Originally published as JCO Early Release 10.1200/JCO.2008.21.1318 on June 22 2009

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Minimal Disseminated Disease in Childhood T-Cell Lymphoblastic Lymphoma: A Report From the Children's Oncology Group

From the Departments of Oncology and Pathology, St Jude Children's Research Hospital, and University of Tennessee Health Center, Memphis, TN; Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City, UT; Department of Epidemiology and Health Policy Research, College of Medicine, University of Florida, Gainesville, FL; and Section of Hematology/Oncology, Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE.

Corresponding author: Dario Campana, MD, PhD, Department of Oncology, St Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis TN 38105; e-mail: dario.campana{at}stjude.org.

Purpose Disease dissemination to the bone marrow is detected at diagnosis in approximately 15% of children with T-cell lymphoblastic lymphoma (T-LL). It is unclear whether the remaining patients have submicroscopic systemic disease and, if so, what is the clinical significance of this finding.

Patients and Methods Using a flow cytometric method that can detect one T-LL cell among 10,000 normal cells, we examined bone marrow and peripheral-blood samples collected from 99 children with T-LL at diagnosis, as well as blood samples collected from 42 patients during treatment.

Results In 71 (71.7%) of the 99 marrow samples obtained at diagnosis, T-LL cells represented 0.01% to 31.6% (median, 0.22%) of mononuclear cells; 57 of the 71 T-LL–positive samples were from patients with stage II/III disease. Results of studies in bilateral marrow aspirates were highly concordant. Two-year event-free survival (EFS) was 68.1% ± 11.1% (SE) for patients with 1% T-LL cells in bone marrow versus 90.7% ± 4.4% for those with lower levels of marrow involvement (P = .031); EFS for patients with 5% lymphoblasts was 51.9% ± 18.0% (P = .009). T-LL cells were as prevalent in blood as in marrow; monitoring residual T-LL cells in blood during remission induction therapy identified patients with slower disease clearance.

Conclusion More than two thirds of children with T-LL have disseminated disease at diagnosis, a proportion much higher than previously demonstrated. Measurements of disease dissemination at diagnosis might provide useful prognostic information, which can be further refined by monitoring response to therapy through blood testing.

Supported by Grants No. CA60419, CA21765, and U10-CA98543 from the National Cancer Institute and by the American Lebanese Syrian Associated Charities.

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

Clinical Trials repository link available on JCO.org.

Clinical trial information can be found for the following: NCT00004228.

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