ObjectiveTo investigate the clinical characteristics and prognostic factors of patients with angioimmunoblastic T-cell lymphoma (AITL).
MethodsFrom January to December, 2012, a total of 44 AITL patients admitted to Department of Hematology, First Affiliated Hospital of Air Force Medical University were included as study subjects. There were 36 males and 8 females, with age of 18-78 years and median age of 57.5 years. All 44 patients were treated with CHOP (cyclophosphamide + pirarubicin + vincristine + prednisone) regimen, 4 of them were combined with chidamide or bortezomib, 6 of them were combined with autologous hematopoietic stem cell transplantation (auto-HSCT). Clinical characteristics of AITL patients were retrospectively analyzed. Kaplan-Meier method was used to map overall survival (OS) curves of patients treated with and without auto-HSCT. And univariate analysis of OS rate was performed in patients treated without auto-HSCT using Log-rank test. Influencing factors included gender, age, International Prognostic Index (IPI) score, Prognostic Index for peripheral T-cell lymphoma (PIT) score, B symptoms, skin rashes, chest/abdominal cavity effusion, bone marrow involvement, white blood cell count (WBC), hemoglobin (Hb) value, platelet count, serum lactate dehydrogenase (LDH) level, ferritin level, β2-microglobulin (MG) level. Factors with statistical significance in univariate analysis and clinical guiding significance were included in COX proportional hazards regression model for multivariate analysis. The procedure of this study was accordance with the requirement of the revisedWorld Medical Association Declaration of Helsinkiin 2008 and 2013.
Results① Among 44 AITL patients, 34 cases (77.3%) had B symptoms. Five cases (11.4%) were Ann Arbor Ⅰ-Ⅱ stage, 39 cases (88.6%) were Ⅲ-Ⅳ stage. Twenty cases (45.5%) had Eastern Cooperative Oncology Group, performance status (ECOG-PS) score<2 , 24 cases (54.5%) had ecog-ps score≥2. nine cases (20.5%) had ipi score of 0-1, 12 cases (27.2%) had score of 2, 23 cases (52.3%) had score of 3-5. ten cases (22.7%) had pit score of 0, 5 cases (11.4%) had score of 1, 12 cases (27.3%) had score of 2, and 17 cases (38.6%) had score of 3-4. ② blood routine test of 44 cases of aitl patients showed that median wbc was 6.2×109/L, median Hb value was 125 g/L, and median platelet count was 163×109/L. Median serum LDH level was 292 U/L, median ferritin level was 171 μg/L, and median β2-MG level was 3.8 mg/L. Bone marrow was involved by lesion in 14 cases (31.8%). Results of immunohistochemistry showed that follicular dendritic cell (FDC) with positive CD21, CD23, and CD35 expression was detected in 27 patients (61.4%). ③ Complete remission (CR) rate of 44 AITL patients was 13.6% (6/44), partial remission (PR) rate was 38.7% (17/44), stable disease (SD) rate was 22.7% (10/44), progressive disease (PD) rate was 25.0% (11/44). The 5-year OS rate was 50.0%, and the median OS time was 14.5 months (8 d-60.0 months). ④ The 5-year OS rate of patients who only received CHOP regimen chemotherapy was 44.1%, and patients who treated combined with new drugs (chidamide or bortezomib) was 75.0%. The 5-year OS rate of AITL patients receiving auto-HSCT was 83.3%, and was higher than that of 22.9% patients who didn′t receive auto-HSCT, and the difference was statistically significant (χ2=6.001,P=0.014). Univariate analysis of prognostic factors in 38 AITL patients treated without auto-HSCT showed that the 5-year OS rate was 37.8% in patients aged≤60 years, and significantly higher than that of 11.8% in patients aged>60 years, and the difference was statistically significant (χ2=0.139,P=0.023). The 5-year OS rate in patients with serum β2-MG level<4 mg/l was 23.9%, and significantly higher than that of 18.6% in patients with serum β2-mg level≥4 mg/l, and the difference was also statistically significant (χ2=5.520,P=0.019). ⑤ Multivariate analysis of prognostic factors in 38 patients treated without auto-HSCT showed that age>60 years (HR=2.716,P=0.031), bone marrow involvement (HR=2.696,P=0.042), serum β2-MG level≥4 mg/L (HR=4.927,P=0.004) were independent risk factors for AITL prognosis.
ConclusionsMajority of AITL patients are middle-aged and elderly males, often accompanied by skin rash and serous effusion. The disease was first diagnosed late-stage in Ann Arbor. Age>60 years, bone marrow involvement and serum β2-MG level≥4 mg/L, can be used as independent indicators of poor prognosis of patients treated without auto-HSCT. New drugs such as chidamide and bortezomib could improve curative effect of AITL patients. auto-HSCT coukl effectively improve the OS of patients.
