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Abstract
Background:
Treatment of T-cell lymphoblastic lymphoma (T-LBL) with CHOP or CHOP-like chemotherapy has resulted in poor long-term outcomes. High-dose chemotherapy followed by ASCT has been applied for this dreaded disease. However, the efficacy is still controversial. T-LBL is considered the nodal/extranodal presentation of acute lymphoblastic leukemia. Favorable results with VPDL chemotherapy have been reported in the setting of adult lymphoblastic leukemia. We, therefore, treated T-LBL patients with modified VPDL chemotherapy and compared the outcomes with those achieved using upfront ASCT.
Methods:
We retrospectively reviewed the outcomes of 24 T-LBL patients treated either with upfront ASCT (n=11) or VPDL chemotherapy without ASCT (n=13) between January 1996 and October 2005.
Results:
The median follow-up duration for surviving patients was 17 months (range, 5∼109 months). The two-year event-free survival (EFS) rates were 83.1% in the VPDL group and 27.3% in the upfront ASCT group (P=0.008). The two-year overall survival (OS) rates were 83.9% in the VPDL group and 27.3% in the upfront ASCT group (P=0.006).
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Fig. 1
Probability of overall survival in 13 patients treated with VPDL chemotherapy (solid line) and 11 patients with ASCT (dashed line).
Fig. 2
Probability of event free survival in 13 patients treated with VPDL chemotherapy (solid line) and 11 patients with ASCT (dashed line).
Table 1.
Prior chemotherapy regimens in the ASCT arm
∗Patients who underwent VPDL induction treatment (See Table 2). Abbreviations: CODOX-M, cyclophosphamide, doxorubicin, vincristine, cytarabine and methotrexate (iv and intrathecal);CVPD, cyclophosphamide, vincristine, dexamethasone, and doxorubicin; DHAP, cytarabine, cisplatin, and dexamethasone;ESHAP, etoposide methylprednisolone, cytarabine, and cisplatin; IVAC, ifosfamide, etoposide, cytarabin, and methotrexate (intrathecal); Vanderbilt, cyclophosphamide, etoposide, vincristine, bleomycin, methotrexate, and prednisolone;VPDL, vincristine, prednisolone, daunorubicin, and L-asparaginase.
Table 2.
Drugs used in the VPDL protocol
Table 3.
Characteristics of all patients at presentation
Table 4.
Patient outcomes after VPDL or ASCT
| VPDL (n=13) | ASCT (n=11) | P-value | |
|---|---|---|---|
| Response | 0.695 | ||
| CR | 9 (69.2%) | 6 (54.5%) | |
| PR | 2 (15.4%) | 2 (18.2%) | |
| PD | 2 (15.4%) | 2 (18.2%) | |
| NA | - | 1 (9.1%)∗ | |
| Status | 0.006 | ||
| Alive | 10 (76.9%) | 3 (27.3%) | |
| Dead | 2 (15.4%) | 8 (72.7%) | |
| Lost to follow up | 1 (7.7%) | - | |
| Cause of death | 0.625 | ||
| Disease progression | 1 (7.7%) | 3 (37.5%) | |
| Infection | 1 (7.7%) | 3 (37.5%) | |
| Other | - | 2 (25.0%)† | |
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