Lymphoblastic Lymphoma in Adults: An Experience of 15 Cases Treated at the Tri-Service General Hospital

我們分析三軍總醫院過去七年間共15例成人淋巴芽球淋巴瘤病人，年齡從19歲至73歲，而中間年齡為25歲。男女比為6.5：1。在診斷時，出現頸部淋巴結大者有13例（佔85%），縱膈腔腫塊有12例（佔80%），骨髓侵犯有8例（í占53%），週邊血液出現淋巴芽細胞有5例（佔33%），並無中樞神經侵犯的病例。大部份病人期數都較高（第四期病人有73%，第三期有20%，第二期有7%），這15個病例都是屬於T細胞的淋巴芽球淋巴瘤。依治療時間的不同，病人接受三種化學治療（CHOP，ProMACE-MOPP，Stanford-NCOG療法）中的一種。在接受ProMACE-MOPP的3人中，無人達完全緩解，6人接受CHOP有1例獲完全緩解，Stanford-NCOG療法的6人中有5例達完全緩解。其中間存活時間分別為6，8.5，12個月。有兩例在疾病復發接受異體骨髓移植，他們分別在移植後的3，24個月後仍是無疾病存活。我們結論是成人淋巴芽球巴瘤是一預後不佳的疾病，即使接受積極化療，很多病人仍復發而死亡。雖然積極的化療如Stanford-NCOP療法己改善治療的結果，但骨髓移植較有機會提供長期存活，即使病人疾病已復發。Fifteen adult patients with lymphoblastic lymphoma (LBL) at Tri-Service General Hospital between 1986 and 1992 were analyzed. The age ranged from 19 to 73 years, with a median of 25 years. The male-to-female ratio was 6.5:1. At presentation, cervical lymphadenopathy was seen in 13 patients (87%), mediastinal mass in 12 patients (80%), bone marrow involvement in 8 patients (53%), the presence of circulating blasts in 5 patients (33%) and no initial CNS involvement was observed. Most patients had advanced stage (stage IV in 73%, III in 20% and II in 7%) at diagnosis. The immunophenotyping of all 15 cases proved to be of T-cell lineage. Pateints were treated with one of the three various chemotherapy regimens (CHOP, ProMACE-MOPP and Stanford-NCOG protocol) depending on the time of tumor being treated. Complete remission (CR) was achieved in none of 3 case treated with ProMACE-MOPP; in one of 6 cases with CHOP; and in five of 6 cases with Stanford-NCOG protocol. The median survival time is 6, 8.5 and 12 months, respectively. Allogeneic bone marrow transplantations (BMT) were performed in two cases who had evidence of relpase. They remained alive and disease-free 3 and 24 months after tranplants. We concluded that adult LBL is associated with a poor prognosis and many patients may relapse and die of their disease, even eith intensive chemotherapy. Though aggressive chemotherapy such as Stanford-NCOG protocol have improved the outcome of LBL patients, BMT has shown the potential for long-term disease-free survival, even in relapsed patients.