Yan Xie, Yuqing Song, Wen Zheng, Yuntao Zhang, Xiaopei Wang, Ningjing Lin, Meifeng Tu, Jun Zhu

Department of lymphoma, beijing cancer hospital

Objective:This study was to evaluate the treatment outcomes using the dose-adjusted Berlin- Frankfurt-Munster (BFM-90) regimen withoutirradiation in adults with lympho blastic lymphoma (LBL) at Peking University Cancer Hospital (Beijing Cancer Hospital). Method: Between March 2004 and March 2014, 42 newly diagnosed LBL patients were treated in our center. We retrospectively analyzed their main clinical characteristics and prognosis. Result: The media age of the patients at diagnosis was 30(range: 18-54). 64.3% were male. The majority of patients presented with stage III or IV disease (30/42, 71.4%) and T cell phenotype (36/42, 85.7%). Bone marrow (BM) infiltration was detected in 18 patients (42.9%), all of whom had less than 25% blast cells in the BM. Fifteen (35.7%) patients presented with bulky mass (>7.5 cm) and 12 (28.6%) patients had lactate dehydrogenase (LDH) levels higher than the institutional upper limit of normal (ULN). Lymphocyte ratios were found to be abnormal in 21 (50%) patients at diagnosis. Twenty seven (64.3%) patients were with international prognostic index (IPI) score of0-1. Thirty three (78.6%) patients achieved complete remission (CR) and 7 (16.7%) achieved partial remission (PR) after induction phase. Among those who achieved CR, 17 patients accepted autologous peripheral blood stem cell transplantation (APBSCT). For reasons 19 patients didn't do maintenance therapy. Grade 3 and 4 hematologic events were seen in 36 patients and grade 3 aminotransferase elevation was seen in 6patients. No death occurred due to toxicity. Among those who were refractory to initial treatment (2 patients) or relapsed after treatment (17 patients) only 4 patients were alive, including 2 patients who were still accepted treatment. At a median follow-up of 28 months (range: 8-106), 26 patients (61.9%) were alive. The estimated 3-year overall survival rate (OS) and progression-free survival rate (PFS) were 61% and 58%, respectively. Advanced stage and BM infiltration predicted shorter PFS (P<0.05) and abnormal lymphocyte ratio at diagnosis predicted shorter OS (P<0.05). No CR after induction treatment and no main tenance therapy were indicated as adverse prognostic factors for both OS and PFS (P<0.05). There was also a trend for better survival in autologous peripheral blood stem cell transplantation (APBSCT) group as compared to non-APBSCT group (3-year OS: 83.9% vs. 60.9%), but without any significant difference. There was no statistically difference in 3-year OS or PFS according to gender, IPI, T or B phenotype, LDH or bulky mass. Conclusion: This study showed that this dose-reduced BFM-90 protocol without irradiation displayed similar long-term results in Chinese adults with LBL. All patients should accepted maintenance therapy. APBSCT may become a choice if we can identify the best candidate.

Key Words: lymphoblastic lymphoma  adults  prognosis