Thirty adult patients with lymphoblastic lymphoma were treated with two different programs according to bone marrow findings. Bone marrow positive patients were given an ALL-like program: vincristine, daunorubicin, cyclophosphamide and prednisone for induction of remission, CNS prophylaxis, continuous maintenance for three years and monthly reinductions. Bone marrow negative patients were given a conventional lymphoma program with CHOP-Bleo and limited RT on bulky mediastinum without CNS prophylaxis. The CR rate of the whole group was 54 % (62 % for ALL-treated versus 47 % for lymphoma-treated patients; not significantly different), with a median survival for remitters of 28.5 mos. Relapse-free survival of the whole group was 65 % at 12 and 25 % at 24 mos. Stage IV ALL-treated patients had a median survival of 16.5 versus 10 mos for stage IV lymphoma-treated ones (p = 0.05); the three-years survival was 24 and 10 %, respectively. No patients undergoing CNS prophylaxis (ALL-therapy) had neurological complications or late meningeal relapse. The better prognosis of ALL-treated patients, in spite of bone marrow positivity, argues in favor of an ALL-like therapy in all adult lymphoblastic lymphomas, in terms of CR rate, overall survival, and absence of CNS relapse. This therapy must be adopted irrespective of bone marrow findings, and regardless of how localized the lymphoma appears to be.
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References
1.
AndersonJ.R., WilsonJ.F., JenkinD.T., MeadowsA.T., KerseyJ., ChilcoteR.R., CocciaP., ExelbyP., HusherJ., SiegelS., HammondD.: Childhood non-Hodgkin's lymphoma: the results of a randomized therapeutic trial comparing a 4-drug regimen (COMP) with a 10-drug regimen (LSA2-L2).N. Engl. J. Med., 308: 559–565, 1983.
2.
BagleyC.M., De VitaV.T., BerardC.W., CanellosG.P.: Advanced lymphosarcoma: intensive cyclical combination with cyclophosphamide, vincristine and prednisone.Ann. Intern. Med., 76: 227–234, 1972.
3.
BarcosM.P., LukesR.J.: Malignant lymphoma of convoluted lymphocytes - a new entity of possible T cell type. In: SinksL.F., GoddenT.O. eds. Conflicts in Childhood Cancer. An evaluation of current management, vol. 4, 147–178, Alan R. Liss, New York, 1975.
4.
BennettJ.M., CatovskyD., DanielM.T., FlandrinG., GaltonD.A.G., GralnickH.R., SultanC.: Proposal for the classification of the acute leukemias.French-American-British (FAB) cooperative group. Br. J. Haematol., 33: 451–458, 1976.
5.
BerksonJ., GageR.P.: Calculation of survival rates for cancer.Proc. Staff Meeting Mayo Clin., 25: 270–286, 1950.
6.
BernasconiC., CastelliG., BrusamolinoE., PagnuccoG., IserniaP.: Clinico-pathologic study on 215 cases of non-Hodgkin's lymphomas (NHLs) defined according to the Kiel classification. Abstract of the International Conference on Malignant Lymphoma: current status and prospect. p. 57, Lugano, Switzerland, 1981.
7.
BertazzoniU., BrusamolinoE., IserniaP., ScovassiA.I., TorselloS., LazzarinoM., BernasconiC.: Prognostic significance of terminal transferase and adenosine deaminase in acute and chronic myeloid leukemia.Blood, 60: 685–692, 1982.
8.
BloomfieldC.D., FrizzeraG., Gail-PeczalskaK.J., BrunningR.D., KerseyJ.: Malignant lymphoma, lymphoblastic (MLLB) in the adult.Proc. Am. Soc. Clin. Oncol., 19: 378, 1978.
9.
BoucheixC., DieboldJ., BernadouA., ReynesM., TulliezM., CadiouM., PaczynskyV., CapronF., Bilski-PasquierG.: Lymphoblastic Lymphoma/Leukemia with convoluted nuclei.The question of its relation to the T-cell lineage studied in 13 patients. Cancer, 45: 1569–1577, 1980.
10.
BrusamolinoE., BertazzoniU., IserniaP., GinelliE., ScovassiA.I., ZurloM.G., PievaniP., SacchiN., BernasconiC.: Clinical relevance of terminal transferase and adenosine deaminase in leukemia.Adv. Exp. Med. Biol., 145: 279–303, 1982.
LazzarinoM., MorraE., AlessandrinoE.P., CanevariA., SalvaneschiL., CastelliG., BrusamolinoE., PagnuccoG., IserniaP., OrlandiE., ZeiG., BernasconiC.: Adult acute lymphoblastic leukemia.Response to therapy according to presenting features in 62 patients. Eur. J. Cancer. Clin. Oncol., 18: 813–819, 1982.
18.
LennertK., MohriN., SteinH., KaiserlingE.: The histopathology of malignant lymphoma. Br. J.Haematol., 31(suppl.): 193–203, 1975.
19.
LevineA.M., FormanS.J., MeyerP.R., KoelerS.C., LiebmanH., Paganini-HillA., PockrosA., LukesR.J., FeinsteinD.I.: Successful therapy of convoluted T-lymphoblastic lymphoma in the adult.Blood, 61: 92–98, 1983.
20.
LongJ.C., McCaffreyR.P., EisenbergA.C., MarksS.M., KungP.C.: Terminal deoxynucleotidyl transferase positive lymphoblastic lymphoma.A study of 15 cases. Cancer, 44: 2127–2139, 1979.
21.
MathéG., RappaportH., O'ConnorG.T., TorloniH.: Histological and cytological typing of neoplastic diseases of hematopoietic and lymphoid tissues. In: WHO International Histological Classification of Tumors, No. 14, World Health Organization, Geneva, 1976.
22.
MurphyS.B.: Classification, staging and end results of treatment of childhood non-Hodgkin's lymphomas: dissimilarities from lymphomas in adults.Semin. Oncol., 7: 332–339, 1980.
National Cancer Institute sponsored study of classification of non-Hodgkin's lymphomas: The non-Hodgkin's lymphoma pathologic classification project.Cancer, 49: 2112–2135, 1982.
27.
Navas PalaciosJ.J., ValdesM.D., Montalban PallaresM.A., Gomez de SalazarM.D., Garcia Mar-ciliaA.: Lymphoblastic Lymphoma/Leukemia of T-cell origin: ultrastructural, cytochemical and immunologic features of ten cases.Cancer, 48: 1982–1991, 1981.
28.
RiveraG., AurR.J., DahlG.V., PrattC.B., WoodA., AveryT.L.: Combined VM-26 and cytosine arabinoside in treatment of refractory childhood lymphocytic leukemia.Cancer, 45: 1284–1288, 1980.
VoakesJ.B., JonesS.E., McKelveyE.M.: The chemotherapy of lymphoblastic lymphoma.Blood, 57: 186–188, 1981.
34.
WeinsteinH.J., VanceZ.B., TaffeN., BuellD., CassadyJ.R., NathanD.G.: Improved prognosis for patients with mediastinal lymphoblastic lymphoma.Blood, 53: 687–694, 1979.
35.
WollnerN., BurchenalJ.H., LiebermanP.H., ExelbyP., D'AngioG., MurphyM.L.: Non-Hodgkin's lymphoma in children: a comparative study of two modalities of therapy.Cancer, 37: 123–134, 1976.
