Clinicopathologic and therapeutic aspects of angioimmunoblastic lymphadenopathy-related lesions

Cancer. 1992 Mar 1;69(5):1259-67. doi: 10.1002/cncr.2820690531.

Abstract

The clinicopathologic features of 14 patients with angioimmunoblastic lymphadenopathy (AIL)-related lesions were analyzed. Lymph node biopsy specimens from all the patients showed a diffuse obliteration of lymph node architecture, prominent vascular proliferation, a polymorphous cellular infiltrate, including immunoblasts, and varying degrees of clear cell proliferation. The patients were eight males and six females, with a median age of 58.5 years. All but one were in an advanced stage at the time of diagnosis. Bone marrow involvement was observed in eight patients. Thirteen patients had a negative serologic reaction for antibody to human T-cell leukemia virus type I (HTLV-I), and one patient was considered to be a HTLV-I carrier. Polyclonal hypergamma-globulinemia was observed in 6 patients, and 6 of the 12 patients showed elevated IgE levels. Immunophenotyping of the involved lymph nodes revealed a preponderance of T-cells in all the patients. Eleven of these patients showed a predominance of CD4+ over CD8+ T-cells, and only one patient showed a predominance of CD8+ over CD4+ T-cells. Two of five patients whose gene analysis was carried out showed clonal rearrangement of the T-cell receptor beta chain gene without rearrangement of the immunoglobulin heavy chain genes. Twelve patients received doxorubicin-containing combination chemotherapy; of these, 7 patients achieved complete response, and the other 5 had partial response. Nine patients are still alive with a median follow-up period of 21 months, and five patients died during the follow-up period. Progression to high-grade T-cell lymphoma with systemic infiltration was ascertained in two of three cases for which autopsy was performed. From our experience, we recommend doxorubicin-containing combination chemotherapy as initial therapy for AIL-related lesions.

MeSH terms

  • Aged
  • Antibodies, Viral / analysis
  • Antigens, CD / analysis
  • Antigens, Surface / analysis
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Cyclophosphamide / administration & dosage
  • Doxorubicin / administration & dosage
  • Female
  • Follow-Up Studies
  • Human T-lymphotropic virus 1 / immunology
  • Humans
  • Immunoblastic Lymphadenopathy / drug therapy*
  • Immunoblastic Lymphadenopathy / mortality
  • Immunoblastic Lymphadenopathy / pathology*
  • Immunophenotyping
  • Lymph Nodes / pathology
  • Male
  • Melphalan / administration & dosage
  • Methotrexate / administration & dosage
  • Middle Aged
  • Neoplasm Staging
  • Prednisone / administration & dosage
  • Remission Induction
  • Survival Rate
  • Vincristine / administration & dosage

Substances

  • Antibodies, Viral
  • Antigens, CD
  • Antigens, Surface
  • Vincristine
  • Doxorubicin
  • Cyclophosphamide
  • Melphalan
  • Prednisone
  • Methotrexate

Supplementary concepts

  • CHOP protocol
  • COP protocol 2
  • VMCP protocol