Abstract
Introduction: Angioimmunoblastic T-cell lymphoma (AITL) is a major subtype of peripheral T-cell lymphoma with a T-cell follicular helper phenotype. It accounts for approximately 1-2% of non-Hodgkin's lymphoma and 15-20% of peripheral T-cell lymphoma. AITL has unique clinical features with an aggressive course and poor prognosis. Therefore, it is essential to uncover the clinically significant prognostic factors to chart an optimal treatment strategy for AITL. Currently, AITL prognostic factors are not well established. Several retrospective AITL series with limited numbers reported varying prognostic factors and occasionally discordant results. Consequently, such studies lacked the power to validate factors that influence long-term clinical outcomes. Therefore, we conducted this meta-analysis to evaluate the pooled impact of selected clinicopathologic factors on progression-free (PFS) and overall survival (OS) in patients with AITL. Methods: A review of the medical literature was conducted using online databases. Inclusion criteria comprised AITL diagnosis, English language, and studies reporting factors impacting PFS and OS with hazard ratios (HR). A meta-analysis was conducted using an inverse variance method. The pooled value for the estimate, with 95% CI, was calculated using the Fixed effects model and the Random effects model. Results: Eight retrospective series with 944 patients were included and analyzed. Factors that impacted both PFS and OS included: Bone marrow involvement (HR 1.51, 95%CI:1.01-2.25; HR 1.58, 95%CI:1.02-2.44), mediastinal involvement (HR 1.44, 95%CI:1.10-1.88; HR 1.48, 95%CI:1.09-2.02), B-symptoms (HR 1.40, 95%CI:1.14-1.71; HR 1.55, 95%CI:1.22-1.96), stage >II (HR 1.50, 95%CI:1.05-2.13; HR 1.74, 95%CI:1.15-2.61), ECOG >2 (HR 1.74, 95%CI:1.42-2.13; HR 2.39, 95%CI:1.65-3.44), ↑LDH (HR 1.47, 95%CI:1.12-1.94; HR 1.39, 95%CI:1.01-1.91), Albumin<3.5g/dl (HR 1.43, 95%CI:1.10-1.85; HR 1.57, 95%CI:1.01-2.45), sIL2R >530U/ml (HR 1.72, 95%CI:1.12-2.65; HR 1.90, 95%CI:1.29-2.80), and extra-nodal involvement >1 site (HR 1.92, 95%CI:1.53-2.41; HR 2.01, 95%CI:1.48-2.72). Factors that impacted OS only are: effusion (HR 2.60, 95%CI:1.32-5.14), leukocytosis (HR 1.11, 95%CI:1.02-1.22), and PIT >1 (HR 1.83, 95%CI:1.22-2.73). Factors that impacted PFS only are: Age (HR 1.37, 95%CI:1.18-1.59), Anemia (HR 1.63, 95%CI:1.34-1.97), and ↑β2-microglobulin (HR 1.73, 95%CI:1.19-2.52). However, sex, thrombocytopenia, ↓total protein, ↑IgG, ↑IgA, ↑IgM, ↑CRP, and IPI >2 did not significantly impact PFS or OS. Conclusions: This is the first meta-analysis to explore the impact of clinicopathologic factors on AITL PFS and OS. It delineates factors that impact PFS and OS and those that do not influence either.
Disclosures
No relevant conflicts of interest to declare.
Author notes
*Asterisk with author names denotes non-ASH members.
