title: Superior vena cava syndrome and poor performance status at presentation affect survival in mediastinal T-lymphoblastic lymphoma--a single institute experience from India.
abstract: Analysis of mediastinal T-lymphoblastic lymphomas (T-LBL) with T-acute lymphoblastic leukemia has precluded identification of prognostic factors. Newly diagnosed T-LBL patients presenting with mediastinal mass and <20% bone marrow involvement were analyzed for clinical features and outcome. In 55 patients with median age 18 years, 39 (71%) had "B" symptoms, 46 (83.6%) had bulky mediastinal mass and two thirds of patients (n = 36) had superior vena cava syndrome/superior mediastinal syndrome (SVCS/SMS). With acute lymphoblastic leukemia (ALL)-like protocols in majority, complete remission was achieved in 58.2% patients. Estimated 5-year overall survival (OS) and event-free survival (EFS) were 59.8 and 51.6% (median follow-up-35 months). On multivariate analysis, poor Eastern Cooperative Oncology Group (ECOG) performance status (PS > 2; n = 14) affected OS (p = 0.007), while Poor ECOG PS and SVCS/SMS affected EFS (p = 0.008 and p = 0.035, respectively). Combination of baseline-poor PS and presence of SVCS/SMS predicted poor EFS in a prognostic model (HR 6.20; p = 0.002). This is the first outcome study from Asia which has been able to predict baseline ECOG PS and presence of SVCS/SMS as prognostic factors affecting EFS.
authors.affiliation: Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, 110029, India. drtilaktvs@gmail.com
authors.forename: T V S V G K
authors.initials: TV
authors.lastname: Tilak
authors.forename: Vinod
authors.initials: V
authors.lastname: Raina
authors.forename: Lalit
authors.initials: L
authors.lastname: Kumar
authors.forename: Atul
authors.initials: A
authors.lastname: Sharma
authors.forename: M C
authors.initials: MC
authors.lastname: Sharma
authors.forename: Sreenivas
authors.initials: S
authors.lastname: Vishnubhatla
authors.forename: Sameer
authors.initials: S
authors.lastname: Bakhshi
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D008479:Mediastinal Neoplasms / Q000150:complications / Q000401:mortality*; D008875:Middle Aged; D054218:Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000401:mortality* / Q000628:therapy; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012074:Remission Induction; D012720:Severity of Illness Index; D033581:Stem Cell Transplantation; D013479:Superior Vena Cava Syndrome / Q000209:etiology*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents