Originally published as JCO Early Release 10.1200/JCO.2005.03.6327 on April 24 2006

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Marker Expression in Peripheral T-Cell Lymphoma: A Proposed Clinical-Pathologic Prognostic Score

Philip Went, Claudio Agostinelli, Andrea Gallamini, Pier Paolo Piccaluga, Stefano Ascani, Elena Sabattini, Francesco Bacci, Brunangelo Falini, Teresio Motta, Marco Paulli, Tullio Artusi, Milena Piccioli, Pier Luigi Zinzani, Stefano A. Pileri

From the Institute of Hematology and Clinical Oncology "L. and A. Seràgnoli," Hematology and Hematopathology Units, St Orsola-Malpighi Hospital, University of Bologna, Bologna; Hematology Unit, S. Croce and Carle Hospital, Cuneo; Institute of Pathology, Perugia University in Terni, Terni; Institute of Hematology, Perugia University, Perugia; Division of Pathology, Spedali Riuniti di Bergamo, Bergamo; Anatomy Pathology Section, Department of Human Pathology, University of Pavia, Pavia; Division of Hematology, University of Modena, Modena, Italy; University of Basel, Basel, Switzerland; and the Intergruppo Italiano Linformi

Address reprint requests to Stefano A. Pileri, MD, and Pier Luigi Zinzani, MD, Pathology and Lymphoma Unit, Institute of Hematology and Clinical Oncology "L. and A. Seràgnoli," St Orsola-Malpighi Hospital, University of Bologna, Via G. Massarenti 9, 40138 Bologna, Italy; e-mail: pileri{at}med.unibo.it

PURPOSE: Although peripheral T-cell lymphoma, unspecified (PTCL/U), is the most common T-cell tumor in Western countries, no study to date has been based on the application of a wide panel of markers to a large series of patients and assessed the impact of phenotype on survival. We evaluated the expression of 19 markers in 148 PTCLs/U and 45 PTCLs of the angioimmunoblastic type (AILD).

PATIENTS AND METHODS: The analysis was performed on tissue microarrays by immunohistochemistry and in situ hybridization. Clinical data were available in 93 PTCL/U patients, most of whom had been included in a previous study proposing a prognostic index (PIT).

RESULTS: An aberrant phenotype with frequent loss of CD5 and/or CD7 was typical for PTCLs, irrespective of whether they were U or AILD. Aberrantly expressed proteins rarely included CD20, CD15, and CD30. Positivity for Epstein-Barr virus–associated small RNAs and CD15 expression emerged as adverse prognostic factors. Among PTCLs/U, the proliferation-associated protein Ki-67 turned out to be prognostically relevant and was integrated in a new predictive score, incorporating age (> 60 years), high lactate dehydrogenase, poor performance status, and Ki-67 80%. This score was associated with the patient outcome (P < .0001) and was found to be more robust than PIT (P = .0043) in the present series.

CONCLUSION: Our retrospective analysis shows a wide range of protein expression in PTCLs and proposes a new prognostic index. The latter represents one of the first examples of mixed score (including patient- and tumor-specific factors) applied to malignant lymphomas and may be the basis for future prospective therapeutic trials.

Supported by grants from Associazione Italiana per la Ricerca sul Cancro (Milan), Fondazione Cassa di Risparmio in Bologna, Fondazione della Banca del Monte e Ravenna, and BolognAIL; P.W. was supported by the Niklaus & Bertha Burckhardt-Bürgin Stiftung and the Krebsliga beider, Basel, Switzerland.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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