Lucia Zoppegno

T-Cell Lymphomas in South America and Europe

Peripheral T-cell lymphomas are a group of rare neoplasms originating from clonal proliferation of mature post-thymic lymphocytes with different entities having specific biological characteristics and clinical features. As natural killer cells are closely related to T-cells, natural killer-cell lymphomas are also part of the group. The current World Health Organization classification recognizes four categories of T/natural killer-cell lymphomas with respect to their presentation: disseminated (leukemic), nodal, extranodal and cutaneous. Geographic variations in the distribution of these diseases are well documented: nodal subtypes are more frequent in Europe and North America, while extranodal forms, including natural killer-cell lymphomas, occur almost exclusively in Asia and South America. On the whole, T-cell lymphomas are more common in Asia than in western countries, usually affect adults, with a higher tendency in men, and, excluding a few subtypes, usually have an aggressive course and poor prognosis. Apart from anaplastic lymphoma kinase-positive anaplastic large cell lymphoma, that have a good outcome, other nodal and extranodal forms have a 5-year overall survival of about 30%. According to the principal prognostic indexes, the majority of patients are allocated to the unfavorable subset. In the past, the rarity of these diseases prevented progress in the understanding of their biology and improvements in the efficaciousness of therapy. Recently, international projects devoted to these diseases created networks promoting investigations on T-cell lymphomas. These projects are the basis of forthcoming cooperative, large scale trials to detail biologic characteristics of each sub-entity and to possibly individuate targets for new therapies.

Risk-Adapted Therapy With Three or Six Cycles of Doxorubicin/Bleomycin/Vinblastine/Dacarbazine Plus Involved-Field Radiation Therapy in Hodgkin Lymphoma, Based on Prognosis at Diagnosis and Early Response: Results From the GATLA Study

BACKGROUND Doxorubicin/bleomycin/vinblastine/dacarbazine (ABVD) plus involved-field radiation therapy (IFRT) is the gold-standard treatment for early and advanced stages of Hodgkin lymphoma (HL). We evaluated the outcomes of patients according to prognosis at diagnosis and over time to determine who achieved complete remission (CR). PATIENTS AND METHODS Treatment-naive patients under the age of 75 years at all stages of HL were eligible. The favorable group (FG) contained patients with stage IA-IIIA disease without bulky areas who achieved CR after the third cycle of ABVD. They received only IFRT at 25 Gy. Patients in the unfavorable group (UG) exhibited stages IIIB and IV HL. The UG also included all patients with bulky disease and the subset of the FG without CR after 3 cycles of ABVD, ie, slow responders (FGSR). The UG received 6 cycles of ABVD plus IFRT at 30 Gy to bulky areas at diagnosis or to those areas remaining positive after the third cycle of ABVD. RESULTS In total, 584 patients were evaluable: 285 of them belonged to the FG, and 299 to the UG. Rates of CR were 98% and 85% for the FG and the UG, respectively (P < .001). Sixty patients in the FG received 6 cycles of ABVD because they had not achieved CR after 3 cycles (ie, the FGSR subgroup). The 5-year event-free survival rate was 89% for the FG, 66% for the FGSR, and 72% for the UG (P < .001). The overall survival at 5 years was significantly better for the FG (98%) than for the FGSR (87%) and the UG (88%; P < .001). CONCLUSION Patients from the FG demonstrated excellent outcomes compared with those from the FGSR and UG, despite receiving less chemotherapy and fewer doses of IFRT.

SAFETY AND EFFICACY ANALYSIS OF ELDERLY PATIENTS TREATED WITHIN THE GATLA HL-05 CLINICAL TRIAL: PET ADAPTED THERAPY AFTER 3 CYCLES OF ABVD FOR ALL STAGES OF HODGKIN LYMPHOMA

tomography (PET) is in the medium and long‐term follow‐up after complete response of Hodgkin lymphoma (HL) and aggressive non‐Hodgkin lymphoma (NHL) with mediastinal involvement at diagnosis. The aim of this study was to verify the reliability of positive PET scans of the mediastinum in following up patients with mediastinal lymphoma, using histological findings as comparison (gold standard). Methods: From January 2002 to February 2016, 483 patients with mediastinal lymphoma were followed after the end of front‐line treatment. Ninety‐six patients with a positive PET scan of the mediastinum underwent computed tomography scanning and surgical biopsy. Results: For 67 HL and 29 NHL, a suspicion of lymphoma relapse was raised based on positive mediastinal PET scanning. Histology confirmed relapse in 63 (48 HL and 15 NHL) of 96 patients (65.6%). In the remaining 33 (34,4%) cases, biopsy revealed: necrotic tissue in 7 patients, fibrosis in 7 patients, thymus in 7 patients, sarcoidosis in 4 patients, tuberculous granulomas in 2 patients, sarcoid‐like lymph node granulomatosis in 1 patient, tuberculosis lymph node granulomatosis in 1 patient, reactive inflammation lymph node in 3 patients, and thymoma in 1 patient. The maximum standardized uptake value was significantly higher among patients who had signs of relapse (63 true positive cases) than among those who stayed in remission (33 false positive cases), the median values being 10.30 (range, 3.2‐25.0) and 5.0 (range, 2.8‐12.6) respectively (P < .05). Conclusions: The analysis on this large series of 96 patients confirms the concept that patients with positive PET in the mediastinum during the follow‐up cannot be considered sufficient for final diagnostic purposes considering that at least one third of the patients can present only benign or, anyway, unrelated neoplastic pictures. Histological confirmation can be safely obtained by various biopsy techniques, the choice of which should be made on the basis of the clinical and imaging study findings case by case.