Abstract
Background: Adult T-cell lymphoma/leukemia (ATLL) represents a fatal disease epidemiologically linked to chronic infection of human T-cell lymphotropic virus type I (HTLV-I) with high incidence among native etnias from south-america. Most patients are stratified according to Shimoyama classification, however it is complex to use and not reliable to show prognostic information about the disease. Hypercalcemia is one of the most ominous factors related to the burden of disease and neutrophil-to-lymphocyte ratio (NLR) represents a systemic biomarker of inflamation. Our aim was to propose a simple score based on hypercalcemia and neutrophil-to-lymphocyte ratio for prognostic stratification among patients with ATLL.
Methods: We reviewed 248 medical records from patients with ATLL diagnosed between 2008-2014 at the Instituto Nacional de Enfermedades Neoplasicas (Peru). Hypercalcemia was defined as ionic calcium > 1.32mmol/L (we score it as normal with 1 point and high with 2 points) and neutrophil-to-lymphocyte ratio ≤3 (1 point) or NLR >3 (2 points). Patients were assigned to high (4 points), Intermediate (3 points) and low risk group (2 points). Outcomes and survival differences were calculated by log-rank test.
Results: Mean age was 56 years (39.5% were >60 years), no differences between males or females. Tuberculosis infection was founded on 12.5%. About 83% were in good status performance (Zubrod 0-2) and a worse status was related to high risk group (33%, p<0.001). According to Shimoyama classification we found: 38% Acute, 47% Lymphoma, 10% Smoldering and 5% Chronic subtypes. Most patients received a CHOP-based chemotherapy (71%) without differences between subgroups and overall response was 41% (CR:24% and PR:17%), we did not find differences between acute, lymphoma and smoldering subtypes, however most patients with smoldering subtype achieved complete remission (6 out 9). By other hand, complete response in low-risk was 33%, intermediate-risk 17% and high-risk group 9.7% (p<0.001). At 5 years follow-up, median overall survival in low-risk group was 14 months, 4 months for intermediate group and one month for high-risk group (Low vs Intermediate HR: 0.3, CI95%[0.2-0.5], p<0.001, Low vs High HR: 0.2, CI95%[0.1-0.3], p<0.001). We did not find survival differences between acute, lymphoma and chronic subtypes.
Conclusion: We present a simple two-parameters classification based on hypercalcemia and neutrophil-to-lymphocyte ratio for adult t-cell leukemia/lymphoma with high impact on complete responses rates and overall survival.
No relevant conflicts of interest to declare.
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