Minimal Disseminated Disease in Childhood T-Cell Lymphoblastic Lymphoma: A Report From the Children's Oncology Group

• Published in: Journal of clinical oncology Vol. 27; no. 21; pp. 3533 - 3539
• Main Authors: COUSTAN-SMITH, Elaine, SANDLUND, John T, PERKINS, Sherrie L, CHEN, Helen, CHANG, Myron, ABROMOWITCH, Minnie, CAMPANA, Dario
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Society of Clinical Oncology 20.07.2009
• Subjects: Biological and medical sciences; Bone Marrow Cells; Bone Marrow Diseases - microbiology; Child; Disease Transmission, Infectious; Flow Cytometry; Humans; Lymphoma, B-Cell - blood; Lymphoma, Non-Hodgkin; Lymphoma, T-Cell - chemistry; Medical sciences; Original Reports; Pediatric Oncology; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma - blood; Precursor Cell Lymphoblastic Leukemia-Lymphoma - genetics; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma - blood; Transplantation Conditioning; Tumors; Human; Cancerology; T lymphoma; Minimal residual disease; Malignant tumor; Child; Cancer
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2008.21.1318

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 > or = 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 > or = 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.