Abstract 2939

Poster Board II-915

Introduction:

Peripheral blood absolute lymphocyte count (ALC) at the time of diagnosis is a prognostic indicator in hematologic malignancies. However, no reports have addressed whether ALC at the time of first relapse (ALC-R) has a prognostic significance in the patients with relapsed T-cell Non-Hodgkin's lymphoma (NHL). We retrospectively studied the prognostic significance of ALC-R in these patients.

Patients and Methods:

We identified 63 patients who had a documented relapsed disease after having reached a complete response, including at least an unconfirmed complete response between 1993 and 2007 and we analyzed their ALC-R and following variables at the time of first relapse; age, gender, the number of extranodal sites, lactate dehydrogenase, ECOG performance status, stage and international prognostic index.

Results:

Out of the 63 patients, 23 (36.5%) had a peripheral T-cell lymphoma, not otherwise characterized, while 15 (23.8%) had an extranodal NK/T-cell lymphoma, nasal type, 6 (9.5%) anaplastic large-cell lymphoma, 5 (7.9%) angioimmunoblastic T-cell lymphoma, 2 (3.2%) primary cutaneous T cell lymphoma and 12 (19%) other types. Among them, 32 (50.8%) had an ALC-R ≥ 1.25 × 109/L, 47 (74.6%) had an ECOG PS 0 or 1 and by IPI at relapse, 0, 1, 2, 3, 4, and 5 were 20.6%, 25.4%, 23.8%, 23.8%, 4.8%, and 1.6%, respectively. Univariate analyses showed that good ECOG PS (HR, 0.408; 95% CI 0.190-0.876; p=0.022) and high ALC at relapse (HR, 0.394; 95% CI 0.210-0.740; p=0.004) were associated with longer survival from relapse (Table 1). Multivariate analysis also showed that high ALC at relapse (HR, 0.369; 95% CI 0.187-0.726; p=0.004) and good ECOG PS (HR, 0.295; 95% CI 0.131-0.666; p=0.003) were still associated with longer survival outcome (Table 2).

Conclusions:

The high ALC-R predicted a better prognosis in patients with relapsed T-cell NHL, suggesting that the host immune system might have a crucial role.

Table 1.

Univariate Cox proportional hazard model

VariablesHazard RatioHR 95 % CIP-value
ALC-R ≥1.25 × 109/L 0.394 0.210-0.740 0.004  
 <1.25 × 109/L 1   
Age, years >60 1.310 0.669-2.564 0.431  
 '60 1   
Gender women 0.994 0.523-1.890 0.986  
 men 1   
the number of extranodal sites >1 1.312 0.605-2.846 0.491  
 '1 1   
LDH abnormal 1.545 0.813-2.937 0.184 
 normal 1   
ECOG PS 0, 1 0.408 0.190-0.876 0.022  
 ≥2    
stage III, IV 1.462 0.795-2.688 0.221  
 I, II 1   
IPI ≥3 1.191 0.618-2.296 0.602  
 <3 1   
VariablesHazard RatioHR 95 % CIP-value
ALC-R ≥1.25 × 109/L 0.394 0.210-0.740 0.004  
 <1.25 × 109/L 1   
Age, years >60 1.310 0.669-2.564 0.431  
 '60 1   
Gender women 0.994 0.523-1.890 0.986  
 men 1   
the number of extranodal sites >1 1.312 0.605-2.846 0.491  
 '1 1   
LDH abnormal 1.545 0.813-2.937 0.184 
 normal 1   
ECOG PS 0, 1 0.408 0.190-0.876 0.022  
 ≥2    
stage III, IV 1.462 0.795-2.688 0.221  
 I, II 1   
IPI ≥3 1.191 0.618-2.296 0.602  
 <3 1   
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Table 2.

Multivariate Cox proportional hazard model

VariablesHazard RatioHR 95% CIP-value
High ALC-R (≥1.25 × 109/L) 0.369 0.188-0.726 0.004  
Good ECOG PS (0, 1) 0.295 0.131-0.666 0.003 
VariablesHazard RatioHR 95% CIP-value
High ALC-R (≥1.25 × 109/L) 0.369 0.188-0.726 0.004  
Good ECOG PS (0, 1) 0.295 0.131-0.666 0.003 
View Large
Disclosures:

No relevant conflicts of interest to declare.

Topics:
lymphocyte count measurement, prognostic factors, t-cell lymphoma, electrocorticogram, extranodal disease, complete remission, angioimmunoblastic lymphadenopathy, hematologic neoplasms, ki-1+ anaplastic large cell lymphoma, lactate dehydrogenase

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2009 by The American Society of Hematology
2009
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