Significance of clinical factors as prognostic indicators for patients with peripheral T-cell non-Hodgkin lymphoma: A retrospective analysis of 252 cases

Abstract

The aim of this study was to retrospectively analyze the significance of different clinical factors for predicting the prognosis of patients with peripheral T-cell non-Hodgkin lymphoma (PTCL) with a median follow-up of 23 months. A total of 252 PTCL patients admitted to the First Affiliated Hospital of the School of Medicine of Zhejiang University between 2005 and 2011 were retrospectively reviewed. At a median follow-up of 23 months, the overall survival (OS) rate was 23.8%. Our results revealed that the presence of B symptoms (P<0.001), Eastern Cooperative Oncology Group (ECOG) score ≥2 (P<0.001), bone marrow involvement (BMI) (P<0.001), elevated lactate dehydrogenase (LDH) levels (P<0.001), elevated β2-MG levels (P<0.001), Ann Arbor stages III/IV (P=0.007) and International Prognostic Index (IPI) ≥3 (P=0.001) were poor prognostic factors for OS and intensive chemotherapy achieved a better OS outcome compared to the CHOP treatment. In conclusion, elevated LDH and β2-MG levels, B symptoms, Ann Arbor stages III/IV, BMI, high IPIs and high ECOG scores predict an unfavorable prognosis for PTCL patients. Compared to the conventional CHOP regimen, the intensive chemotherapy treatment may improve the prognosis of PTCL patients.

Keywords: bone marrow involvement; international prognostic index; lactate dehydrogenase; peripheral T-cell non-Hodgkin lymphoma; β2-microglobulin.

Figure 1

Overall survival of peripheral T-cell lymphoma (PTCL) subtypes. SCPTCL, subcutaneous panniculitis-like T-cell lymphoma; N-NKTCL, extranodal natural killer/T-cell lymphoma, nasal type; ETTL, enteropathy type T-cell lymphoma; ALK- ALCL, ALK-negative anaplastic large-cell lymphoma; AITL, angioimmunoblastic T-cell lymphoma; PTCL-NOS, peripheral T-cell lymphoma, not otherwise specified; Cum, cumulative.

Figure 2

Kaplan-Meier estimates for the overall survival (OS) outcome of peripheral T-cell non-Hodgkin lymphoma (PTCL) patients with different treatments. The estimated OS rate in the intensive chemotherapy group (33.9%) was significantly higher compared to that in the CHOP therapy group (11.9%). Cum, cumulative; CHOP, cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone.

Figure 3

Kaplan-Meier estimates for the overall survival (OS) probability for different peripheral T-cell non-Hodgkin lymphoma (PTCL) patient groups. (A) The OS rate in the normal-level lactate dehydrogenase (LDH) group (34.5%) was significantly higher compared to that of the elevated LDH group (18.0%, P<0.001). (B) The OS rate in the normal-level β2-MG group (34.7%) was significantly higher compared to that of the elevated β2-MG group (20.5%, P<0.001). (C) The OS rate of patients with B symptoms (17.3%) was significantly lower compared to that of patients without B symptoms (39.6%, P<0.001). (D) The OS rate of patients with bone marrow involvement (BMI) (14.7%) was significantly lower compared to that of patients without BMI (32.5%, P<0.001). Cum, cumulative.

Figure 4

Kaplan-Meier estimates for the overall survival (OS) probability of different peripheral T-cell non-Hodgkin lymphoma (PTCL) patient groups. (A) The OS rate in the low/low-intermediate risk group (28.3%) was significantly higher compared to the intermediate-high/high risk group (19.1%, P<0.001). (B) The OS rate in the low Eastern Cooperative Oncology Group (ECOG) score (0–1) group (20.9%) was significantly higher compared to the high ECOG score (–4) group (11.5%, P<0.001). (C) The OS rate in the group with fewer extranodal involvement (ENI) sites (27.7%) was not significantly higher compared to the group with more ENI sites (18.0%, P=0.596). (D) The OS rate in the early-stage group (I–II) (35.9%) was significantly higher compared to the late-stage group (III–IV, 24.4%, P=0.007). Cum, cumulative.