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DOI: 10.1055/s-0042-1743507
Assessment of Cranial Radiotherapy Treatment in T-cell Lymphoblastic Lymphoma: Retrospective Study from Tertiary Care Center
Finding None.![](https://www.thieme-connect.de/media/10.1055-s-00050348/202202/lookinside/thumbnails/10-1055-s-0042-1743507_21298436-1.jpg)
Abstract
Introduction Leukemia-like regimens given for acute lymphoblastic leukemia (ALL) are the cornerstone of treatment for T-cell lymphoblastic lymphoma (LBL) and can produce complete remission rates exceeding 90%. For central nervous system (CNS) prophylaxis, intrathecal chemotherapy and cranial irradiation are used to prevent future CNS recurrence.
Objective The purpose of this study was to assess CNS relapse rate after cranial prophylaxis treatment given at our institute.
Materials and Methods In this retrospective analysis, between July 2013 and June 2019, 149 files of lymphoblastic lymphoma were reviewed. Out of these, 53 patients received cranial irradiation. All patients were given CNS-directed therapy in the form of intrathecal methotrexate and patients with CNS-negative disease and primary tumor complete response or more than partial response after chemotherapy were given prophylactic cranial irradiation (18 Gy/10#), and in patients with upfront CNS involvement, therapeutic cranial irradiation (24 Gy/12#) was delivered. Radiotherapy was delivered as per the standard conventional protocol on a linear accelerator.
Results Out of 53 patients (age range: 2–50 years, mean–16.79 years, 26 [49.1%] pediatric [<14 years], 27 [50.9%] adults [>14 years]), 13/53 (24.5%), and 40/53 (75.5%) patients were on MCP 841 and BFM 90 protocols, respectively. Also, 48 (90.56%) patients received prophylactic cranial irradiation (25 [52.1%] pediatric, 23 [47.9%] adults). Moreover, 3/48 (6.25%) (2 [4.16%] pediatric, 1 [2.08%] adult) patients had CNS failure after receiving prophylactic cranial irradiation. For 48 target patients, with the median follow-up of 27.27 months (26.1 months–pediatric, 28.2 months– adults), EFS (event-free survival) in the brain was 93.8% (92%: pediatric, 95.7%: adults). Also, the difference between pediatric and adult groups was not statistically significant (p-value = 0.662). Five (9.43%) patients had CNS-positive disease upfront and received therapeutic cranial irradiation.
Conclusion In BFM 90/MCP 841 protocol in lymphoblastic lymphoma, prophylactic cranial irradiation and intrathecal methotrexate have been the standard of care as the CNS-directed therapy to prevent cranial infiltration. Though our results are not at par with the published world literature, further research and efforts are required to prevent CNS relapse in a selected sub-set of patients with lymphoblastic lymphoma.
Authors' Contributors
Dr. Maitrik Mehta proposed the stated study objective to be assessed and contributed to data collection, analysis of the data, conception and design, drafting the article, and final approval of the version to be published. Dr. Isha Shah helped in collecting and analyzing the data and helped in the preparation of the manuscript. Dr. Harsha Panchal helped in manuscript assessment and analysis of data. Dr. Ankita Parikh, Dr. U. Suryanarayan, Dr. Jayesh Singh, Dr. Arun T. helped in manuscript editing. All authors approved the final version of the manuscript.
Publication History
Article published online:
29 April 2022
© 2022. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Campo E, Swerdlow SH, Harris NL, Pileri S, Stein H, Jaffe ES. The 2008 WHO classification of lymphoid neoplasms and beyond: evolving concepts and practical applications. Blood 2011; 117 (19) 5019-5032
- 2 Soslow RA, Baergen RN, Warnke RA. B-lineage lymphoblastic lymphoma is a clinicopathologic entity distinct from other histologically similar aggressive lymphomas with blastic morphology. Cancer 1999; 85 (12) 2648-2654
- 3 Kantarjian HM, O'Brien S, Smith TL. et al. Results of treatment with hyper-CVAD, a dose-intensive regimen, in adult acute lymphocytic leukemia. J Clin Oncol 2000; 18 (03) 547-561
- 4 Kantarjian HM, Thomas D, Ravandi F. et al. Defining the course and prognosis of adults with acute lymphocytic leukemia in first salvage after induction failure or short first remission duration. Cancer 2010; 116 (24) 5568-5574
- 5 Cortelazzo S, Ponzoni M, Ferreri AJM, Hoelzer D. Lymphoblastic lymphoma. Crit Rev Oncol Hematol 2011; 79 (03) 330-343
- 6 Sweetenham JW, Mead GM, Whitehouse JM. Adult lymphoblastic lymphoma: high incidence of central nervous system relapse in patients treated with the Stanford University protocol. Ann Oncol 1992; 3 (10) 839-841
- 7 Kolotas C, Daniel M, Demetriou L. et al. Long-term effects on the intelligence of children treated for acute lymphoblastic leukemia. Cancer Invest 2001; 19 (06) 581-587
- 8 Raje NS, Vaidya SJ, Kapoor G. et al. Low incidence of CNS relapse with cranial radiotherapy and intrathecal methotrexate in acute lymphoblastic leukemia. Indian Pediatr 1996; 33 (07) 556-560
- 9 Reiter A, Schrappe M, Parwaresch R. et al. Non-Hodgkin's lymphomas of childhood and adolescence; results of a treatment stratified for biological subtypes and stage: a report of the BFM Group. J Clin Oncol 1995; 13 (02) 359-372
- 10 Müller-Weihrich S, Henze G, Jobke A. et al. BFM study 1975/81 for treatment of non-Hodgkin lymphoma of high malignancy in children and adolescents [article in German]. Klin Padiatr 1982; 194 (04) 219-225
- 11 Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958; 53: 457-481
- 12 Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep 1966; 50 (03) 163-170
- 13 Hustu HO, Aur RJ. Extramedullary leukaemia. Clin Haematol 1978; 7 (02) 313-337
- 14 Schrappe M, Reiter A, Henze G. et al. Prevention of CNS recurrence in childhood ALL: results with reduced radiotherapy combined with CNS-directed chemotherapy in four consecutive ALL-BFM trials. Klin Padiatr 1998; 210 (04) 192-199
- 15 Rivera GK, Raimondi SC, Hancock ML. et al. Improved outcome in childhood acute lymphoblastic leukaemia with reinforced early treatment and rotational combination chemotherapy. Lancet 1991; 337 (8733): 61-66
- 16 Abromowitch M, Ochs J, Pui CH. et al. High-dose methotrexate improves clinical outcome in children with acute lymphoblastic leukemia: St. Jude Total Therapy Study X. Med Pediatr Oncol 1988; 16 (05) 297-303
- 17 Rivera GK, Pui CH, Hancock ML. et al. Update of St Jude Study XI for childhood acute lymphoblastic leukemia. Leukemia 1992; 6 (Suppl. 02) 153-156
- 18 Gelber RD, Sallan SE, Cohen HJ. et al. CNS relapse in leukemias. Cancer 1993; 72: 261-270
- 19 Coleman CN, Picozzi Jr VJ, Cox RS. et al. Treatment of lymphoblastic lymphoma in adults. J Clin Oncol 1986; 4 (11) 1628-1637
- 20 Komp DM, Fernandez CH, Falletta JM. et al. CNS prophylaxis in ALL. Cancer 1982; 50: 1031-1036
- 21 Burkhardt B, Woessmann W, Zimmermann M. et al. Impact of cranial radiotherapy on central nervous system prophylaxis in children and adolescents with central nervous system-negative stage III or IV lymphoblastic lymphoma. J Clin Oncol 2006; 24 (03) 491-499
- 22 Murphy SB, Fairclough DL, Hutchison RE, Berard CW. Non-Hodgkin's lymphomas of childhood: an analysis of the histology, staging, and response to treatment of 338 cases at a single institution. J Clin Oncol 1989; 7 (02) 186-193
- 23 Murphy SB. Classification, staging and end results of treatment of childhood non-Hodgkin's lymphomas: dissimilarities from lymphomas in adults. Semin Oncol 1980; 7 (03) 332-339
- 24 Rosenberg SA. Validity of the Ann Arbor staging classification for the non-Hodgkin's lymphomas. Cancer Treat Rep 1977; 61 (06) 1023-1027