Peripheral T-cell lymphomas have a worse prognosis than B-cell lymphomas: A prospective study of 361 immunophenotyped patients treated with the LNH-84 regimen

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Abstract
The prognostic significance of phenotype in malignant lymphomas (ML) is a matter of controversy. Here we analyze the clinical presentation, response to treatment, and survival of the 361 phenotyped patients with ML who were treated by the LNH-84 regimen. Histologic subtypes were diffuse-small cell in 10 patients, diffuse mixed in 69, diffuse large-cell in 177, immunoblastic in 94, and anaplastic large-cell in 11. One hundred and eight patients (30%) had a peripheral T-cell ML and 253 (70%) a B-cell ML. Most of B-cell MLs were of diffuse large-cell type, and the T-cell MLs were distributed among diffuse mixed and immunoblastic subtypes. T-cell MLs had an aggressive presentation with more patients having advanced stage (21% versus 41% stage II, 53% versus 45% stage IV, p =.0002), and B symptoms (58% versus 42%, p <.01). The only significant difference in clinical manifestations were the higher frequency of gastrointestinal involvement in B-cell MLs (20% versus 2%, p <.0001) and the more frequent spleen (39% versus 21%, p =.0005) and skin (19% versus 3%, p <.0001) involvement in T-cell MLs. There was no difference in response to the LNH-84 regiment between the two subgroups, but T-cell ML patients relapsed at a higher rate (43% versus 29%, p <.001). T-cell ML patients have a significantly shorter freedom-from-relapse (FFR) survival (median: 34 months versus not reached, logrank test: p =.002) and a non-significant shorter overall survival (median: 42 versus 50 months). Multivariate analyses of all major prognostic factors for FFR survival and overall survival show that T phenotype is the only adverse prognostic factor for FFR survival and the fourth and last prognostic factor for overall survival, along with LDH level, serum albumin level, and number of extranodal sites. Our results definitively show that peripheral T-cell MLs are associated with a poor prognosis and that the phenotype is independent of other adverse prognostic factors.