1 / 36

Prognostic Factors in Peripheral T-Cell Lymphoma: International PTCL Study Findings

Explore the clinical applicability and reproducibility of the new WHO classification for PTCL through IPI, histologic, and pathologic factors. International study data, survival rates, and significant prognostic markers are analyzed.

viviand
Download Presentation

Prognostic Factors in Peripheral T-Cell Lymphoma: International PTCL Study Findings

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Peripheral T Cell LymphomaPrognostic Factors Dennis D. Weisenburger, M.D. for the International PTCL Study

  2. Prognostic Factors • Histologic type – ALCL,ALK+ good • International Prognostic Index (IPI) • Clinical features – B symptoms, β2-microglobulin, bulky disease, etc; • Pathologic features – transformed cells, proliferation, EBV infection, etc;

  3. International PTCL Study Purpose To assess the clinical applicability and reproducibility of the new WHO classification of peripheral T-cell and NK-cell lymphomas

  4. Case Selection • Previously-untreated adult patients (>19 yrs) with de novo peripheral T-cell or NK/T-cell lymphoma, • excluding mycosis fungoides and Sézary syndrome • Initial presentation between January 1, 1990, and December 31, 2002 • Consecutive cases representative of the geographic region • Tissue biopsies adequate for diagnosis and classification • Clinical features, treatment and follow-up information

  5. International PTCL Study

  6. International PTCL StudyContributing Sites • North America – Omaha, Vancouver, Bethesda, Boston, Los Angeles, Tucson • Europe – Barcelona, Madrid, London, Oslo, Lyon, Wuerzburg, Bologna • Far East – Seoul, Hong Kong, Singapore, Bangkok, Tokyo, Nagoya, Okayama, Fukuoka

  7. Overall Survival by diagnosis group 1.0 0.9 Test: p<0.001 0.8 0.7 0.6 Proportion 0.5 0.4 0.3 0.2 0.1 0.0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Time Diagnosis CENSOR FAIL TOTAL MEDIAN Adult T-cell leuk/lymph (ATLL) 23 103 126 0.79 Anaplastic large cell lymphoma, ALK- 38 33 71 4.49 Anaplastic large cell lymphoma, ALK+ 63 27 90 . Angioimmunoblastic T-cell lymphoma 87 154 241 2.26 Peripheral T-cell lymphoma 112 218 330 2.01 Generic NK-cell 49 85 134 0.65

  8. Overall Survival by diagnosis group 1.0 0.9 Test: p<0.001 0.8 0.7 0.6 Proportion 0.5 0.4 0.3 0.2 0.1 0.0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 Time Diagnosis CENSOR FAIL TOTAL MEDIAN Enteropathy-type T-cell lymphoma 9 52 61 0.88 Hepatosplenic T-cell lymphoma 3 16 19 0.67 Subcutaneous panniculitis-like T-cell ly 7 5 12 6.19 Primary cutaneous ALCL 20 3 23 .

  9. Overall Survival Nasak NK/T and Nasal-type NK/T and Aggressive/Unclass. NK/T 1.0 0.9 Test: p<0.001 0.8 0.7 0.6 Proportion 0.5 0.4 0.3 0.2 0.1 0.0 0 1 2 3 4 5 6 7 8 9 10 11 12 Time Diagnosis CENSOR FAIL TOTAL MEDIAN Nasal NK/T-cell lymphoma 42 50 92 1.61 NK/T-cell lymphoma, nasal type 5 29 34 0.36 Unclassifiable or Aggressive NK-cell leu 2 6 8 0.23

  10. Survival in PTCL correlates with IPI Scores

  11. Survival in PTCL Correlates with IPI Scores

  12. Consensus Diagnoses

  13. Overall Survival Disease Category: Peripheral T-cell lymphoma by IPI 1.0 0.9 Test: p<0.001 0.8 0.7 0.6 Proportion 0.5 0.4 0.3 0.2 0.1 0.0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Time IPI CENSOR FAIL TOTAL MEDIAN 0/1 40 47 87 5.11 2 38 72 110 2.1 3 19 51 70 1.41 4/5 9 39 48 0.67

  14. Overall Survival Disease Category: Peripheral T-cell lymphoma by Marrow Involvement 1.0 0.9 Test: p=0.027 0.8 0.7 0.6 Proportion 0.5 0.4 0.3 0.2 0.1 0.0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Time Bone marrow involvement CENSOR FAIL TOTAL MEDIAN no 87 159 246 2.11 yes 20 52 72 1.12

  15. Overall Survival Disease Category: Peripheral T-cell lymphoma by T-IPI 1.0 0.9 Test: p<0.001 0.8 0.7 0.6 Proportion 0.5 0.4 0.3 0.2 0.1 0.0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Time T-IPI CENSOR FAIL TOTAL MEDIAN 0 31 33 64 4.68 1 42 76 118 2.1 2 25 65 90 1.46 3/4 8 35 43 0.7

  16. Clinical Features of PTCL-NOS

  17. Overall Survival Disease Category: Peripheral T-cell Lymphoma-NOS by Transformed T-cell counts 1.0 0.9 Test: p=0.0078 0.8 0.7 0.6 Proportion 0.5 0.4 0.3 0.2 0.1 0.0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Time Median transformed T-cell count CENSOR FAIL TOTAL MEDIAN <=30% 37 49 86 3.23 31-70% 33 56 89 2.03 >70% 19 60 79 1.23

  18. Overall Survival Disease Category: Peripheral T-cell Lymphoma-NOS by Ki67+ cells 1.0 0.9 Test: p<0.001 0.8 0.7 0.6 Proportion 0.5 0.4 0.3 0.2 0.1 0.0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Time Ki67+ cells (%) CENSOR FAIL TOTAL MEDIAN <=25% 25 27 52 5.26 26-75% 35 68 103 1.89 >75% 12 44 56 1.36

  19. Overall Survival PTCL-US vs. PTCL-LE 1.0 0.9 Test: p=0.0032 0.8 0.7 0.6 Proportion 0.5 0.4 0.3 0.2 0.1 0.0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Time Diagnosis CENSOR FAIL TOTAL MEDIAN PTCL, unspecified 88 204 292 1.83 PTCL, lymphoepithelioid variant 18 10 28 17.2

  20. Clinical Features of PTCL-US and PTCL-LE

  21. Final Multivariate Analysis of PrognosticFactors in PTCL-NOS

  22. Overall Survival Peripheral T-cell Lymphoma-NOS, and Disease sub-group: Angioimmunoblastic T-cell lymphoma 1.0 0.9 Test: p=0.89 0.8 0.7 0.6 Proportion 0.5 0.4 0.3 0.2 0.1 0.0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Time Diagnosis CENSOR FAIL TOTAL MEDIAN Angioimmunoblastic T-cell lymphoma 87 154 241 2.26 Peripheral T-cell lymphoma-NOS 112 218 330 2.01

  23. Clinical Prognostic Factors of PTCL-NOSvs. Angioimmunoblastic (AI)

  24. Overall Survival Disease Category: Angioimmunoblastic T-cell Lymphoma by IPI 1.0 0.9 Test: p=0.096 0.8 0.7 0.6 Proportion 0.5 0.4 0.3 0.2 0.1 0.0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Time IPI CENSOR FAIL TOTAL MEDIAN 0/1 15 15 30 5.94 2 23 39 62 2.93 3 22 45 67 1.67 4/5 18 44 62 1.37

  25. Overall Survival Disease Category: Angioimmunoblastic T-cell Lymphoma by patient age 1.0 0.9 Test: p=0.036 0.8 0.7 0.6 Proportion 0.5 0.4 0.3 0.2 0.1 0.0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Time Age CENSOR FAIL TOTAL MEDIAN <=60 40 60 100 3.21 >60 47 94 141 1.68

  26. Overall Survival Disease Category: Angioimmunoblastic T-cell Lymphoma by performance status 1.0 0.9 Test: p=0.0022 0.8 0.7 0.6 Proportion 0.5 0.4 0.3 0.2 0.1 0.0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Time Performance status CENSOR FAIL TOTAL MEDIAN Ambulatory 63 85 148 3.1 Non-ambul. 22 67 89 1.37

  27. Overall Survival Disease Sub-group: Angioimmunoblastic T-cell lymphoma by B-symptoms 1.0 0.9 Test: p=0.0046 0.8 0.7 0.6 Proportion 0.5 0.4 0.3 0.2 0.1 0.0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Time B symptoms CENSOR FAIL TOTAL MEDIAN no 36 38 74 4.8 yes 51 116 167 1.62

  28. Overall Survival Disease Sub-group: Angioimmunoblastic T-cell lymphoma by Platelet Count 1.0 0.9 Test: p=0.017 0.8 0.7 0.6 Proportion 0.5 0.4 0.3 0.2 0.1 0.0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Time Platelet Count CENSOR FAIL TOTAL MEDIAN <150K/cmm 19 41 60 1.03 >=150K/cmm 52 90 142 2.4

  29. Overall Survival Disease Category: Angioimmunoblastic by Transformed T-cell counts 1.0 0.9 Test: p=0.14 0.8 0.7 0.6 Proportion 0.5 0.4 0.3 0.2 0.1 0.0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Time Median transformed T-cell count CENSOR FAIL TOTAL MEDIAN <=30% 47 72 119 2.4 31-70% 25 51 76 1.52 >70% 5 13 18 1.76

  30. Overall Survival Disease Category: Angioimmunoblastic T-cell Lymphoma by UNMC-IPI2 1.0 0.9 Test: p<0.001 0.8 0.7 0.6 Proportion 0.5 0.4 0.3 0.2 0.1 0.0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Time UNMC-PI2: Age / Perf. Stat / Plt Ct<150k CENSOR FAIL TOTAL MEDIAN 0 8 7 15 6.03 1 20 32 52 4.26 2 33 45 78 1.68 3 9 37 46 1.37 4 1 9 10 0.51

  31. Overall Survival Disease Sub-group: Anaplastic large cell lymphoma, ALK+ by IPI 1.0 0.9 0.8 Test: p<0.001 0.7 0.6 Proportion 0.5 0.4 0.3 0.2 0.1 0.0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Time IPI CENSOR FAIL TOTAL MEDIAN 0/1 31 4 35 . 2 12 6 18 . 3 4 7 11 0.6 4/5 4 6 10 1.73

  32. Overall Survival Disease Sub-group: Anaplastic large cell lymphoma, ALK+ by Hemoglobin 1.0 0.9 Test: p=0.043 0.8 0.7 0.6 Proportion 0.5 0.4 0.3 0.2 0.1 0.0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Time Hemoglobin CENSOR FAIL TOTAL MEDIAN <11 g/dl 8 6 14 . >=11 g/dl 32 9 41 .

  33. Overall Survival Disease Sub-group: Anaplastic large cell lymphoma, ALK- by IPI 1.0 0.9 Test: p<0.001 0.8 0.7 0.6 Proportion 0.5 0.4 0.3 0.2 0.1 0.0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Time IPI CENSOR FAIL TOTAL MEDIAN 0/1 22 5 27 . 2 8 4 12 . 3 5 11 16 1.71 4/5 2 8 10 0.66

  34. Conclusions • Histologic type is a good predictor of survival • IPI is a good predictor of survival in PTCL-NOS along with % of transformed cells • IPI is a poor predictor of survival in angioimmunoblastic type and better prognostic models are needed • IPI is a good predictor of survival in ALCL,ALK+ (along with Hgb <11g/dl) and ALCL,ALK-

  35. Conclusions • IPI is useful for stratification of most PTCL patients for risk-adapted therapies • New clinical, pathological and molecular genetic predictors are needed to develop more biologically-relevant prognostic models for the various disease entities

More Related