Minimal disseminated disease in childhood T-cell lymphoblastic lymphoma: A report from the Children's Oncology Group

Elaine Coustan-Smith, John T. Sandlund, Sherrie L. Perkins, Helen Chen, Myron Chang, Minnie Abromowitch, Dario Campana

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Abstract

Purpose: Disease dissemination to the bone marrow is detected at diagnosis in approximately 15% of children with T-cell lymphoblastic lymphoma (T-LL). It is unclear whether the remaining patients have submicroscopic systemic disease and, if so, what is the clinical significance of this finding. Patients and Methods: Using a flow cytometric method that can detect one T-LL cell among 10,000 normal cells, we examined bone marrow and peripheral-blood samples collected from 99 children with T-LL at diagnosis, as well as blood samples collected from 42 patients during treatment. Results: In 71 (71.7%) of the 99 marrow samples obtained at diagnosis, T-LL cells represented 0.01% to 31.6% (median, 0.22%) of mononuclear cells; 57 of the 71 T-LL-positive samples were from patients with stage II/III disease. Results of studies in bilateral marrow aspirates were highly concordant. Two-year event-free survival (EFS) was 68.1% ± 11.1% (SE) for patients with ≥ 1% T-LL cells in bone marrow versus 90.7% ± 4.4% for those with lower levels of marrow involvement (P = .031); EFS for patients with ≥ 5% lymphoblasts was 51.9% ± 18.0% (P = .009). T-LL cells were as prevalent in blood as in marrow; monitoring residual T-LL cells in blood during remission induction therapy identified patients with slower disease clearance. Conclusion: More than two thirds of children with T-LL have disseminated disease at diagnosis, a proportion much higher than previously demonstrated. Measurements of disease dissemination at diagnosis might provide useful prognostic information, which can be further refined by monitoring response to therapy through blood testing.

Original languageEnglish (US)
Pages (from-to)3533-3539
Number of pages7
JournalJournal of Clinical Oncology
Volume27
Issue number21
DOIs
StatePublished - Jul 20 2009

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T-Cell Lymphoma
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Bone Marrow
Bone Marrow Cells
Disease-Free Survival
Remission Induction
Blood Cells
Therapeutics

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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Minimal disseminated disease in childhood T-cell lymphoblastic lymphoma : A report from the Children's Oncology Group. / Coustan-Smith, Elaine; Sandlund, John T.; Perkins, Sherrie L.; Chen, Helen; Chang, Myron; Abromowitch, Minnie; Campana, Dario.

In: Journal of Clinical Oncology, Vol. 27, No. 21, 20.07.2009, p. 3533-3539.

Research output: Contribution to journalArticle

Coustan-Smith, Elaine ; Sandlund, John T. ; Perkins, Sherrie L. ; Chen, Helen ; Chang, Myron ; Abromowitch, Minnie ; Campana, Dario. / Minimal disseminated disease in childhood T-cell lymphoblastic lymphoma : A report from the Children's Oncology Group. In: Journal of Clinical Oncology. 2009 ; Vol. 27, No. 21. pp. 3533-3539.
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abstract = "Purpose: Disease dissemination to the bone marrow is detected at diagnosis in approximately 15{\%} of children with T-cell lymphoblastic lymphoma (T-LL). It is unclear whether the remaining patients have submicroscopic systemic disease and, if so, what is the clinical significance of this finding. Patients and Methods: Using a flow cytometric method that can detect one T-LL cell among 10,000 normal cells, we examined bone marrow and peripheral-blood samples collected from 99 children with T-LL at diagnosis, as well as blood samples collected from 42 patients during treatment. Results: In 71 (71.7{\%}) of the 99 marrow samples obtained at diagnosis, T-LL cells represented 0.01{\%} to 31.6{\%} (median, 0.22{\%}) of mononuclear cells; 57 of the 71 T-LL-positive samples were from patients with stage II/III disease. Results of studies in bilateral marrow aspirates were highly concordant. Two-year event-free survival (EFS) was 68.1{\%} ± 11.1{\%} (SE) for patients with ≥ 1{\%} T-LL cells in bone marrow versus 90.7{\%} ± 4.4{\%} for those with lower levels of marrow involvement (P = .031); EFS for patients with ≥ 5{\%} lymphoblasts was 51.9{\%} ± 18.0{\%} (P = .009). T-LL cells were as prevalent in blood as in marrow; monitoring residual T-LL cells in blood during remission induction therapy identified patients with slower disease clearance. Conclusion: More than two thirds of children with T-LL have disseminated disease at diagnosis, a proportion much higher than previously demonstrated. Measurements of disease dissemination at diagnosis might provide useful prognostic information, which can be further refined by monitoring response to therapy through blood testing.",
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