Analysis of clinical characteristics and prognosis factors in patients with angioimmunoblastic T-cell lymphoma

Abstract

Objective To investigate the clinical characteristics and prognostic factors of patients with angioimmunoblastic T-cell lymphoma (AITL). Methods From January to December, 2012, a total of 44 AITL patients admitted to Department of Hematology, First Affiliated Hospital of Air Force Medical University were included as study subjects. There were 36 males and 8 females, with age of 18-78 years and median age of 57.5 years. All 44 patients were treated with CHOP (cyclophosphamide + pirarubicin + vincristine + prednisone) regimen, 4 of them were combined with chidamide or bortezomib, 6 of them were combined with autologous hematopoietic stem cell transplantation (auto-HSCT). Clinical characteristics of AITL patients were retrospectively analyzed. Kaplan-Meier method was used to map overall survival (OS) curves of patients treated with and without auto-HSCT. And univariate analysis of OS rate was performed in patients treated without auto-HSCT using Log-rank test. Influencing factors included gender, age, International Prognostic Index (IPI) score, Prognostic Index for peripheral T-cell lymphoma (PIT) score, B symptoms, skin rashes, chest/abdominal cavity effusion, bone marrow involvement, white blood cell count (WBC), hemoglobin (Hb) value, platelet count, serum lactate dehydrogenase (LDH) level, ferritin level, β2-microglobulin (MG) level. Factors with statistical significance in univariate analysis and clinical guiding significance were included in COX proportional hazards regression model for multivariate analysis. The procedure of this study was accordance with the requirement of the revised World Medical Association Declaration of Helsinki in 2008 and 2013. Results ① Among 44 AITL patients, 34 cases (77.3%) had B symptoms. Five cases (11.4%) were Ann Arbor Ⅰ-Ⅱ stage, 39 cases (88.6%) were Ⅲ-Ⅳ stage. Twenty cases (45.5%) had Eastern Cooperative Oncology Group, performance status (ECOG-PS) score 60 years, and the difference was statistically significant (χ2=0.139, P=0.023). The 5-year OS rate in patients with serum β2-MG level 60 years (HR=2.716, P=0.031), bone marrow involvement (HR=2.696, P=0.042), serum β2-MG level≥4 mg/L (HR=4.927, P=0.004) were independent risk factors for AITL prognosis. Conclusions Majority of AITL patients are middle-aged and elderly males, often accompanied by skin rash and serous effusion. The disease was first diagnosed late-stage in Ann Arbor. Age>60 years, bone marrow involvement and serum β2-MG level≥4 mg/L, can be used as independent indicators of poor prognosis of patients treated without auto-HSCT. New drugs such as chidamide and bortezomib could improve curative effect of AITL patients. auto-HSCT coukl effectively improve the OS of patients. Key words: Lymphoma; Immunoblastic lymphadenopathy; Drug therapy; Hematopoietic stem cell transplantation; Prognosis; Angioimmunoblastic T-cell lymphoma; Restrospective studies