Outcome of adult T-lymphoblastic lymphoma after acute lymphoblastic leukemia-type treatment: a GOELAMS trial.
OBJECTIVE
T-lymphoblastic lymphoma is an infrequent disease usually treated as T-acute lymphoblastic leukemia with an induction chemotherapy course and sequential reinduction and maintenance chemotherapy. The T-LBL/ALL-GOELAL02 study evaluated the impact of randomized reinduction chemotherapy against intensified conditioning followed by autologous stem cell transplantation (ASCT), after an induction regimen of the type used for acute lymphoblastic leukemia (ALL).


METHODS
Patients with favorable characteristics were randomized to receive chemotherapy or ASCT. Patients with unfavorable characteristics (bone marrow involvement and age over 35 years old or leukocytosis >30 x 10(9)/L or failure to achieve medullar complete remission [CR] after one induction course) received a second induction course and ASCT.


RESULTS
Among 45 patients, the CR rate was 71% after induction and 87% after a second induction course. Within the group of 27 patients with favorable characteristics, ten received ASCT and 17 chemotherapy. Ten patients in the group with unfavorable characteristics received ASCT. The 7-year overall survival and progression-free survival rates were 64 and 65%, respectively. Surprisingly, CR obtained after only two induction courses was associated with improved overall survival (p=0.04). None of the known prognostic factors significantly affected survival.


CONCLUSIONS
Randomized maintenance or high-dose therapy (HDT) and ASCT or intensified HDT according to initial presentation gave similar overall and relapse-free survival rates. However, HDT allowed sparing of mediastinal irradiation and shortened treatment duration.
Haematology Department, Angers.
Mathilde
M
Hunault
Malgorzata
M
Truchan-Graczyk
Denis
D
Caillot
Jean-Luc
JL
Harousseau
Serge
S
Bologna
Chantal
C
Himberlin
Denis
D
Guyotat
Christian
C
Berthou
Philippe
P
Casassus
Laurence
L
Baranger
Marie-Christine
MC
Béné
Norbert
N
Ifrah
Emmanuel
E
Gyan
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000097:blood / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D012074:Remission Induction; D033581:Stem Cell Transplantation; D015996:Survival Rate; D014182:Transplantation, Autologous