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Lymphoma

Hematopoietic stem cell transplantation for adults with T-cell lymphoblastic lymphoma: can we successfully step into the era of precision medicine?

Leukemia volume 34, pages 1213–1214 (2020)Cite this article

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Lymphoblastic lymphoma (LBL) is a relatively rare but highly aggressive type of non-Hodgkin lymphoma (NHL), most of which have T-cell origin (T-LBL) [1]. Due to the rarity of T-LBL, no well-designed prospective clinical trials have been conducted to establish the optimal treatment regimens. It is generally recognized that acute lymphoblastic leukemia (ALL)-like intensive chemotherapies can acheive more favorable prognosis in T-LBL than NHL-like regimens [1,2,3]. Though the prognosis of pediatric T-LBL has been improved significantly, unmet clinical needs exist in the treatment of adult T-LBL [2]. Although ALL-like intensive induction chemotherapies could induce high remission rate, the relapse rate remains high (40–50%). Currently, intensive consolidation chemotherapies followed by maintenance treatment or hematopoietic stem cell transplantation (HSCT) are used to reduce the relapse rate although the role of HSCT consolidation has not been defined [1].

In addition, no reliable prognostic factors have been defined in adult T-LBL as in T-ALL [4]. Commonly used risk factors, such as bone marrow and central nervous system involvement, advanced stage, and elevated serum lactate dehydrogenase level showed prognostic value [5] which is yet to be validated in the era of ALL-like treatment. Recently the GRAALL-LYSA LL03 study has proposed a four-gene oncogenetic classifier (NOTCH1/FBXW7/RAS/PTEN) [6]. Cortelazzo et al. suggested that minimal residual disease (MRD) in the bone marrow, based on analysis of T-cell receptor gene rearrangement in a small number (n = 11) of patients, was a useful index to assign adult patients with T-LBL to HSCT [7]. MRD monitoring may be combined with PET-CT scan for selection of HSCT and maintenance therapy. However, several studies found that PET-CT findings did not predict clinical outcome in T-LBL [6, 8], and the incidence of false-positive PET-CT scan for mediastinum lesions can be high [9].

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  1. Duke University School of Medicine, Duke Medical Center, Duke Cancer Institute, Durham, NC, 27710, USA

    Ken H. Young

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Young, K.H. Hematopoietic stem cell transplantation for adults with T-cell lymphoblastic lymphoma: can we successfully step into the era of precision medicine?. Leukemia 34, 1213–1214 (2020). https://doi.org/10.1038/s41375-019-0608-4

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