Primary cutaneous large-cell lymphoma: analysis of 49 patients included in the LNH87 prospective trial of polychemotherapy for high-grade lymphomas

Abstract

The objectives of this study were to evaluate the outcome after polychemotherapy for patients with primary cutaneous large-cell lymphomas (PCLL) and to validate the recently proposed immunohistologic classification of cutaneous lymphomas. Among 140 patients with positive skin biopsies included in the LNH87 protocol (for treatment of aggressive lymphomas), 49 patients met the criteria of PCLL. Characteristics were: sex ratio M/F, 2.3; age 18 to 83 years (median, 52), peripheral lymph nodes, n = 22; diffuse disease, n = 12; median tumor size, 4.5 cm; elevated lactate dehydrogenase, n = 9; ECOG: 0/1, n = 49. Histology was: follicular center B cell, n = 23; B-lymphoblastic, n = 1; anaplastic large-cell lymphoma, n = 14 (T cell phenotype n = 8); CD30⁻ T cell lymphoma, n = 11. All patients received polychemotherapy: under 70 years, ACVBP (three to four cycles and consolidation for 6 months) n = 25; mBACOD (eight cycles) n = 16; over 70 years, C(T)VP (six cycles) n = 8. Radiation therapy was not included in the protocol. With a median follow-up of 5 years, 24/49 patients had relapsed, with 20 skin relapses. Event-free (EFS) and overall survival (OS) at 5 years were, respectively, 50 and 77%. Significant adverse prognostic factors were: histology (CD30⁻ T cell lymphoma) and diffuse cutaneous disease (>10% of skin). The presence of nodal involvement was only significant for EFS. When compared to 140 non-cutaneous lymphoma patients included in the same trial and fully matched for the main clinical characteristics, OS was similar. In conclusion, PCLL behaves like other localized B or T cell extranodal lymphomas with the same prognostic factors (LDH, ECOG, age) except for CD30⁺ PCLL which have a very good prognosis.