T- Cell Non-Hodgkin's Lymphoma, Data From a Mexican Tertiary Health Center..

T cell Non/Hodgkin's lymphomas (TCNHL) are a group of lymphomas characterized by an aggressive clinical course and resistance to the usual chemotherapy agents. Due to the limited availability of immunochemistry techniques the frequency and clinical presentation of these lymphomas are not well described in underdeveloped countries. Here we describe the experience with these diseases in a tertiary referral health center.

We reviewed 520 cases with diagnosis of Non-Hodgkin's Lymphoma from the records of the Pathology Department of the Hospital General de Mexico, seen from January 2002 to July 2006.

We found 80 cases with TCNHL (15.3%). In 62 cases the clinical information was available for review. We found a 1.45:1 male/female ratio, median age 32 years (range 17 to 83). Symptoms were present for a median of 6 months (range 1 to 120 months) before diagnosis. Regarding the pathological classification the Unspecified Peripheral T-cell lymphomas were more common (56%), followed by the anaplastic lymphoma (23%), T/NK (16%), Cutaneous lymphoma (3%) and angioimmunoblastic lymphoma (2%). In 56% the initial presentation was nodal and in 44% extranodal. The extranodal sites were: Nasal (34%), bone marrow (22%), pleura and lung (14%), parotid (5%), colon (5%), and liver (5%). Sixty seven percent of the patients had advanced clinical stages and 73% had at least 3 B symptoms. One quarter of patients had bulky disease at their first visit to our Hospital; the most frequent site was retroperitoneal (19%). The lactic dehydrogenase (LDH) was elevated in 89% of cases (range:97 U/L -3017 IU L, median 418 U/L); patients with anaplastic NHL had the highest values and NHL-TNK patients the lowest. HIV serology was performed in 41 of 62 patients. Ninety four percent of the patients had an ECOG between 1 and 3. We calculated the International Prognostic Index (IPI); it was low in 23 patients (37%), low-intermediate in 18 (29%), intermediate-high in 16 (26%) and high in just 5 patients (8%). When we classified the patients with the Prognostic Index for non-specific peripheral T-NHL (PIT or PTCL-L), we found that 79.4% of cases were in the high-risk group in contrast with 73.6% low group according to IPI.

All patients were treated with CHOP chemotherapy. A complete response (CR) was achieved in 10 patients (16%); 13 patients (21%) were still on treatment at the end of the study, 4 patients (6.45%) did not respond to treatment and 14 patients (24.1%) had progressive disease. Ten patients discontinued treatment (16%) and 5 died (8.06%). At the end of the observation period 8 patients were alive without tumor activity, 2 patients were lost without tumor activity, 7 patients were alive with disease, 24 patients were missing with tumor activity, 9 patients were on treatment and 12 patients had died.

This study shows that in Mexico as in other populations, the TCNHL are less frequent than the B-cell lymphomas. It also confirms the poor response of the T-Cell lymphomas to CHOP. The population that attends our hospital is of a low socioeconomic stratum, and this fact explains the large abandonment of medical care. It is desirable the development of new drugs for these neoplasia.

No relevant conflicts of interest to declare.