LYMPHOBLASTIC LYMPHOMA IN ADULTS - A STUDY ON 30 PATIENTS TREATED WITH 2 DIFFERENT PROGRAMS ACCORDING TO BONE-MARROW FINDINGS

Thirty adult patients with lymphoblastic lymphoma were treated with 2 different programs according to bone marrow findings. Bone marrow positive patients were given an ALL[acute lymphoblastic leukemia]-like program: vincristine, daunorubicin, cyclophosphamide and prednisone for induction of remission, CNS prophylaxis, continuous maintenance for 3 yr and monthly reinductions. Bone marrow negative patients were given a conventional lymphoma program with [CHOP-Bleo and limited RT [response time] on bulky mediastinum without CNS prophylaxis. The CR [complete response] rate of the whole group was 54% (62% for ALL-treated vs. 47% for lymphoma-treated patients; not significantly different), with a median survival for remitters of 28.5 mo. Relapse-free survival of the whole group was 65% at 12 and 25% at 24 mo. Stage IV ALL-treated patients had a median survival of 16.5 vs. 10 mo. for stage IV lymphoma-treated ones (P = 0.05); the 3 yr survival was 24 and 10%, respectively. No patients undergoing CNS prophylaxis (ALL-therapy) had neurological complications or late meningeal relapse. The better prognosis of ALL-treated patients, in spite of bone marrow positivity, argues in favor of an ALL-like therapy in all adult lymphoblastic lymphomas, in terms of CR rate, overall survival and absence of CNS relapse. This therapy must be adopted irrespective of bone marrow findings and regardless of how localized the lymphoma appears to be.