Results of a lymphoblastic leukemia-like chemotherapy program with risk-adapted mediastinal irradiation and stem cell transplantation for adult patients with lymphoblastic lymphoma.

Sergio Cortelazzo, Tamara Intermesoli, Elena Oldani, Fabio Ciceri, Giuseppe Rossi, Enrico M. Pogliani, Daniele Mattei, Claudio Romani, Agostino Cortelezzi, Erika Borlenghi, Consuelo Corti, Barbara Peruta, Orietta Spinelli, Alessandro Rambaldi, Renato Bassan

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Abstract

The therapeutic role of mediastinal radiotherapy and stem cell transplantation (SCT) in lymphoblastic lymphoma (LL) remains controversial. In a risk-oriented design, we adopted a flexible treatment program in which (1) patients with persistent mediastinal abnormality, evaluated by post-induction computed chest tomography, received mediastinal irradiation; and (2) those with persistence of minimal residual disease (MRD), evaluated by MRD analysis of the bone marrow, underwent SCT. Twenty-eight out of 30 patients (T-lineage, n = 24; B-lineage, n = 6) achieved a complete response. Of 21 patients with mediastinal mass, 13 (62%) achieved a complete response after chemotherapy alone, while 6 (28.5%) required additional irradiation. Eleven patients were evaluated for MRD: 6 were negative and 5 positive. On the basis of MRD findings and clinical risk characteristics, 14 patients underwent SCT, 13 received maintenance chemotherapy, and 1 had local radiotherapy. Five patients relapsed. Among the 14 non-irradiated patients with T-LL, the mediastinal recurrence rate was only 7%. After a median follow-up of 3.9 years, 21 patients who responded were alive without recurrence (75%). The projected 5-year survival, disease-free survival, and relapse rate were 72%, 77%, and 18%, respectively. This program induced high remission and survival rates, indicating the feasibility and the benefits potentially associated with a selective, response-oriented policy of mediastinal irradiation and a concurrent MRD-based strategy to assign adult LL patients to SCT.

Original languageEnglish
Pages (from-to)73-82
Number of pages10
JournalAnnals of Hematology
Volume91
Issue number1
DOIs
Publication statusPublished - Jan 2012

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ASJC Scopus subject areas

  • Hematology

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Cortelazzo, S., Intermesoli, T., Oldani, E., Ciceri, F., Rossi, G., Pogliani, E. M., Mattei, D., Romani, C., Cortelezzi, A., Borlenghi, E., Corti, C., Peruta, B., Spinelli, O., Rambaldi, A., & Bassan, R. (2012). Results of a lymphoblastic leukemia-like chemotherapy program with risk-adapted mediastinal irradiation and stem cell transplantation for adult patients with lymphoblastic lymphoma. Annals of Hematology, 91(1), 73-82. https://doi.org/10.1007/s00277-011-1252-x