T-cell non-Hodgkin Lymphoma Research Articles

HL-401: Long-Term Follow-Up of Patients with Non-Hodgkin and Hodgkin Lymphomas with a Modified BEAM Conditioning Regimen

Auto BMT has been performed in Non-Hodgkin Lymphomas (NHL) and Hodgkin Lymphoma (HL) patients with a poor prognosis using a modified BEAM conditioning regimen in a tertiary referral center in Mexico City. A retrospective analysis of patients with the diagnosis of T-cell NHL (anaplastic T-cell NHL, cytotoxic T-cell NHL, centrofacial T-cell NHL, angioimmunoblastic T-cell NHL, NOS T-cell NHL), and MCL in first complete remission and diffuse large B cell NHL in chemosensitive relapse, as well as HL patients (nodular sclerosis, mixed cellularity, lymphocyte depleted, and non-specified disease) in chemosensitive relapse underwent autologous transplantation between January 1990 and December 2018. G-CSF at 10 mcg/kg/day 5–6 days and cell collection was conducted on an ambulatory basis. We avoided using cryopreservation of blood products in order to reduce costs. Patients were conditioned with high-dose BEAM chemotherapy (Carmustine BCNU IV, 300 mg/m2 infused over 3 hours on day 3, Cytosine Arabinoside IV, 1000 mg/m2 in two doses on day 2, Etoposide IV, 800 mg/m2 in three doses on days 2 and 3 and Melphalan PO, 140 mg/m2 on day 1). Prophylactic antibiotics were administered. Thirty nine (61%) patients were transplanted: 42 had NHL and 19 had HL. The patients' age ranged between 17 and 64 years at diagnosis (median: 31 years); 17 were female (34.5%), and 40 were male (65.5%). The estimated 5-year survival was 65% (91% in HL and 78% in NHL) and disease-free survival 51%, values similar to other published series. T-cell lymphomas were analyzed separately, yielding a DFS and OS of 73% for both. Patients with a negative PET scan after transplant had a greater OS than those with a positive scan (74% vs. 35%, respectively); this difference was statistically significant (log rank=0.0001). These results are higher than those reported by other groups. In summary, patients with high-risk lymphoma can be salvaged with HSCT with a modified conditioning regimen that minimizes cost and time in developing countries.

PRIMARY MANIFESTATION OF ADULT T-CELL NON-HODGKIN LYMPHOMA ON THE TONGUE: CASE REPORT

Adult T-cell non-Hodgkin lymphoma is a rare malignant neoplasm that may be associated with human T- cell leukemia virus (HTLV) infection. Primary extranodal manifestations in oral cavity are uncommon, making early diagnosis difficult and consequently affecting disease prognosis. The aim of this study is to report a case of adult T-cell non-Hodgkin lymphoma associated with HTLV virus manifesting as a primary lesion on the tongue. A 55-year-old female patient presented an ulcerated lesion with hardened raised edges on the side of the tongue with characteristics similar to oral squamous cell carcinoma. Histopathological analysis demonstrated a mucosa with intense lymphocytic infiltrate and acanthosis of lining epithelium. Other complementary tests were requested, among which HTLV-positive serology was observed. Following the diagnosis of HTLV-associated T-cell non-Hodgkin lymphoma, antiviral therapy for infection reduction and neoplasia control was initiated. The patient continues treatment and follow-up, without clinical manifestations of disease. Adult T-cell non-Hodgkin lymphoma is a rare malignant neoplasm that may be associated with human T- cell leukemia virus (HTLV) infection. Primary extranodal manifestations in oral cavity are uncommon, making early diagnosis difficult and consequently affecting disease prognosis. The aim of this study is to report a case of adult T-cell non-Hodgkin lymphoma associated with HTLV virus manifesting as a primary lesion on the tongue. A 55-year-old female patient presented an ulcerated lesion with hardened raised edges on the side of the tongue with characteristics similar to oral squamous cell carcinoma. Histopathological analysis demonstrated a mucosa with intense lymphocytic infiltrate and acanthosis of lining epithelium. Other complementary tests were requested, among which HTLV-positive serology was observed. Following the diagnosis of HTLV-associated T-cell non-Hodgkin lymphoma, antiviral therapy for infection reduction and neoplasia control was initiated. The patient continues treatment and follow-up, without clinical manifestations of disease.

Gastrointestinal lymphoproliferative lesions: a practical diagnostic approach.

SummaryThe gastrointestinal tract (GI) is the primary site of lymphoproliferative lesions, spanning from reactive lymphoid hyperplasia to overt lymphoma. The diagnosis of these diseases is challenging and an integrated approach based on clinical, morphological, immunohistochemical and molecular data is needed. To reach to confident conclusions, a stepwise approach is highly recommended. Histological evaluation should first assess the benign versus neoplastic nature of a given lymphoid infiltrate. Morphological and phenotypic analyses should then be applied to get to a definite diagnosis.This review addresses the key histological features and diagnostic workup of the most common GI non-Hodgkin lymphomas (NHLs). Differential diagnoses and possible pitfalls are discussed by considering distinct groups of lesions (i.e. small to medium B-cell NHLs; medium to large B-cell NHLs; T-cell NHLs; and mimickers of Hodgkin lymphoma). The key clinical and epidemiological features of each entity are also described.

Immunohistochemical profile and distribution of Non-Hodgkin and Hodgkin lymphoma - An experience in a medical college hospital in Tamil Nadu

AbstractContext: The subtype distribution of non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) shows distinct pattern across geographic regions. This study analyzes the subtype distribution of lymphomas based on the WHO 2017 Classification using immunohistochemistry (IHC) and also investigates the IHC profile of various lymphomas. Subjects and Methods: Fifty consecutive cases of lymphoma diagnosed in the department of pathology in a medical college hospital were included in the study. The cases were subcategorized using panels of IHC based on the light microscopic findings. Results: The ratio of NHL to HL was 4.5:1. B-NHL formed 78.5% (n = 32), while T-cell NHL formed 21.5% (n = 9). Among the B-NHL cases, small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL) (34.4%) was the most common, followed by diffuse large B-cell lymphoma, NOS (DLBCL NOS) (31.2%), follicular lymphoma (FL) (25%), and then by Burkitt's lymphoma (BL) constituting 9.4%. Peripheral T-cell lymphoma, NOS (PTCL NOS) (14.1%) (n = 6) was the most common T-cell NHL, followed by angioimmunoblastic T-cell lymphoma (4.8%), and then by lymphoblastic lymphoma (T-LL) (2.4%). Among Hodgkin lymphomas, mixed cellularity (MC) accounted for 55.6% (n = 5), lymphocyte depleted type (LD) being 22.2%, while nodular lymphocyte predominant and lymphocyte rich type each constituted 11.1%. Conclusion: SLL/CLL was the most common lymphoma reported in the study followed by DLBCL which is different from the other Indian studies where DLBCL was most common. CD5 expression was noted in 21% of FLs. PTCL-NOS constituted the most common T-cell lymphoma and MC, the most frequent subtype of classical HL. Further replication studies including larger sample size will be needed to understand the difference in subtype distribution in our population.

Navigating Women's BIA-ALCL Information Needs: Group Seminars May Offer an Opportunity to Empower the Patient-Surgeon Team.

Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is a T-cell non-Hodgkin's lymphoma that has been linked to textured breast implants, and is an emerging concern within the plastic and reconstructive surgery community. Many surgeons are struggling with how best to inform their patients and manage BIA-ALCL care without overwhelming their standard clinical practice. Five educational group seminars were held for 53 patients. A thematic analysis of the field notes taken at each seminar was conducted to identify recurring patient and surgeon behaviors. The thematic analysis identified 5 key themes: seeking, amplifying, framing, trusting, and empowering. Seeking describes the knowledge sought by patients and their varying engagement in their care. Amplifying underlines how the emotionally charged topic of BIA-ALCL impacted patient and surgeon behaviors. Framing presents surgeon efforts to help patients understand the risk level of BIA-ALCL. Trusting addresses the ways BIA-ALCL has impacted patient trust in the medical community and the mechanisms to rebuild this trust. Empowering outlines surgeon efforts to engage patients in shared decision-making. Herein is presented a possible framework for efficient BIA-ALCL patient education that can be adapted to different surgical practices. Lessons learned are: (1) patients want information on BIA-ALCL's clinical features and prophylactic implant removal; (2) BIA-ALCL discussions are emotionally charged and surgeons must remain cognizant of group dynamics and that the physician-patient power differential may impact patient decision-making; (3) patient trust has been strained but can be restored; and (4) patient responses to BIA-ALCL are variable and subjective; thus, surgeons should emphasize patient-centered care.

Immunotherapy for T-Cell ALL and T-Cell NHL

Immunotherapy for T-Cell ALL and T-Cell NHL

Different roles of surveillance positron emission tomography according to the histologic subtype of non-Hodgkin's lymphoma.

Background/AimsAlthough the use of surveillance 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is discouraged in patients with diffuse large B-cell lymphoma, its usefulness in different subtypes has not been thoroughly investigated.MethodsWe retrospectively evaluated 157 patients who showed positive results on surveillance FDG-PET/CT every 6 months following complete response for up to 5 years. All of the patients also underwent biopsies.ResultsSeventy-eight (49.6%) of 157 patients had true positive results; the remaining 79 (50.3%), including eight (5.1%) with secondary malignancies, were confirmed to yield false positive results. Among the 78 patients with true positive results, the disease in seven (8.9%) had transformed to a different subtype. The positive predictive value (PPV) of FDG-PET/CT for aggressive B-cell non-Hodgkin’s lymphoma (NHL) was lower than that for indolent B-cell or aggressive T-cell NHL (p = 0.003 and p = 0.018, respectively), especially in patients with a low/low-intermediate international prognostic index (IPI) upon a positive PET/CT finding. On the other hand, indolent B-cell and aggressive T-cell NHL patients showed PPVs of > 60%, including those with low/low-intermediate secondary IPIs.ConclusionsThe role of FDG-PET/CT surveillance is limited, and differs according to the lymphoma subtype. FDG-PET/CT may be useful in detecting early relapse in patients with aggressive T-cell NHL, including those with low/low-intermediate risk secondary IPI; as already known, FDG-PET/CT has no role in aggressive B-cell NHL. Repeat biopsy should be performed to discriminate relapse or transformation from false positive findings in patients with positive surveillance FDG-PET/CT results.

Predicting worse survival for newly diagnosed T cell lymphoma based on the decreased baseline CD16\u2212/CD16\u2009+\u2009monocyte ratio

T cell non-Hodgkin lymphoma (T-NHL) is highly invasive and heterogeneous without accurate prognosis prediction. We proposed peripheral CD16−/CD16 + monocytes the additional indicators for T-NHL prognosis. We prospectively recruited 31 T-NHL patients without previous treatment. The CD16−/CD16 + monocyte ratio before chemotherapy was calculated and regular follow up was performed to calculate prognostic prediction value. Tumor associated macrophages (TAM) in tumor tissue were counted and transcriptome sequencing of CD16− and CD16 + monocytes was applied to explore potential mechanisms. We found that T-NHL patients had higher ratio of total monocytes especially the CD16 + monocytes along with a decreased ratio of CD16−/CD16 + monocytes, compared to the health control. The 1-year overall survival rate was 0.492 and 0.755 for CD16− monocyte/CD16 + monocyte ratio of <11 and ≥11(p < 0.05), respectively. The peripheral CD16−/CD16 + monocyte ratio was significantly relevant with the pathological CD68/CD206 macrophage ratio. The differently expressed genes in CD16− and CD16 + monocytes from T-NHL patients were mainly involved in signaling molecules related to tumor microenvironment. Pro-tumor genes were identified in monocyte subsets especially in CD16 + monocytes. In conclusion, the ratio of peripheral CD16−/CD16 + monocyte helps to stratify the prognosis of T-NHL. The relatively increased CD16 + monocytes may contribute to the pro-tumor microenvironment of T-NHL.

Aberrant CD3-Positive, CD8-Low, CD7-Negative Lymphocytes May Appear During Viral Infections and Mimic Peripheral T-Cell Lymphoma.

Flow cytometry (FC) facilitates diagnosis of peripheral T-cell non-Hodgkin lymphoma (T-NHL), but overlapping features between reactive and neoplastic T-cell proliferations often hamper a rapid assessment. One hundred forty peripheral blood samples submitted to diagnostic FC for T-cell immunophenotyping were retrospectively analyzed. A T-cell population with a conspicuous aberrant surface epitope expression pattern was observed in 18 cases and diagnostic follow up was performed. The aberrant T-cell population exhibited a low scatter profile, a CD7-negative/low, CD8-low and CD3-positive immunophenotype, and monoclonal T-cell receptor expansion. T-NHL was ruled out by follow up in all cases. Epstein-Barr virus infection was diagnosed in 12 cases, cytomegalovirus infection in three cases; one patient had been vaccinated. The irregular subpopulation disappeared spontaneously within days or weeks. We describe a novel peripheral blood T-cell subpopulation with a low light scatter and CD8-low, CD7-negative/low and CD3-positive marker expression profile, which indicates reactive T-cell expansion in patients who present with peripheral lymphadenopathy and/or B symptoms.

Clinical Characteristics and Prognostic Factors of Children with Non-Hodgkin's Lymphoma of Different Pathological Subtypes

To investigate the clinical characteristics and prognostic factors of children with non-Hodgkin's lymphoma of different pathological subtypes. Ninety-three patients with newly-diagnosed childhood NHL in Fujian Medical University Union Hospital from March 2011 to September 2017 were salected. The diagnosis of patients was performed according to the World Health Organization classification of tumors 2008 ys. The chemotherapy regimens were based on immune phenotype, pathological type and clinical stages. The 5-years event-free survival rate (EFS) were calculated and analyzed by Kaplan-Meier method, and difference of survival rate between groups were compared. The possible factors influencing 5-years EFS was analyzed using Cox proportional hazards model. Among the 93 patients, male to female ratio was 2.88:1, the median age at diagnosis was 6 (0.9 to 13) years old. According to pathological types, Burkitt's lymphoma was the most common, follow by ALK+ anaplastic large-cell lymphoma (ALCL) and lymphoblastic lymphoma (LBL). Clinically, the most common initial symptoms observed at diagnosis were swelling of superficial lymph node, and abdominal pain and abdominal mass in mature B-cell neoplasms, and the swelling of mediastinal lymph nodes in LBL, and hemophagocytic syndrome (HPS) in mature T-cell and natural killer cell NHL. Seventy-nine cases completed 2 courses of induction chemotherapy, and 64 cases (81.01%) reached complete remission (CR). In a median follow up for 32.5(1.0-88.5) months, ten patients (11.90%) relapsed, the median relapsed time was 5.7(3.4-15.7) months. 5-year EFS rate in 84 patients received standardized treatments were (77.1±4.9)%. As compared with lymphoblastic lymphoma and extranodal NK/T cell lymphoma, there was a trend towards better outcomes in B-LBL, and mature B-cell neoplasms and ALK+ ALCL showing 5-year EFS was (86.2±5.2)% and (93.8±6.1)% vs (53.3%±16.1)% and (28.6±17.1)%. Univariate analysis showed that B symptoms, LDH level, secondary HLH, immunophenotype, pathological subtypes, clinical stage and whether reached CR after induction chemotherapy significantly correlated with prognosis. Cox regression analysis showed that no CR after 2 courses was an independent unfavorable prognostic factor (HR0.001, 95%CI: 0.000-0.122). The clinical characteristics and prognosis of patients with NHL of different pathological types are different. Whether reached CR after induction chemotherapy is the imdependent risk factor affecting the prognosis.

Primary dural lymphomas: Clinical presentation, management, and outcome

Clinical experience is limited for primary central nervous system (CNS) lymphoma that arises from the dura mater, which is denoted with the term primary dural lymphoma (PDL). This study was aimed at determining the relative incidence, presentation, and outcomes of PDL. The institutional databases of the Divisions of Neuro-Oncology at the Massachusetts General Hospital and the Yale School of Medicine were retrospectively searched for patients with primary CNS lymphoma. Patients with pathologically confirmed dural lymphoma and no evidence of primary cerebral or systemic involvement were identified. Clinical data, diagnostic findings, treatments, and outcomes were recorded. A total of 20 patients with PDL were identified, and they represented 6.3% of the individuals with primary CNS lymphomas (20 of 316). Histopathological examination of PDL revealed the following underlying subtypes: diffuse large B-cell lymphoma (10 of 20 patients), marginal zone lymphoma (6 of 20), follicular lymphoma (2 of 20), undefined B-cell non-Hodgkin lymphoma (1 of 20), and T-cell non-Hodgkin lymphoma (1 of 20). On imaging, all tumors appeared as extra-axial masses with avid contrast enhancement and mostly mimicked meningioma. The median apparent diffusion coefficient value was 667±26mm2 /s. Cerebrospinal fluid analyses and symptoms were nonspecific, and the diagnosis rested on tissue analysis. Therapeutic approaches included surgery, radiotherapy, and chemotherapy. The median overall survival was not reached after 5years. Three patients were deceased at database closure because of tumor progression. The extent of tumor resection correlated positively with overall survival (P=.044). PDL is a rare variant of primary CNS lymphoma that can be radiographically mistaken for meningioma. The outcome is excellent with multimodality treatment, and aggressive surgery may convey a survival advantage in select cases.

Clinicopathological characteristics of non-Hodgkin lymphoma in Shandong province: analysis of 2 886 cases

Objective To investigate the clinicopathological characteristics of non-Hodgkin lymphoma (NHL) in Shandong province. Methods The clinicopathological data of 2 886 NHL cases in Shandong Cancer Hospital from January 2002 to December 2017 were retrospectively analyzed, the clinicopathological characteristics of patients were summarized and compared with other regions in China and abroad. Results The median age of all NHL cases was 52 years old (4-90 years old), and the ratio of male to female was 1.57∶1. The subtypes distribution analysis revealed that B-cell NHL (B-NHL) accounted for 66.7% (1 925 cases) of all cases and T-cell NHL (T-NHL) accounted for 27.3% (788 cases) of all cases. The common subtypes were diffuse large B-cell lymphoma (36.0%, 1 039/2 886), NK/T-cell lymphoma (8.8%, 254/2 886), follicular lymphoma (8.2%, 237/2 886) and peripheral T-cell lymphoma (7.4%, 214/2 886). Of all the cases, the nodal lymphomas accounted for 45.8% (1 322 cases) and the extra nodal lymphomas accounted for 54.2% (1 564 cases); there were 389 patients (13.5%) with stage Ⅰ, 678 patients (23.5%) with stage Ⅱ, 975 patients (33.8%) with stage Ⅲ, and 722 patients (25.0%) with stage Ⅳ. The distribution of NHL subtypes in Shandong province was consistent with the domestic multicenter study. However, T-NHL subtype ratio was significantly higher than the foreign studies. Conclusions The overall incidence of NHL in Shandong province of China is dominated by middle-aged people, and the proportion of B-NHL is higher than that of T-NHL. The distribution of NHL subtypes in Shandong province of China are different from those in the European and American countries, but are roughly consistent with the domestic multicenter study. Key words: Lymphoma, non-Hodgkin; Diagnosis; Pathological classification; Immunophenotyping

Long Term Outcomes of Patients with Aggressive T-Cell Non-Hodgkin Lymphoma Undergoing Allogeneic Stem Cell Transplantation: Retrospective Results from Single Center.

<h3>Introduction</h3> Peripheral T-cell lymphomas (PTCL) comprise 15-20% of adult non-Hodgkin lymphoma and have a poor prognosis; 5-year survival is less than 30% for the most aggressive subtypes. Allogeneic HCT (allo-HCT) is offered to eligible patients as a potentially curative modality in the salvage setting or in high risk patients to consolidate an initial response to frontline therapy. <h3>Objective</h3> To report clinical outcomes derived from large sample size and long-term follow up data. <h3>Methods</h3> We retrospectively reviewed medical records of 87 consecutive patients with PTCL who underwent allo-HCT at City of Hope from January 2000 to June 2018. Baseline patient demographic, treatment, and disease characteristics were summarized by descriptive statistics. Overall survival (OS) and progression-free survival (PFS) were evaluated by Kaplan-Meier curves and the log-rank test. Cumulative incidences of time to relapse and time to non-relapse mortality (NRM) were calculated with relapse and NRM as competing risks. Cumulative incidences of acute and chronic GVHD were calculated as time to onset of GVHD with relapse and death as competing events for GVHD. <h3>Results</h3> Median age at allo-HCT was 49 (range 2-70) years. Histologies were PTCL-NOS (n=21); transformed CTCL (n=19); NK TCL (n=17); AITL (n=15), ALCL (n=7); γδTCL (n=6) and other rare subtypes (n=2). No patients had a prior auto transplant. 42 patients (48%) had myeloablative conditioning; FTBI-based (n=39), or BEAM regimen (n=3). 45 patients (52%) had reduced intensity conditioning with a fludarabine/melphalan based regimen in 39. Sibling HCT was done in 47 (54%) patients. MUD HCT was done in 36 (41%); donors were fully HLA matched for 15 (17%) patients and mismatched in 21 (24%); 4 (5%) got haploidentical HCT. The most common GVHD prophylaxis was tacrolimus/sirolimus (n=54). Stem cell source was PBSC in 77 (88%), bone marrow in 5 (6%), and cord blood in 5 (6%) patients. At allo-HCT 25 (29%) patients were in complete remission, 25 (29%) in partial remission, 22 (25%) with induction failure and 14 (16%) with relapsed disease. The median follow-up among survivors was 6.9 years (range 1.1-15.5). The 5- and 10-year PFS was 47% (95% CI: 36%-58%) and 38% (95% CI: 26%-50%), respectively. The 5- and 10-year OS was 53% (95% CI: 41%-63%) and 42% (95% CI: 29%-54%), respectively (Fig.1). At day 100 after allo-HCT, the rate of acute GVHD grade II-IV was 41% (95% CI: 30%-51). Chronic GVHD rates at 3 years were 62% (95% CI: 51%-72%), with extensive GVHD of 55% (95% CI: 44%-65%). On univariate analysis, age (> 60 or not), sex, TBI-based conditioning, donor type, stem cell source or remission status prior to allo-HCT did not predict for OS. <h3>Conclusions</h3> This large single-institution series with a long-term follow-up on allo-HCT outcomes in patients with high-risk, aggressive T-cell NHL shows encouraging survival outcomes for these patients with limited treatment options.

Vorinostat and Combination Chemotherapy Before Donor Stem Cell Transplantation for the Treatment of Relapsed Aggressive B-cell or T-cell Non-Hodgkin Lymphoma

Vorinostat and Combination Chemotherapy Before Donor Stem Cell Transplantation for the Treatment of Relapsed Aggressive B-cell or T-cell Non-Hodgkin Lymphoma

Practical Approach to the Histologic Diagnosis of Gastrointestinal Lymphomas Through the First-line Marker Battery of CD20, CD3, CD30, and Epstein-Barr Virus-encoded RNAs.

The gastrointestinal (GI) tract is a prevalent site for extranodal lymphomas. Some subtypes of GI tract lymphomas are aggressive and have dismal clinical outcomes. Therefore, prompt histopathologic detection of such types can be very important. We thus introduce a practical approach in the histopathologic diagnosis of GI lymphomas according to the revised World Health Organization (WHO) classification. When lymphocyte proliferation is found in the GI tract, a stepwise approach can help narrow down the differential diagnoses. When considering subtype incidence, macroscopic findings, and microscopic patterns, applying a first-line marker battery of CD20, CD3, CD30, and Epstein-Barr virus-encoded RNAs can effectively narrow down the top differential diagnoses at the initial step. Generally, the most common subtype among GI tract lymphomas is B-cell non-Hodgkin lymphoma identified by CD20 expression, followed by T-cell and NK-cell non-Hodgkin lymphomas identified by the CD3 expression, and some subtypes are defined by Epstein-Barr virus infection or CD30 expression. Macroscopically, lymphomas present as various gross types, such as large masses, small lesions, superficial and shallow lesions, polyp-like or polyposis-like features, or ulcer/necrosis/perforation. Microscopically, large pleomorphic cells or small to medium-sized tumor cells grow with various architectures and tumor microenvironments. Incorporation of macroscopic and microscopic features and the stepwise immunophenotyping may be a practical approach to the differential diagnosis of aggressive lymphoma, indolent/low-grade lymphoma, or benign to indolent lymphoproliferative disease. Exceptions always exist; this approach focuses on the relatively prevalent circumstances of lymphomatous lesions initially encountered in the GI tract.

T-Cell Lymphoma: Clinical Presentation and Therapeutic Outcome from a Tertiary Care Hospital in Eastern India

T-cell non-Hodgkin’s lymphoma (T-NHL) is rare and heterogeneous disease. There is a marked difference in biology, clinical presentation and therapeutic outcomes worldwide. This is a retrospective study from May 2014 to May 2018. Patients with established T-NHL after diagnosis were included, and their clinical presentation and therapeutic outcomes were analysed in detail. In the above-mentioned period, a total of 248 NHL patients were evaluated out of which 32(12.9%) had T-NHL. The median age of presentation was 37 years (range 7–69 years), with a male predominance 26 (81.2%). Most common presentation was painless lymphadenopathy 18 (56.2%). B symptoms were found in 8 (25%). In the Ann Arbor staging system, most T-NHL presented with either Stage III or IV with 12 (37.5%) patients respectively. Among the T-NHL subtypes, peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS), 20 (62.5%); anaplastic large-cell lymphoma (ALCL), 7 (21.9%); angioimmunoblastic T-cell lymphoma (AITL), 3 (9.4%); cutaneous T-cell lymphoma (CTCL), 2 (6.2%); and prolymphocytic leukaemia (PLL), 1 (3.1%) were diagnosed. Therapeutic options for T-NHL used were cyclophosphamide, doxorubicin, vincristine, prednisolone and etoposide (CHOEP) based. Response assessment after 6 cycles showed complete response (CR) and partial response (PR), 13 (40.6%) and 16 (50%), respectively. Three patients died during therapy. The progression-free survival (PFS) at 18 months was 57.34%. In our study, 12.9% patients had T- NHL among all patients of lymphoma. Lymphadenopathy and advanced stage disease were most common presentations. Chemotherapy outcomes showed CR in 40.6% of patients and PFS at 18 months was 57.34%.

CPI-613 in Combination With Bendamustine in Patients With Relapsed/Refractory T-Cell Non-Hodgkin Lymphoma

CPI-613 in Combination With Bendamustine in Patients With Relapsed/Refractory T-Cell Non-Hodgkin Lymphoma

Antibody-drug Conjugates Change the Standard of Care for Both B- and T-cell Non-Hodgkin Lymphoma

Antibody-drug Conjugates Change the Standard of Care for Both B- and T-cell Non-Hodgkin Lymphoma

Gemcitabine, dexamethasone, and cisplatin salvage in relapsed lymphomas: A single institutional experience

Introduction: Salvage chemotherapy followed by autologous stem cell transplantation is the standard of care in relapsed lymphoma. The optimal regimen for salvage is not defined. The combination of gemcitabine, dexamethasone, and cisplatin (GDP) is an outpatient regimen which can lead to high response rates with minimal toxicity.Methods: This was a retrospective study of all patients with relapsed diffuse large B-cell lymphoma, Hodgkin's lymphoma (HL), or peripheral T-cell lymphoma who received GDP as salvage chemotherapy between January 2014 and December 2017. Baseline characteristics, treatment details, toxicity, and outcomes including survival were analyzed.Results: We included 39 patients in the study. The most common indication was relapsed high grade B-cell non-Hodgkin's lymphoma (NHL) (n = 20, 51%) followed by HL (n = 10, 25%) and T-cell NHL (n = 9, 24%). The median age was 46 years (range, 17–62 years); 27 patients (69%) were males. The most common Grade 3/4 toxicity was thrombocytopenia (n = 7, 18%) followed by neutropenia (n = 5, 12%) and anemia (n = 3, 8%). Overall response rate for GDP was 64% (complete response-10%, partial response-54%). Of the 30 patients who were eligible for transplant, 16 (57%) could undergo transplant. At a median follow-up of 12 months, the 2-year overall survival (OS) and progression-free survival (PFS) were 50% and 38% for the entire patient cohort. The 2-year OS was 68% in the patients who underwent transplant and 38% in the non-transplant group. The 2-year PFS was 58% in those who underwent transplant and 18% in those who did not undergo transplant.Conclusions: GDP is an effective and well-tolerated salvage regimen in relapsed lymphoma. The regimen is feasible in a resource-limited setting.

A diagnostic surprise in a breast lump: Primary T-cell non-Hodgkin's lymphoma

Unilateral primary breast lymphoma (PBL) is a rare entity usually occurring in elderly women and when present is of B-cell variety. We present a premenopausal female who presented with an asymptomatic breast lump whose initial investigations were inconclusive but for final histopathology and immunohistochemistry that revealed a non-Hodgkin's PBL of T-cell variety that is extremely rare. A detailed review has been presented.