Clinical Features And Treatment Outcomes Of Patients With Primary Systemic Anaplastic Large Cell Lymphoma

Background:This study aims to analyze the clinical features and treatment outcomes in patients with primary systemic anaplastic large cell lymphoma (ALCL) in a single institution from China.Patients and methods:A total of106patients were included. There were22patients with stage Ⅰ disease,36patients with stage Ⅱ disease,26patients with stage Ⅲ disease and22patients with stage Ⅳ disease. Patients with early stage disease received chemotherapy followed by radiotherapy, whereas patients with advanced stage disease received primary chemotherapy with or without irradiation to the primary or residual tumor.Results:Of106patients,44were ALK positive ALCL,34were ALK negative ALCL and28were not available for ALK status. Compared with European studies, patients in this study tended to be young, good performance status, early stage, and less extranodal disease. The5-year overall survival (OS) and progression-free survival (PFS) of the whole series were70.5%and55.4%, respectively. The5-year OS and PFS rates were92.7%and79.8%for patients21years old or younger compared with64.0%and47.6%for patients more than21years old (P=0.020for OS, P=0.017for PFS). Patients with CR showed favorable prognosis compared with those with non-CR (P<0.001for OS and PFS). Compared with ALK-ALCL patients, ALK+ALCL showed a superior OS and PFS (P=0.073for OS, P=0.026for PFS).Conclusions:The clinical features of primary systemic ALCL in Chinese patients were different from that of ALCL in Europe; however, survivals were comparable. Patients with early stage disease, age younger than22years old, IPI score of0-1, expression of the ALK protein and CR after therapy had favorable prognosis. Background:Prognosis between patients with ALK-negative anaplastic large-cell lymphoma (ALK-ALCL) and peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) is controversial. The aim of this study is to determine the different clinical features and outcomes of the two entities of peripheral T-cell lymphoma.Patients and methods:Thirty-four patients with ALK-ALCL and73patients with PTCL-NOS between1998and2010were compared. There were22cases of stage I,34cases of stage Ⅱ,28cases of stage Ⅲ and23cases of stage IV disease. Patients received primary chemotherapy with or without radiotherapy.Results:The major clinical features, including age, lactate dehydrogenase, microglobulin, B symptom, extranodal involvement, stage and international prognostic index were comparable between patients with ALK-ALCL and PTCL-NOS. However, compared with patients with ALK-ALCL, patients with PTCL-NOS had a significant male predominance (75%vs53%; P=0.02) and a large proportion of poor performance status (22%vs6%; P=0.039). The3-year overall survival and progression-free survival rates were70.1%and48.3%for ALK-ALCL, compared with31.7%and20.1%for PTCL-NOS (P=0.003for OS, P=0.004for PFS).Conclusions:With similar clinical features, ALK-ALCL showed better treatment outcome than PTCL-NOS. Purpose:The prognostic value of clinical features has been clearly defined in patients with extranodal nasal-type NK/T-cell lymphoma. This study aims to explore new prognostic biomarkers and their clinical relevance.Patients and methods:A total of158patients diagnosed with extranodal nasal-type NK/T-cell lymphoma were retrospectively analyzed. There were116cases of stage IE,38cases of stage HE and4cases of stage IVE disease. Stage IE patients received radiotherapy alone. Stage IE patients with1or more adverse factors of International Prognostic Index (IPI) or paranasal extension and stage HE patients received additional chemotherapy. Stage IVE patients received primary chemotherapy.Results:Patients with elevated beta-2-microglobulin (β-2MG)(>2.2mg/L) at initial diagnosis tended to have more adverse clinical features:B symptom (48%), high lactate dehydrogenase (LDH)(53%), high-risk of IPI score (2-3,18%) and high risk of Korean NK/T-cell Prognostic Index (2-4,43%). The5-year overall survival (OS) and progression-free survival (PFS) rates were74.4%and58.7%for patients with normal β-2MG, compared with61.9%and61.2%for patients with elevated P-2MG (P=0.048for OS, P=0.411for PFS), respectively. Multivariate analysis showed that β-2MG, globulin and regional lymph nodes involvement were independent prognostic factors for survival. The5-year OS rates for patients with no adverse factor, one adverse factor and two and more adverse factors were79.3%,66.4%and53.5%, respectively (P<0.001).Conclusions:Our data suggest that β-2MG is an independent prognostic factor in extranodal nasal-type NK/T-cell lymphoma. Future prognostic model with incorporation of P-2MG should allow for better identification of high risk group in patients with extranodal nasal-type NK/T-cell lymphoma. Objective:The aim of this study was to evaluate the actual dose variability to the targets and organs at risk (OARs) during intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC) and investigate the significance of replanning.Methods:Eleven patients with NPC were included in this study. Each patient had both a planning CT and weekly repeated CT. Simulated plans that were generated by using the same beam configurations mapped to the repeated CT represented the actual delivered doses to the target volumes and OARs. An IMRT replanning was performed with the fifth week CT scan. Doses among the initial plan, the simulated plans and replanning were compared.Results:There were no significant dosimetric differences in the gross tumor volume (GTV), clinical target volume (CTV)1or CTV2for either the simulated plans or the replanning compared with the initial plan. Dosimetric variability of both parotids and brainstem were unique to each individual, and doses to spinal cord were always maintained within the limit. Replanning in the fifth week had significantly decreased the doses delivered to both parotids (p values of Dmean were0.008and0.041for the left and right parotid, respectively), whereas it did not reduce the doses to brainstem and spinal cord. There was no relationship between dose variability and weight loss.Conclusions:There are no significant dose changes for target volumes and spinal cord, and doses to brainstem and both parotids changed individually during NPC IMRT. Replanning helps to spare bilateral parotids.