title: Results of a lymphoblastic leukemia-like chemotherapy program with risk-adapted mediastinal irradiation and stem cell transplantation for adult patients with lymphoblastic lymphoma.
abstract: The therapeutic role of mediastinal radiotherapy and stem cell transplantation (SCT) in lymphoblastic lymphoma (LL) remains controversial. In a risk-oriented design, we adopted a flexible treatment program in which (1) patients with persistent mediastinal abnormality, evaluated by post-induction computed chest tomography, received mediastinal irradiation; and (2) those with persistence of minimal residual disease (MRD), evaluated by MRD analysis of the bone marrow, underwent SCT. Twenty-eight out of 30 patients (T-lineage, n = 24; B-lineage, n = 6) achieved a complete response. Of 21 patients with mediastinal mass, 13 (62%) achieved a complete response after chemotherapy alone, while 6 (28.5%) required additional irradiation. Eleven patients were evaluated for MRD: 6 were negative and 5 positive. On the basis of MRD findings and clinical risk characteristics, 14 patients underwent SCT, 13 received maintenance chemotherapy, and 1 had local radiotherapy. Five patients relapsed. Among the 14 non-irradiated patients with T-LL, the mediastinal recurrence rate was only 7%. After a median follow-up of 3.9 years, 21 patients who responded were alive without recurrence (75%). The projected 5-year survival, disease-free survival, and relapse rate were 72%, 77%, and 18%, respectively. This program induced high remission and survival rates, indicating the feasibility and the benefits potentially associated with a selective, response-oriented policy of mediastinal irradiation and a concurrent MRD-based strategy to assign adult LL patients to SCT.
authors.affiliation: Division of Hematology, Ospedale Civile, Bolzano, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Cortelazzo
authors.forename: Tamara
authors.initials: T
authors.lastname: Intermesoli
authors.forename: Elena
authors.initials: E
authors.lastname: Oldani
authors.forename: Fabio
authors.initials: F
authors.lastname: Ciceri
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rossi
authors.forename: Enrico M
authors.initials: EM
authors.lastname: Pogliani
authors.forename: Daniele
authors.initials: D
authors.lastname: Mattei
authors.forename: Claudio
authors.initials: C
authors.lastname: Romani
authors.forename: Agostino
authors.initials: A
authors.lastname: Cortelezzi
authors.forename: Erika
authors.initials: E
authors.lastname: Borlenghi
authors.forename: Consuelo
authors.initials: C
authors.lastname: Corti
authors.forename: Barbara
authors.initials: B
authors.lastname: Peruta
authors.forename: Orietta
authors.initials: O
authors.lastname: Spinelli
authors.forename: Alessandro
authors.initials: A
authors.lastname: Rambaldi
authors.forename: Renato
authors.initials: R
authors.lastname: Bassan
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008482:Mediastinum / Q000473:pathology / Q000528:radiation effects*; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery*; D061089:Radiotherapy, Image-Guided / Q000379:methods*; D012307:Risk Factors; D033581:Stem Cell Transplantation / Q000379:methods*; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult