Incidence and Outcome of T-Cell Lymphomas in Malaysia.

The T- and NK-cell neoplasms are a heterogenous group and are relatively uncommon. From the International Non-Hodgkin’s Lymphoma classification study, precursor T-lymphoblastic lymphoma and the mature T- and NK-cell lymphomas account for 1.7% and 12% of all NHLs. T-NHL are in general more common in Asia. The outcome of this disease is poorer with a 5-y overall survival of 20% (excluding anaplastic NHL). Hospital Kuala Lumpur is the major hematology referral centre in Malaysia. A total of 414 new cases of lymphoma was seen during 2000–2005. The majority were DLBCL 46% and follicular grade I/II lymphomas 15.8%. Only 48 cases (12%) were T-NHL. These were PTCL 19 (5%), anaplastic T-NHL 9 (2.2%), cutaneous T-NHL Stage IV 9 (2.2%), T/NK-NHL 5 (1.2%) and angioimmunoblastic NHL 3 (0.7%). Between 2002–2005, 15 patients were treated with HyperCVAD regimen alternating with Mtx/Ara-C. Three had T-lymphoblastic lymphoma, 7 had PTCL and 5 had T/NK cell. The complete remission was 40% with two proceeding to stem cell transplant. One received local DXT. The median duration of remission was 18.5mths(10–30mths) with median follow-up of 30mths(25–35mths). Alemtuzumab(Campth-1H) is a humanised monoclonal antibody that targets the CD 52 antigen including the T-cell. We combined HyperCVAD with Alemtuzumab 30mg sc on day 1 of every chemotherapy cycle. Four patients with relapsed/refractory T-ALL and 1 patient with T/NK NHL were treated. Two patients, one who relapsed six months after chemotherapy and the other after allogeneic transplant achieved complete remission. The patient with T/NK who had progressive disease with enlarging hepatosplenomegaly after 1 pair of HyperCVAD achieved remission after the addition of Campath. The median duration between each chemotherapy cycle was 25 days(23–26d). One patient had CMV reactivation with no evidence of disease. All patients are still undergoing treatment. The addition of Campath 30mg on day 1 of each chemotherapy cycle appears to be a viable option to try to improve the results in aggressive T-NHL. In view of these preliminary findings, we are starting a study protocol using Campath plus HyperCVAD in aggressive T-cell disease.