Journal of Clinical Oncology, Vol 7, 725-731, Copyright © 1989 by American Society of Clinical Oncology
Direct comparisons of peripheral T-cell lymphoma with diffuse B-cell lymphoma of comparable histological grades--should peripheral T-cell lymphoma be considered separately?
AL Cheng, YC Chen, CH Wang, IJ Su, HC Hsieh, JY Chang, WS Hwang, WC Su, TW Liu and HF Tien
Department of Internal Medicine, National Taiwan University Hospital, Taipei, ROC.
Peripheral T-cell lymphoma (PTCL) forms a morphologically heterogeneous
group of non-Hodgkin's lymphomas (NHL) with distinct immunophenotypes of
mature T cells. Progress has been slow in defining specific
clinicopathological entities to this particular group of NHL. In order to
elucidate the specific characteristics of PTCL, a direct comparison of PTCL
with a group of diffuse B-cell lymphomas (DBCL) was performed. Between June
1983 and December 1987, we studied 114 adults with NHL, using a battery of
immunophenotyping markers. Adult T-cell leukemia/lymphoma, lymphoblastic
lymphoma, mycosis fungoides/Sezary syndrome, follicular lymphoma,
well-differentiated lymphocytic lymphoma, and true histiocytic lymphoma
were excluded from this study since these are distinct clinicopathologic
entities with well- recognized immunophenotypes. Of the remaining 75
patients, 70 who had adequate clinical information were analyzed, and of
these, 34 were PTCL and 36 were DBCL. Classified according to the National
Cancer Institute (NCI) Working Formulation (WF), 68% of PTCL and 31% of
DBCL were high- grade lymphomas. Clinical and laboratory features were
similar, except PTCL had a characteristic skin involvement and tended to
present in more advanced stages with more constitutional symptoms.
Induction chemotherapy was homogeneous in both groups, and complete
remission rates were 62% for PTCL and 67% for DBCL. Patients with DBCL had
a better overall survival than patients with PTCL, but the survival benefit
disappeared after patients were stratified according to intermediate- or
high-grade lymphoma. A subgroup of PTCL patients who had received less
intensive induction chemotherapy was found to have a very unfavorable
outcome. We conclude that (1) PTCL follows the general grading concept
proposed in WF classification; (2) within a given intermediate or high
grade, PTCL and DBCL respond comparably to treatment; (3) the intensity of
induction chemotherapy has a crucial impact on the outcome of PTCL
patients; and (4) with a few exceptions, the clinical and laboratory
features of PTCL and DBCL are comparable.
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