechan V, Pradutkanchana J, Suwiwat S, Takao S, Ishida T. Epstein-Barr virus-associated peripheral T-cell lymphoma with gastrointestinal tract involvement. J Med Assoc Thai 2003; 86:816-28. [PMID: 14649966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Peripheral T-cell lymphoma (PTCL) is a group of diseases which are common in Asia and areas of South and Central America. They are highly associated with the Epstein-Barr virus (EBV) infection. In the present study the authors evaluated patients with gastrointestinal involvement of PTCL with respect to clinical findings and outcome, pathologic features, and molecular analysis for EBV infection and the clonality of tumor cells. From January 1997 through December 2000, 7 patients with gastrointestinal tract involvement of PTCL were identified. The frequency of gastrointestinal tract involvement in the various types of PTCL was 5.4 per cent (7 of 129 cases). The pertinent clinical features were prolonged fever, weight loss, anemia, hepatosplenomegaly, lymphadenopathy, multiorgan involvement, and gastrointestinal bleeding. Laboratory results showed a significantly high serum level of alkaline phosphatase and lactate dehydrogenase, and abnormal coagulograms. Five patients died within 4 months after onset of illness, while two were in complete remission after chemotherapy. The tumor cell morphology was classified into three categories: small-sized cells, mixed medium- and large-sized cells, and large-sized cells. The antigenic phenotypes of the tumor cells were LCA+, CD3+, CD15-, CD16-, CD30-, CD45R0+, CD57-, CD68-, EMA-, betaF1-, granzyme B+, TIA-1+, and p53+. The expression of CD4, CD8, CD56 and CD20 was variable. EBV-RNA expression by in situ hybridization (EBER-ISH) study was positive and T-cell receptor (TCR) beta and/or gamma gene rearrangements were detected in all patients. DNA sequence analysis showed high identity to the human TCR germline gene. PTCL with gastrointestinal tract involvement was associated with EBV infection. The tumor cells were mature T cells with some NK-cell antigenic expression and all demonstrated TCR gene rearrangements.
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Affiliation(s)
- Winyou Mitarnun
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
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16
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Rüdiger T, Weisenburger DD, Anderson JR, Armitage JO, Diebold J, MacLennan KA, Nathwani BN, Ullrich F, Müller-Hermelink HK. Peripheral T-cell lymphoma (excluding anaplastic large-cell lymphoma): results from the Non-Hodgkin's Lymphoma Classification Project. Ann Oncol 2002; 13:140-9. [PMID: 11863096 DOI: 10.1093/annonc/mdf033] [Citation(s) in RCA: 299] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Peripheral T-cell lymphoma (PTCL) is rare in most parts of the world. Therefore, we have evaluated the 96 cases of PTCL diagnosed within the Non-Hodgkin's Lymphoma Classification Project (NHLCP) (1378 cases) for their geographical distribution, pathologic features and diagnostic reliability, as well as clinical presentation and outcome. MATERIALS AND METHODS Diagnoses of all cases were rendered independently by five experienced hematopathologists based on morphology only, and after introduction of the immunophenotype and clinical data. Divergent diagnoses were jointly discussed and a final consensus diagnosis was established in each case. Reliability of the diagnoses was evaluated statistically, and the clinical features and outcome were analyzed according to the consensus diagnoses. RESULTS Seven per cent of all non-Hodgkin's lymphoma (NHL) cases reviewed were classified as PTCL and the frequency varied from 1.5% to 18.3% in different countries. The interobserver agreement with the consensus diagnosis of PTCL was 86% in the Revised European-American Lymphoma (REAL) classification, but the designation of subtypes was less reliable. Diagnostic reliability improved from 41% to 86% after immunophenotyping, but did not improve further with the addition of detailed clinical data. Clinically, angiocentric nasal lymphoma presented in young females (median age 49 years) at extranodal sites, but with few adverse risk factors, whereas angioimmunoblastic lymphoma presented most often in older males (median age 65 years) at nodal and extranodal sites with numerous risk factors. The 5-year overall and failure-free survivals for patients with PTCL treated with doxorubicin (Adriamycin)-containing regimens were only 26% and 20%, respectively. Both failure-free and overall survival were strongly correlated with the performance status and International Prognostic Index scores at presentation, but differences in survival were not observed between the major histological types. However, within the PTCL 'not otherwise specified' category, but not angioimmunoblastic lymphoma, the number of transformed blasts was prognostically relevant. CONCLUSIONS PTCLs can be diagnosed reliably by experienced hematopathologists, but immunophenotyping is absolutely necessary. Currently, all types of PTCL should be considered high-grade lymphomas. An increased ability to distinguish T-lymphocyte subsets is needed in order to better subclassify the PTCLs for therapeutic and prognostic purposes.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Female
- Humans
- Lymphoma, Non-Hodgkin/classification
- Lymphoma, T-Cell, Peripheral/diagnosis
- Lymphoma, T-Cell, Peripheral/drug therapy
- Lymphoma, T-Cell, Peripheral/epidemiology
- Lymphoma, T-Cell, Peripheral/pathology
- Male
- Middle Aged
- Neoplasm Staging
- Prognosis
- Reproducibility of Results
- Retrospective Studies
- Survival Rate
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17
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Abstract
We have studied the clinicopathological features of 19 Korean cases of peripheral T-cell and natural killer (NK) cell lymphomas, not including mycosis fungoides. Primary cutaneous involvement was demonstrated in eight of these 19 cases, and we recognized four clinicopathologic subtypes among these eight patients: nasal type NK/T cell lymphoma, three cases; primary cutaneous CD30 positive anaplastic large cell lymphoma, two cases; subcutaneous panniculitis-like T-cell lymphoma, one case; lymphoma with hydroa vacciniforme-like cutaneous lesions, two cases. We did not, however, encounter any cases of HTLV-associated adult T-cell lymphoma/leukemia, which is common in Taiwan and Japan. EBV-associated lymphoma is the most prominent type of peripheral T-cell and NK cell neoplasm involving the skin in Korea.
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MESH Headings
- Adult
- Aged
- Arm
- Diagnosis, Differential
- Eyelids
- Female
- Herpesvirus 4, Human/isolation & purification
- Humans
- Immunohistochemistry
- In Situ Hybridization
- Killer Cells, Natural
- Korea/epidemiology
- Lymphoma, T-Cell, Peripheral/classification
- Lymphoma, T-Cell, Peripheral/diagnosis
- Lymphoma, T-Cell, Peripheral/epidemiology
- Lymphoma, T-Cell, Peripheral/pathology
- Male
- Middle Aged
- Nose Neoplasms/classification
- Nose Neoplasms/diagnosis
- Nose Neoplasms/epidemiology
- Nose Neoplasms/pathology
- Skin Neoplasms/classification
- Skin Neoplasms/diagnosis
- Skin Neoplasms/epidemiology
- Skin Neoplasms/pathology
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Affiliation(s)
- K H Cho
- Department of Dermatology, Seoul National University College of Medicine, Korea
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18
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Quintanilla-Martinez L, Franklin JL, Guerrero I, Krenacs L, Naresh KN, Rama-Rao C, Bhatia K, Raffeld M, Magrath IT. Histological and immunophenotypic profile of nasal NK/T cell lymphomas from Peru: high prevalence of p53 overexpression. Hum Pathol 1999; 30:849-55. [PMID: 10414505 DOI: 10.1016/s0046-8177(99)90147-8] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Nasal NK/T-cell lymphoma is a unique form of lymphoma highly associated with Epstein-Barr virus (EBV). These lymphomas are rare in Western populations and much more prevalent in some Asian and Latin American countries. Although there are several sizable studies from Asian countries, the same is not true from South America. The aim of this study was to analyze a series of 32 cases of nasal T-cell lymphoma from Peru and to further extend the characterization of this disease. Immunohistochemistry was performed on paraffin sections using the following antibodies: CD20 (L26), CD45RO, CD3, Ki67, CD57, CD56, TIA-1, bcl-2, and p53. The presence of EBV was investigated with immunohistochemical analysis for latent membrane protein (LMP)-1 and in situ hybridization using an antisense riboprobe to EBER 1. The 32 patients included 18 men and 14 women (M:F ratio, 1.2:1), with a median age of 43 years (11 to 72). Three categories were identified: (1) Nasal NK/T cell lymphomas (28 cases): The morphology ranged from small or medium-sized cells to large transformed cells. Necrosis was present in 86% of the cases, and angioinvasion was seen in 36% of the cases. All cases were positive for CD45RO, CD3, and for TIA-1. CD56 was positive in 21 of 27 cases (78%), and CD57 was negative in all cases. EBER 1 positivity was identified in most of the tumor cells in 27 of 28 cases (96%), including the six cases in which CD56 was negative. Overexpression of p53 was detected in 24 cases (86%). (2) Blastic NK cell lymphoma (1 case): The neoplastic cells resembled those of lymphoblastic lymphoma. CD56 and CD45RO were positive; TIA-1, TdT, and EBER-1 were negative. (3) Peripheral T-cell lymphoma (PTCL) unspecified (3 cases): CD56, TIA-1, and EBER-1 were negative. Nasal lymphomas from Peru with a T cell phenotype are predominantly EBV-associated NK/T cell lymphomas, similar to those described in Asian countries. The expression of CD56, TIA-1, and EBER-1, in combination, are very useful markers for the diagnosis of nasal NK/T cell lymphoma in paraffin-embedded tissue. The differential diagnosis of T-cell lymphomas in the nasal region should include rare cases of PTCL unspecified and the blastic variant of NK cell lymphoma. P53 is overexpressed in 86% of the cases. The significance of this finding with regard to clinical behavior and prognosis remains to be determined.
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MESH Headings
- Adolescent
- Adult
- Child
- Female
- Humans
- Immunohistochemistry
- Immunophenotyping
- In Situ Hybridization
- Killer Cells, Natural/metabolism
- Killer Cells, Natural/pathology
- Lymphoma, T-Cell/epidemiology
- Lymphoma, T-Cell/metabolism
- Lymphoma, T-Cell/pathology
- Lymphoma, T-Cell, Peripheral/epidemiology
- Lymphoma, T-Cell, Peripheral/metabolism
- Lymphoma, T-Cell, Peripheral/pathology
- Male
- Middle Aged
- Nose Neoplasms/epidemiology
- Nose Neoplasms/metabolism
- Nose Neoplasms/pathology
- Peru
- Prevalence
- Tumor Suppressor Protein p53/metabolism
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Affiliation(s)
- L Quintanilla-Martinez
- Hematopathology Section, Laboratory of Pathology, and Pediatric Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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19
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Abstract
Forty-two cases of Chinese T-cell lymphoma were studied for expression of Epstein-Barr virus (EBV) encoded RNA (EBER-1) and EBV latent membrane protein-1 (LMP-1) using in situ hybridization and immunohistochemistry, respectively. EBV was detected in tumour cells in 24/39 peripheral T-cell lymphomas (62%), comprising 18/27 pleomorphic, medium and large cell lymphomas (67%), 4/6 angioimmunoblastic lymphadenopathy-like lymphomas (67%), 2/2 Lennert's lymphomas, 0/2 anaplastic large cell lymphomas, and 0/2 T-zone lymphomas. EBV was not found in three T-lymphoblastic lymphomas. EBV was associated with 12/24 nodal (50%) compared with 12/15 extranodal (80%) peripheral T-cell lymphomas. In EBV positive nodal lymphomas, 9/12 cases (75%) contained less than 10% EBER positive tumour cells. In EBV positive extranodal lymphomas, 9/11 cases (82%) showed EBV gene expression in more than 50% of the tumour cells, and in five of these almost all tumour cells were positive. Lymphomas of the nasopharynx (mainly midline granuloma-type) showed EBER-1 expression in nearly all tumour cells. LMP-1 was detected in 19/23 EBER positive peripheral T-cell lymphomas (83%). Our results show that EBV is strongly associated with peripheral T-cell lymphomas in Chinese. An important role for the virus is suggested in lymphomas of the nasopharynx. The significance of EBV in T-cell lymphomas that contain only a minor population of virally infected tumour cells is currently unclear.
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Affiliation(s)
- X G Zhou
- Laboratory of Immunopathology, Aarhus University Hospital, Denmark
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20
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Abstract
The peripheral T-cell lymphomas of 50 patients were classified by histological type and tumour cell size, the latter as described by the Nebraska Group. There was no difference in the pattern of their clinical features among the various histological subtypes and their clinical outcome was similar. Cell size and other factors including sex, age, presence of B symptoms, sites of primary disease, histological subtypes according to the Japanese classification, lactate dehydrogenase level and presence of bulky disease did not appear to correlate with clinical outcome. However, patients with stage IV disease had significantly lower CR rate (9/29 versus 16/21, p = 0.01) and poorer survival at 3 years (p = 0.05) than those with stage I, II and III disease. Patients receiving COPP, the less intensive chemotherapy regimen, appeared to have poorer clinical outcome but the difference observed was not statistically significant because of the number of patients in each subgroup.
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Affiliation(s)
- R Liang
- Department of Medicine, Queen Mary Hospital, University of Hong Kong
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21
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Abstract
The nasal peripheral (post-thymic) T-cell lymphoma is an important cause of the midline granuloma syndrome (MGS), in which ulceration and destruction of the tissues of the nose and paranasal sinuses occurs. We reviewed the histology of 9 cases of the MGS treated with radiotherapy, and, using immunocytochemistry, showed 8 cases to be peripheral T-cell lymphomas (PTCL) and 1 a B-cell lymphoma. All patients received radiotherapy and 2 died shortly after treatment from unrelated causes. Two patients with T-cell lymphoma and the solitary case of B-cell lymphoma achieved long-term disease-free survival. The 4 remaining cases of T-cell lymphoma relapsed locally at a median interval of 3.5 months despite megavoltage irradiation of 45-50 Gy (in 3 cases) and inclusion of uninvolved paranasal sinuses and the nasopharynx in the field (in 2 cases). All patients with local relapse achieved, and remain in, remission after treatment with alkylating agents and prednisolone. The disappointing response of some cases of nasal T-cell lymphoma to radiotherapy has been reported by others, and this may be due partly to the heterogeneity of nasal lymphomas. We are unable to provide clear guidelines for treatment but suggest that a role exists for initial treatment with oral alkylating agents and steroids in newly diagnosed cases.
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MESH Headings
- Age Factors
- Combined Modality Therapy
- Granuloma, Lethal Midline/epidemiology
- Granuloma, Lethal Midline/etiology
- Granuloma, Lethal Midline/pathology
- Granuloma, Lethal Midline/radiotherapy
- Humans
- Lymphoma, B-Cell/complications
- Lymphoma, B-Cell/epidemiology
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/radiotherapy
- Lymphoma, T-Cell, Peripheral/complications
- Lymphoma, T-Cell, Peripheral/epidemiology
- Lymphoma, T-Cell, Peripheral/pathology
- Lymphoma, T-Cell, Peripheral/radiotherapy
- Neoplasm Recurrence, Local/complications
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/radiotherapy
- Nose Neoplasms/complications
- Nose Neoplasms/epidemiology
- Nose Neoplasms/pathology
- Nose Neoplasms/radiotherapy
- Remission Induction
- Retrospective Studies
- Scotland/epidemiology
- Sex Factors
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Affiliation(s)
- S Senan
- Beatson Oncology Centre, Western Infirmary, Glasgow, UK
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22
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Abstract
The clinico-pathologic features of 107 adult Chinese patients with peripheral T-cell lymphoma (excluding primary cutaneous lymphoma) are described and a comparison between HTLVI+ and HTLV-I- patients is made. There were 27 HTLV-I+ and 80 HTLV-I- patients. The virus-positive and -negative groups both had a male predominance and an identical median age of 48. Most patients in both groups presented with stage-IV disease, B symptoms, lymphadenopathy and hepatosplenomegaly. The HTLV-I+ group had a significantly higher incidence of skin and pulmonary lesions, bone marrow and peripheral blood involvement, hypercalcemia, and elevated LDH level compared to the HTLV-I- group. Sinonasal lesions (10), mediastinal mass (5), and GI tract involvement (6) were only seen in the HTLV-I- group. Leukocytosis with the presence of circulating pleomorphic lymphoid cells was characteristic of HTLV-I+ cases, while cytopenia was more frequently present in HTLV-I- cases. All of the 24 HTLV-I+ patients tested were CD4+CD8-; of the 67 HTLV-I- patients tested, 46 were CD4+CD8-, 9 were CD4-CD8 , 5 were CD4-CD8- and 7 were CD4+CD8+. Phenotypic studies revealed significant differences in the expression of CD7 and CD25 between virus-positive and -negative groups. Both groups responded poorly to therapy. The median survival of HTLVI+ and HTLV-I- patients was 4 months and 13.5 months, respectively. Apart from the presence of more than 3 extranodal lesions, none of the other clinical features or histologic subtypes had prognostic significance in the entire group or either of the subgroups. This series of peripheral T-cell lymphomas in Taiwan indicate that HTLV-I+ and HTLV-I- patients had many features in common, but presented several distinct differences.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- China/ethnology
- Female
- Humans
- Immunophenotyping
- Leukemia-Lymphoma, Adult T-Cell/epidemiology
- Leukemia-Lymphoma, Adult T-Cell/immunology
- Leukemia-Lymphoma, Adult T-Cell/metabolism
- Lymphoma, T-Cell, Peripheral/epidemiology
- Lymphoma, T-Cell, Peripheral/immunology
- Lymphoma, T-Cell, Peripheral/metabolism
- Male
- Middle Aged
- Taiwan/epidemiology
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Affiliation(s)
- L Y Shih
- Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan, Republic of China
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23
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Abstract
T-lymphoma, including adult T-cell leukemia-lymphoma (ATL) accounted for 75% of non-Hodgkin's lymphoma in the Kyushu district of Japan and for 43% in the nation as a whole. Human T-cell leukemia/lymphoma virus type I (HTLV-I) is closely associated with ATL; however, 11 (7.5%) of 147 patients with ATL were HTLV-I negative. The cumulative percentage incidence of anti-HTLV-I seropositive ATL patients can be simply described by a Weibull model of the typical tear-off type, suggesting that ATL leukemogenesis may be the result of accumulation of approximately five critical events, most likely somatic mutations within HTLV-I-infected T-cells. ATL is still a difficult disease to treat successfully, while peripheral non-ATL T-lymphoma responded to standard chemotherapy in the same way as B-lymphoma. The disease entity of immunoblastic lymphadenopathy (IBL)-like T-lymphoma was also described. Morphological recognition of focal or sheetlike proliferation of atypical neoplastic pale cells and immunoblasts of T-cell nature were important findings for the diagnosis. Major prognostic factors differed greatly among ATL, peripheral non-ATL T-lymphoma and B-lymphoma. Pathology was not associated with treatment outcome and survival in T-cell diseases. These results indicate that the terms ATL, peripheral non-ATL T-lymphoma, and B-lymphoma should be used instead of the all-inclusive term non-Hodgkin's lymphoma, because of differences in cellular origin, clinical features, treatment outcome, prognosis, prognostic factors, chromosomal aberrations, and etiology.
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Affiliation(s)
- M Shimoyama
- Hematology-Oncology and Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan
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