J Korean Med Sci.  2006 Aug;21(4):633-638. 10.3346/jkms.2006.21.4.633.

Primary Systemic Anaplastic Large Cell Lymphoma in a Single Korean Institution: Clinical Characteristics and Treatment Outcome

• Park SR
• Baek JY
• Kim DW
• Im SA
• Kim TY
• Bang YJ
• Kim NK
• Jeon YK
• Kim CW
• Heo DS

• KMID: 2157813
• DOI: http://doi.org/10.3346/jkms.2006.21.4.633

Abstract

Despite advances in the characterization of anaplastic large cell lymphoma (ALCL), little data is available on Asian patients. We report here upon single Korean institution's experience regarding the clinical characteristics and outcomes of ALCL. We performed a retrospective study of 32 adults with ALCL. Most of the patients received anthracycline-based chemotherapy. Ann Arbor stage III-IV, B symptoms, high-intermediate/ high International Prognostic Index (IPI), and extranodal disease at diagnosis were present in 56%, 44%, 41%, and 63%, respectively. Compared with Western studies, the male/female ratio (4.3) was markedly higher and skin (9%) and bone involvement (9%) were less frequent. The staining results for anaplastic lymphoma kinase were positive in 6 (33%) of 18 cases available. The complete response (CR) rate was 62% (95% CI, 44-80%). With a median follow-up of 51.0 months, 5 yr overall survival was 40+/-11%. The 3 yr relapse-free survival for the 18 patients who achieved CR was 74+/-12%. Age, performance status, lactate dehydrogenase, extranodal disease sites number, and IPI were correlated with treatment response and survival. Our data suggest that Korean ALCL patients appear to have a higher male/female ratio, less frequent skin/bone involvement, and lower CR rate compared with those of Western studies.

Keyword

Lymphoma, Large Cell, Ki-1; CD30-Positive Anaplastic Large-Cell Lymphoma; anaplastic lym-phoma kinase; Drug Therapy

MeSH Terms

Treatment Outcome
Survival Analysis
Retrospective Studies
Prognosis
Neoplasm Staging
Neoplasm Recurrence, Local
Middle Aged
Male
Lymphoma, Large-Cell, Ki-1/*drug therapy/immunology/*pathology
Korea
Humans
Female
Antigens, CD30/analysis
Aged, 80 and over
Aged
Adult
Adolescent

Figure

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  Fig. 1 Overall survival of the 30 patients with ALCL who received chemotherapy (median 54.0 months; 5 yr survival rate 40±11%).

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  Fig. 2 Relapse-free survival for the 18 patients who achieved complete remission (3 yr relapse-free survival rate 74±12%).

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  Fig. 3 Overall survival according to International Prognostic Index in the 30 patients who received chemotherapy. The median survival of low and low-intermediate group was not reached and that of high-intermediate and high risk groups was 19.0 months and 3.0 months, respectively (p=0.03).

Reference

1. Melnyk A, Rodriquez A, Pugh WC, Cabanillas F. Evaluation of the revised European-American lymphoma classification confirms the clinical relevance of immunophenotype in 560 cases of aggressive non-Hodgkin's lymphoma. Blood. 1997. 89:4514–4520.

2. The Non-Hodgkin's lymphoma Classification Project. A clinical evaluation of the International Lymphoma Study Group Classification of non-Hodgkin's lymphoma. Blood. 1997. 89:3909–3918.

3. Shih LY, Liang DC. Non-Hodgkin's lymphomas in Asia. Hematol Oncol Clin North Am. 1991. 5:983–1001.

4. Ko YH, Kim CW, Park CS, Jang HK, Lee SS, Kim SH, Ree HJ, Lee JD, Kim SW, Huh JR. REAL classification of malignant lymphomas in the Republic of Korea. Cancer. 1998. 83:806–812.

5. Kang YK, Kim BS, Kim TW, Ryu MH, Lee SS, Ryoo BY, Kim TY, Im YH, Lee KH, Huh J, Heo DS, Bang YJ, Kim C, Lee JS, Kim BK, Kim WK, Kim SH, Kim NK. Clinicopathologic characteristics of Korean non-Hodgkin's lymphomas based on REAL classification. J Korean Cancer Assoc. 1999. 31:641–652.

6. Harris NL, Jaffe ES, Stein H, Banks PM, Chan JK, Cleary ML, Delsol G, De Wolf-Peeters C, Falini B, Gatter KC, Grogan TM, Isaacson PG, Knowles DM, Mason DY, Muller-Hermelink HK, Pileri SA, Piris MA, Ralfkiaer E, Warnke RA. A revised European-American classification of lymphoid neoplasms: a proposal from the International Lymphoma Study Group. Blood. 1994. 84:1361–1392.

7. Rimokh R, Magaud JP, Berger F, Samarut J, Coiffier B, Germain D, Mason DY. A translocation involving a specific breakpoint (q35) on chromosome 5 is characteristic of anaplastic large cell lymphoma (Ki-1 lymphoma). Br J Haematol. 1989. 71:31–36.

8. Falini B, Pileri S, Zinzani PL, Carbone A, Zagonel V, Wolf-Peeters C, Verhoef G, Menestrina F, Todeschini G, Paulli M, Lazzarino M, Giardini R, Aiello A, Foss HD, Araujo I, Fizzotti M, Pelicci PG, Flenghi L, Martelli MF, Santucci A. ALK+ lymphoma: clinico-pathological findings and outcome. Blood. 1999. 93:2697–2706.

9. Gascoyne RD, Aoun P, Wu D, Chhanabhai M, Skinnider BF, Greiner TC, Morris SW, Connors JM, Vose JM, Viswanatha DS, Coldman A, Weisenburger DD. Prognostic significance of anaplastic lymphoma kinase (ALK) protein expression in adults with anaplastic large cell lymphoma. Blood. 1999. 93:3913–3921.

10. Jaffe ES, Harris NL, Stein H, Vardiman JW. World Health Organization classification of tumours. Pathology and genetics of tumours of haematopoietic and lymphoid tissues. 2001. Lyon: IARC Press.

11. Carbone PP, Kaplan HS, Musshoff K, Smithers DW, Tubiana M. Report of the committee on Hodgkin's disease staging classification. Cancer Res. 1971. 31:1860–1861.

12. Fisher RI, Gaynor ER, Dahlberg S, Oken MM, Grogan TM, Mize EM, Glick JH, Coltman CA Jr, Miller TP. Comparison of a standard regimen (CHOP) with three intensive chemotherapy regimens for advanced non-Hodgkin's lymphoma. N Engl J Med. 1993. 328:1002–1006.

13. Coleman M, Armitage JO, Gaynor M, McDermott D, Weisenburger DD, Adler K, Beshevkin M, Silver RT, Reisman AM, Pasmantier MW. The COPBLAM programs: Evolving chemotherapy concepts in large cell lymphoma. Semin Hematol. 1988. 25:23–33.

14. World Health Organization. WHO offset publication no. 48. WHO handbook for reporting results of cancer treatment. Geneva, Switzerland: World Health Organization.

15. Kaplan EL, Meier P. Nonparametric estimation from incomplete observation. J Am Stat Assoc. 1958. 53:457–481.

16. Shulman LN, Frisard B, Antin JH, Wheeler C, Pinkus G, Magauran N, Mauch P, Nobles E, Mashal R, Canellos G. Primary Ki-1 anaplastic large-cell lymphoma in adults: Clinical characteristics and therapeutic outcome. J Clin Oncol. 1993. 11:937–942.

17. Zinzani PL, Bendandi M, Martelli M, Falini B, Sabattini E, Amadori S, Gherlinzoni F, Martelli MF, Mandelli F, Tura S, Pileri SA. Anaplastic large-cell lymphoma: Clinical and prognostic evaluation of 90 adult patients. J Clin Oncol. 1996. 14:955–962.

18. Clavio M, Rossi E, Truini M, Carrara P, Ravetti JL, Spriano M, Vimercati AR, Santini G, Canepa L, Pierri I, Celesti L, Miglino M, Castellaneta A, Damasio E, Gobbi M. Anaplastic large cell lymphoma: A clinicopathologic study of 53 cases. Leuk Lymphoma. 1996. 22:319–327.

19. Longo G, Fiorani C, Sacchi S, Callea V, Lombardo M, Federico M, Stelitano C, Angrilli F, Vallisa D, Gobbi PG, Ilariucci F, Frassoldati A, Petrini M, Silingardi V. Clinical characteristics, treatment outcome and survival of 36 adult patients with primary anaplastic large cell lymphoma. Haematologica. 1999. 84:425–430.

20. Tilly H, Gaulard P, Lepage E, Dumontet C, Diebold J, Plantier I, Berger F, Symann M, Petrella T, Lederlin P, Briere J. Primary anaplastic large-cell lymphoma in adults. Clinical presentation, immunophenotype, and outcome. Blood. 1997. 90:3727–3734.

21. Pileri S, Bocchia M, Baroni CD, Martelli M, Falini B, Sabattini E, Gherlinzoni F, Amadori S, Poggi S, Mazza P. Anaplastic large cell lymphoma (CD30+/Ki-1+): results of a prospective clinico-pathological study of 69 cases. Br J Haematol. 1994. 86:513–523.

22. Lee SC, Kueh YK, Lehnert M, Chong SM, Tan YO, Wong J. Characteristics and prognosis of KI-1 positive anaplastic large cell lymphoma in Asians. Aust N Z J Med. 1998. 28:790–794.

23. Lin CN, Hou CC, Hwang WS, Chuang SS. Anaplastic large cell lymphoma-a rare disorder in southern Taiwan. Leuk Lymphoma. 2003. 44:1727–1731.

24. Nakamura S, Shiota M, Nakagawa A, Yatabe Y, Kojima M, Motoori T, Suzuki R, Kagami Y, Ogura M, Morishima Y, Mizoguchi Y, Okamoto M, Seto M, Koshikawa T, Mori S, Suchi T. Anaplastic large cell lymphoma: a distinct molecular pathologic entity. A reappraisal with special reference to p80^NPM/ALKexpression. Am J Surg Pathol. 1997. 21:1420–1432.

25. Kinney MC, Kadin ME. The pathologic and clinical spectrum of anaplastic large cell lymphoma and correlation with ALK gene dysregulation. Am J Clin Pathol. 1999. 111:Suppl 1. 56–67.

26. ten Berge RL, Dukers DF, Oudejans JJ, Pulford K, Ossenkoppele GJ, de Jong D, Misere JF, Meijer CJ. Adverse effects of activated cytotoxic T-lymphocytes on the clinical outcome of nodal anaplastic large cell lymphoma. Blood. 1999. 93:2688–2696.

27. ten Berge RL, Oudejans JJ, Ossenkoppele GJ, Pulford K, Willemze R, Falini B, Chott A, Meijer CJ. ALK expression in extranodal anaplastic large cell lymphoma favours systemic disease with (primary) nodal involvement and a good prognosis and occurs before dissemination. J Clin Pathol. 2000. 53:445–450.

28. ten Berge RL, de Bruin PC, Oudejans JJ, Ossenkoppele GJ, van der Valk P, Meijer CJ. ALK-negative anaplastic large-cell lymphoma demonstrates similar poor prognosis to peripheral T-cell lymphoma, unspecified. Histopathology. 2003. 43:462–469.

29. Suzuki R, Kagami Y, Takeuchi K, Kami M, Okamoto M, Ichinohasama R, Mori N, Kojima M, Yoshino T, Yamabe H, Shiota M, Mori S, Ogura M, Hamajima N, Seto M, Suchi T, Morishima Y, Nakamura S. Prognostic significance of CD56 expression for ALK-positive and ALK-negative anaplastic large-cell lymphoma of T/null cell phenotype. Blood. 2000. 96:2993–3000.

30. Lopez-Guillermo A, Cid J, Salar A, Lopez A, Montalban C, Castrillo JM, Gonzalez M, Ribera JM, Brunet S, Garcia-Conde J, Fernandez de Sevilla A, Bosch F, Montserrat E. Peripheral T-cell lymphomas: initial features, natural history, and prognostic factors in a series of 174 patients diagnosed according to the REAL classification. Ann Oncol. 1998. 9:849–855.

31. de Bruin PC, Noorduyn AL, van der Valk P, van Heerde P, van Diest PJ, van de Sandt MM, Ossenkoppele GJ, Meijer CJ. Noncutaneous T-cell lymphomas. Recognition of a lymphoma type (large cell anaplastic) with a relatively favorable prognosis. Cancer. 1993. 71:2604–2612.