Tcell Phenotype

The T-cell phenotype is an important adverse prognostic factor all by itself. Except for CD30+ anaplastic large T-cell lymphomas, patients with T-cell lymphomas have significantly lower response rates and shorter disease-free and overall survival results than do those with B-cell lymphomas.222380 Gisselbrecht et al.22

showed that patients with non-ALCL T-cell tumors have more disseminated disease, B symptoms, bone marrow involvement, hepatosplenomegaly, and skin involvement than do those with B-cell lymphomas with comparable histologic grades. Furthermore, patients with T-cell lymphomas are more likely to be anemic, and have hypereosinophilia, hypergamma-globulinemia, and increased ^-microglobulin levels. On the other hand, T-ALCL patients are more likely to have localized disease with more favorable IPI scores, with better remission and overall survival rates, than those with non-ALCL T-cell or B-cell lymphomas. Complete remission (CR) rates were 63% for B-NHL, 54% for T-NHL (72% for ALCL and 49% for non-ALCL T-NHL). Five-year survival rates were 52% for B-NHL, and 41% for T-NHL (64% for ALCL and 35% for non-ALCL T-NHL). Five-year event-free survival rates were 42% for B-NHL and 33% for T-NHL. Five adverse factors significantly influenced survival outcome by multivariate analysis: age greater than 60 years, disseminated stage, elevated LDH, performance status, and non-ALCL T-cell lymphoma histology. Coiffier et al.80 compared patients with PTCL and B-cell diffuse large-cell lymphoma, and found that PTCL patients were more likely to have an aggressive presentation with advanced-stage and B symptoms. While there was no difference in response rates between the two groups, patients with T-cell lymphomas had higher relapse rates (43% vs 29%), shorter freedom-from-relapse results (median: 34 months vs outcome not reached), and shorter overall survival rates (median: 42 months vs 50 months). Multivariate analysis demonstrated that the T-cell phenotype was an independent adverse prognostic factor. Comparing patients with ALCL and non-ALCL PTCL, Lopez-Guillermo et al.76 showed that ALCL histology was an important variable predicting favorable results, with CR rates of 69% for those with ALCL and 45% for those with other PTCL; median survival results were 65 months for ALCL and 20 months for other PTCL; and 4-year survival probabilities were 62% for ALCL and 32% for other PTCL. In another series containing 560 cases of aggressive lymphomas (68 patients with T-cell and 492 with B-cell lymphomas) at MD Anderson Cancer Center, the T-cell phenotype was an independent adverse prognostic factor, with T-cell tumors having worse outcomes than B-cell lymphomas of comparable IPI or MD Anderson Prognostic Tumor Score Index. Patients with T-cell lymphomas were more likely to have advanced disease, B symptoms, and other poor prognostic features compared to those with B-cell lymphomas, including elevated LDH or ^-microglobulin levels. However, age and extranodal disease distributions were not significantly different between these two groups. Compared to their B-cell counterparts, T-cell lymphomas had lower CR rates (65% for T-cell and 76% for B-cell lymphomas), shorter 5-year failure-free survival (38% for T-cell and 56% for B-cell lymphomas), and lower over all survival (38% for T-cell and 63% for B-cell lymphomas). Consistent with other studies, patients with ALCL had higher response and survival rates. There was a significantly greater number of deaths in patients with non-ALCL tumors more than 3 years after treatment, many of which were due to late relapses.23

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