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Event-free survival at 24 months is a robust surrogate endpoint for long-term survival in pediatric, adolescent, and adult T cell lymphoblastic lymphoma

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Abstract

T cell lymphoblastic lymphoma (T-LBL) has an aggressive clinical behavior. To date, powerful and consistent prognostic factors have not been established for T-LBL. In this study, we first evaluated the association of event-free survival (EFS) at 24 months (EFS24) with overall survival (OS) in T-LBL patients. Besides, we sought to identify clinical factors of prognostic importance in this rare entity. Between January 2006 and December 2017, ninety-one patients with newly diagnosed T-LBL were retrospectively analyzed. EFS was defined as the time from diagnosis to relapse or progression, unplanned retreatment, death from any cause, or to the last follow-up. In total, 91 patients with a median age of 24 years were enrolled. At a median follow-up of 40.4 months (range, 1.4 to 163.3 months), the 5-year OS and EFS was 47.9% and 43.2%, respectively. Of all patients, 45 (49.5%) achieved EFS24 and 46 (50.5%) did not. Patients who achieved EFS24 showed a markedly superior outcome, compared with those who failed to achieve EFS24 (5-year OS, 90.5% vs 3%, P < 0.001). Univariate analysis indicated bone marrow involvement, response to induction treatment, and stem cell transplantation (SCT) consolidation to be prognostic factors for EFS and OS. In addition, compared with the patients receiving non-Hodgkin's lymphoma (NHL)-like treatment protocols, patients treated with hyper-CVAD showed significantly improved EFS and OS. Such survival advantage in terms of EFS and OS was also observed of BMF-90 regimens over NHL-like therapy, despite that the difference in EFS did not reach statistical significance (P = 0.056). Multivariate analysis demonstrated that achievement of complete remission (CR) after induction therapy and SCT consolidation were independent prognostic indicators for both EFS and OS. We confirm that EFS24 is a strong surrogate endpoint for long-term survival in T-LBL, which is clinically useful for individualized risk reassessment, future clinical trial design, and biomarker discovery validation. Further validation in the context of directed prospective clinical trials is warranted.

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Acknowledgements

We sincerely thank the patients, their families, and all the investigators for their contribution to this study.

Funding

This study was financially supported by the Chinese Academy of Medical Sciences (CAMS) Innovation Fund for Medical Sciences (CIFMS) (Grant no. 2016-I2M-1-001).

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Authors and Affiliations

  1. Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China

    Haizhu Chen, Yan Qin, Jianliang Yang, Peng Liu, Changgong Zhang, Xiaohui He, Shengyu Zhou, Sheng Yang, Lin Gui, Liqiang Zhou, Yan Sun & Yuankai Shi

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  1. Haizhu Chen
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  2. Yan Qin
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Contributions

YKS designed, supervised and supported this study, interpreted the results and revised the manuscript. HZC designed the study, collected the data, analyzed the data and wrote the manuscript. YKS, YQ, JLY, PL, CGZ, XHH, SYZ, SY, LG, LQZ and YS participated in patient management and contributed to material in this study. All authors have critically read, reviewed and approved the final version of the manuscript.

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Correspondence to Yuankai Shi.

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The authors declare that they have no conflicts of interest.

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This study was performed in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College.

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Chen, H., Qin, Y., Yang, J. et al. Event-free survival at 24 months is a robust surrogate endpoint for long-term survival in pediatric, adolescent, and adult T cell lymphoblastic lymphoma. Ann Hematol 99, 2847–2857 (2020). https://doi.org/10.1007/s00277-020-04195-z

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