The Prognosis of Limited Stage Peripheral T-Cell Lymphoma (PTCL): A Population-Based Analysis and Comparison to Diffuse Large B-Cell Lymphoma (DLBCL)
Notice bibliographique
Résumé
Abstract Abstract 4129 Multiple prospective and retrospective studies have demonstrated an inferior prognosis of peripheral T-cell lymphoma (PTCL), with the exception of ALK-positive anaplastic large cell lymphoma (ALCL). However, there is very little information regarding the prognosis of patients with limited stage PTCL and how it compares to diffuse large B-cell lymphoma (DLBCL). Given disease rarity, patients with limited stage PTCL from two institutions, the British Columbia Cancer Agency (BCCA) and the University of Nebraska Medical Center (UNMC) were evaluated. Methods: Patients >15 y of age diagnosed with limited stage PTCL between 1981 and 2008, excluding NK/T-cell lymphoma, nasal type and cutaneous ALCL, were identified in the BCCA Lymphoid Cancer Database and from the UNMC. Limited stage PTCL was defined as stage I/IIA, non-bulky (< 10cm) and considered ‘minimal' extent ie. potentially encompassable in a radiotherapy field. Results: 62 patients with limited stage PTCL were identified (n=35 BCCA and n=27 UNMC). The main histologic subtype was PTCL-NOS (n= 50, 81%) and the remaining patients had ALCL (ALK-negative (neg) ALCL n=7; ALK-positive (pos) ALCL n=5). 14 cases of PTCL-NOS had cutaneous-only disease. Patients had the following clinical characteristics: M:F 1.2:1, median age 52y (18-98y), stage I 68%, 52% extranodal involvement. The majority of patients were treated with anthracycline-based chemotherapy (81%) and over half (53%) received combined modality therapy. The 5-y time to progression (TTP) was similar in irradiated and non-irradiated patients (p=0.52). The outcome of patients with cutaneous-only limited stage PTCL-NOS was excellent with a 5-y TTP and OS of 86% and 92%, respectively. Similarly, patients with ALK-pos ALCL had a very favourable outcome with only 1/5 patients developing relapsed disease and no deaths to date. The 5-y TTP and OS for the remaining cases of PTCL-NOS and ALK-neg ALCL (n=43) were 61% and 67%, respectively. For the whole cohort, there was a more favourable prognosis in patients with a low risk disease by the stage adjusted International Prognostic Index (L-IPI) score at diagnosis (5-y TTP 0 factor 83%, 1 factor 66%, 2 factors 50%, 3 factors 25%, p=.013 and 5-y OS 0 factor 91%, 1 factor 73%, 2 factors 50%, 3 factors 25%, p<.0001). Late relapses (> 5 y) were uncommon, occurring in 2 patients with PTCL-NOS presenting with skin relapses and 1 patient with ALK-neg ALCL with a nodal relapse. The outcome of limited stage PTCL patients was compared to a cohort of BCCA patients diagnosed with limited stage DLBCL who were treated with CHOP-like chemotherapy (without rituximab) and radiotherapy (n=245) (Campbell BA ASCO 2010). In multivariate analysis, excluding cutaneous-only PTCL-NOS and ALK-pos ALCL, there was an inferior TTP in cases with a T-cell phenotype (HR 2.28, p=.003) and a high L-IPI score (HR 1.57, p<.00001). Similarly, the OS was inferior in patients with a T-cell phenotype (HR 1.90, p=.011) and high L-IPI score (HR 1.78, p<.0001). Surprisingly, all of the patients with relapsed (n=4) or refractory (n=3) disease who were able to receive salvage treatment which included stem cell transplant (SCT), (n=7 allogeneic (n=1), autologous (n=6)) are alive and free of disease a median of 7.2 y from the date of transplant (range 1.4 – 16 years). This is in stark contrast to DLBCL patients (n=6), where all but one patient relapsed and died of lymphoma post-transplant. Conclusion: Limited stage cutaneous-only PTCL-NOS and ALK-pos ALCL as well as selected patients with PTCL-NOS and ALK-neg ALCL with low risk disease have a favourable prognosis. However, the prognosis remains inferior to limited stage DLBCL. Despite an overall higher risk of relapse, the cure rate is high in limited stage PTCL patients who are able to receive a stem cell transplant as part of their salvage therapy for relapsed or refractory disease. Disclosures: No relevant conflicts of interest to declare.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».