Clinicopathological Features of Adult Lymphoblastic Lymphoma Patients: Data from Turkiye

Clinicopathological Features of Adult Lymphoblastic Lymphoma Patients: Data from Turkiye | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Clinicopathological Features of Adult Lymphoblastic Lymphoma Patients: Data from Turkiye Cem SELİM, Rafiye Çiftçiler, Deniz Gören, Kemal Fidan, Ali Ünal, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6814198/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction Lymphoblastic lymphoma (LBL) is a highly malignant tumor composed of immature lymphocytes derived from B or T cells. LBL is usually distinguished from ALL by the presence of less than 25% of bone marrow-invading blasts. Our study examined the data of LBL patients diagnosed and treated at centers within our country. Material method Thirty-eight patients from seven distinct tertiary adult hematology clinics were chosen for this investigation. Individuals aged 18 and older with a pathologically confirmed diagnosis of LBL, who had radiological assessments for clinical staging and received a minimum of one chemotherapy regimen, were included in the study. Results Overall survival (OS) for all patients was 23 months, 21 months for patients with T-LBL, and 56 months for individuals with B-LBL. Despite a significant difference in overall survival (OS) between patients diagnosed with T-LBL and those diagnosed with B-LBL, no significant difference in OS was found between the two groups (p > 0.05). The median progression-free survival (PFS) of the patients was determined as 6 months. Discussion The data from our study indicate that elevated LDH levels, central nervous system involvement, involvement in three or more regions, cervical lymph node involvement, achieving remission after the initial treatment, and male gender (with no significant difference observed in the T-LBL subgroup) adversely affect prognosis. Biological sciences/Cancer Health sciences/Oncology Lymphoblastic Lymphoma Diagnosis Risk Factors Treatment Figures Figure 1 Figure 2 Introduction Lymphoblastic lymphoma (LBL) is a highly malignant tumour composed of immature lymphocytes that originate from B or T cells and, less commonly, from killer (NK) cells. It shares similar biological and morphological characteristics with acute lymphoblastic leukaemia (ALL). Although the 2017 and 2022 WHO classification groups these entities together, LBL is often distinguished from ALL by the presence of fewer than 20% marrow-invading blasts ( 1 , 2 ). Extraorgan involvement and lymphadenopathy are more prevalent in LBL compared to ALL and has prognostic significance ( 2 ). Despite being clinically identical, LBL ALL should be considered distinct clinically due to their significant differences in clinical presentation, as well as certain variations in prognostic variables and therapeutic approaches ( 3 ). LBL is an uncommon disease, and precise incidence data are insufficient; in significant research and epidemiological surveys, LBL is frequently categorised with ALL (with an estimated incidence of 1.3 per 100,000 annually) or Burkitt lymphoma (1.46 per 100,000 annually) ( 4 ). LBL constitutes 2–4% of non-Hodgkin lymphomas or ALL's in adults and under 30% in children. The prevalence of LBL seems to be rising alongside heightened disease awareness. LBL is primarily detected in young males aged 10 to 30 years, and unlike ALL, it occurs more commonly with a T-cell immunophenotype, causing greater lymph node and solid organ involvement. ( 4 , 5 ). B-LBL is consistently positive for at least two B-cell markers among CD19, CD79, and CD22. CD10, CD24, PAX5, and TdT are expressed in most cases, while the expression of CD20 and the stem cell antigen CD34 is variable, and CD45 may be absent ( 6 ). T-LBL often expresses a cortical CD1a + phenotype; early-T phenotypes are rare, confer a lower risk of mediastinal involvement, but a higher risk of bone marrow dissemination. An early thymic precursor (ETP) phenotype, originally described in T-ALL, is sometimes present in LBL. These cases express very early T-lymphoid markers without CD1a, CD8, and CD antigens (CD5-negative or dim) and normally co-express stem/myeloid cell markers ( 7 ). The International Prognostic Index (IPI), which includes age, extranodal sites, LDH levels, stage, and performance status, was not predictive for LBL. Historically, LBL stage IV patients with bone marrow or CNS involvement and high LDH levels (> 300 IU/L) had only a 19% five-year relapse-free probability, compared to 94% in low-risk patients ( 8 ). Recent studies suggest that older age, Black ethnicity, and advanced disease stage may worsen prognosis. Genetic changes such as t(9;17) (q34;q32) and loss of heterozygosity at 6q could also negatively impact outcomes ( 9 ). The GRAAL-LYSA study developed an oncogenetic-based prognostic score for T-LBL, where NOTCH1/FBXW7 mutations, in the absence of RAS/PTEN alterations, indicated a favourable prognosis ( 10 ). In contrast, adult patients with ETP LBL treated with standard chemotherapy had significantly poorer outcomes than those without ETP. This T-LBL variant is considered very high-risk, similar to ETP ALL ( 11 ). Additionally, CT/PET responses and analyses of minimally disseminated disease (MDD)/measurable residual disease (MRD) may be crucial for prognosis ( 3 ). The execution of intensive ALL-like protocols has resulted in considerable progress in the treatment of adult LBL ( 12 ). Moreover, significant advancements have resulted from diverse treatment protocols, distinct pediatric regimens, radiation, allogeneic hematopoietic stem cell transplantation, and intrathecal therapy, particularly for patients at elevated risk of central nervous system involvement ( 13 , 14 ). Consensus on various aspects, such as prognostic factors and treatment of LBL, a rare disease, remains elusive. The limited patient population hinders the formation of a unified consensus. Our study examined the data of LBL patients diagnosed and treated at centers within our country. Material method Patient Selection This retrospective study selected 38 patients from seven separate tertiary adult hematology clinics from 2018 to June 2024. Patients who were 18 years or older, had a confirmed diagnosis of LBL from lymph nodes or other areas, had less than 20% blasts in their bone marrow from a biopsy, had imaging tests for staging, and had at least one round of chemotherapy were included in the study. The principal endpoint of the trial was identified as patient mortality. Due to the retrospective nature of our investigation, the varied treatment and follow-up regimens implemented by the participating sites augmented the data diversity. Participants were informed in accordance with the principles stated in the Declaration of Helsinki and their written consent was obtained. The study received approval from the Konya Selçuk University Research Ethics Committee, number 2024/586, and was conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants. Evaluation and Follow-up All patients at the study centers underwent enhanced computed tomography (CT) or positron emission tomography/computed tomography (PET/CT) for evaluation and staging purposes. All participants in the study received a bone marrow biopsy. Treatment response was evaluated based on the updated efficacy assessment criteria set forth by the International Working Group (IWG) for malignant lymphoma ( 15 ). Following treatment, patients at the participating centers were monitored every three months for the initial two years if in remission, every six months from years three to five, and annually thereafter. Patients not in remission were scheduled for follow-up more frequently based on clinical and laboratory findings, and hospitalization was requested when necessary. Patients in remission were assessed at each evaluation, with parameters including blood cell count, serum lactate dehydrogenase (LDH) levels, and imaging techniques such as ultrasonography when clinical suspicion arose. Statistical analysis Statistical analyses were performed using SPSS version 25 software. Survival was examined using univariate analyses using the log-rank test. In multivariate analysis, independent factors in predicting survival were examined using Cox regression analysis with the backward selection method using possible factors determined in previous analyses. Survival rates were calculated using the Kaplan-Meier method. Clinically significant parameters were selected from the interrelated parameters that had similar effects on survival. Model fit and periodic risk proportionality assumptions were evaluated using residual (Schoenfeld and Martingale) analyses. Situations with a Type-1 error level below 5% were interpreted as statistically significant. Results The median age of 38 patients with LBL included in the study was 37 ± 13 years; 24 (63%) were male, and 14 (37%) were female. The ages of patients diagnosed with T-LBL and B-LBL were statistically similar (p > 0.05), and no statistical association was found between increasing age and OS (p > 0.05). The median follow-up period of the patients was determined as 23 months (range 1 to 64 months). Among the 38 patients in the study, 10 (26%) were identified with B-LBL using tissue biopsy and flow cytometry, whereas 28 (74%) were classified as T-LBL based on the same diagnostic methods. The overall survival (OS) was determined to be 23 months for all patients, 21 months for those with T-LBL, and 56 months for individuals with B-LBL. Despite a notable disparity in median OS between patients diagnosed with T-LBL and those with B-LBL, no significant difference in median OS was detected between the two groups, attributable to the limited number of patients with a B-LBL diagnosis (p > 0.05). The average progression-free survival (PFS) of the patients was determined to be 6 months. Progression-free survival (PFS) was seen to be 4 months in individuals diagnosed with T-LBL, but it was 12 months in those diagnosed with B-LBL. No statistically significant difference was observed in the PFS values between the two groups. Figure 1 illustrates the data pertaining to median overall survival (OS) and progression-free survival (PFS). Twenty patients diagnosed with T-LBL were male and eight were female, while four patients identified with B-LBL were male and six were female. Despite a higher prevalence of women among those diagnosed with B-LBL, no statistically significant difference in gender was seen between the two groupings (p > 0.05). The median OS for men diagnosed with T-LBL was 20 months, whereas for women it was 24 months, with no statistically significant difference observed between the two groups (p > 0.05). The median OS for men diagnosed with B-LBL was 13 months, whereas for women it was 56 months, revealing a statistically significant difference between the two groups (p < 0.05). Upon examination of all patients diagnosed with LBL, the median OS for men was 18 months, while for women it was 56 months, revealing a statistically significant difference between the two groups (p < 0.05). Information on the laboratory values ​​of the patients is given in Table 1 . While 19 (50%) of the patients were diagnosed with mediastinal lymph node biopsy, 10 (26%) were diagnosed with cervical lymph node biopsy. Mediastinal lymph node involvement was present in 34 (89.5%) of the patients, while 30 (79%) had cervical lymph node involvement. Pleural or pericardial fluid formation was detected in 29 (76%) of the patients, and bone marrow involvement was detected in 21 (55%). Central nervous system involvement was detected in 6 (16%) patients, involvement of three or more anatomic regions in 22 (58%) patients, and extra organ involvement in 19 (50%) patients. Twenty-nine patients, constituting 76% of the study cohort, were classified as stage 4. Nine (24%) of the patients included in the study underwent auto-SCT and 11 (29%) underwent allo-SCT, while the remaining 18 patients did not receive transplantation. Second-line treatment was applied to 28 (73.7%) patients, while 18 (47%) required third-line treatment. The median survival of the patients was determined to be 23 months. General information about the patients participating in the study is given in Table 2 . Table 1 Characteristics of patients in study LBL T-LBL B-LBL Age 37.3 38.5 34.2 Sedimentation 42.7 48.6 26.1 LDH 604 660 440 Platelet (mcL) 213800 200000 250800 WBC (mcL) 8970 8990 5050 Lymphocyte (mcL) 3320 3800 4300 Hemoglobin (g/dl) 12.3 12.0 13.3 Median OS (month) 23 21 56 OS : Overall survival Table 2 Details of the patients included in the study Gender LBL T-LBL B-LBL Male 24 (63%) 20 4 Female 14 (37%) 8 6 Cervical LAP 30 (79%) 25 5 Mediastinal LAP 34 (89.5%) 25 9 Axillary LAP 15 (39.5%) 13 2 Supraclavicular LAP 12 (32%) 10 2 Abdominal LAP 16 (42%) 14 2 Ingunal LAP 9 (24%) 8 1 Pleural – Pericardial fluid 29 (76%) 22 7 Bone marrow involvement 21 (55%) 19 2 CNS involvement 6 (16%) 5 1 Presence of involvement in three or more anatomical regions 22 (58%) 17 5 Extra organ involvement 19 (50%) 11 8 T cell marker 28 (74%) B cell marker 10 (26%) Myeloid marker 6 (16%) 3 3 Stage 1 4 (11%) 2 2 2 2 (5%) 2 0 3 3 (8%) 2 1 4 29 (76%) 22 7 First line treatment EPOCH 12 (31.6%) 10 2 CHOP 5 (13%) 3 2 HYPERCVAD 11 (29%) 7 4 BFM 3 (8%) 1 2 GMALL 3 (8%) 3 0 CALGB 2 (5%) 2 0 CHOEP 2 (5%) 2 0 Response to first-line therapy Complete Remission 13 (34%) 9 4 Partial remission 15 (39.5%) 12 3 Stable 3 (8%) 3 0 Progressive disease 7 (18.5%) 4 3 Transplantation Auto-SCT 10 (26%) 7 3 Allo-SCT 11 (29%) 9 2 None 17 (45%) 12 5 Patient status Living 15 (39.5%) 10 5 Exitus 23 (60.5%) 18 5 Total 38 28 10 Auto-SCT : autologous hematopoietic stem cell transplantation, allo-SCT : allogeneic hematopoietic stem cell transplantation, LAP : lymphadenopathy, T-LBL : T-cell lymphoblastıc lymphoma, B-LBL : B-cell T-cell lymphoblastıc lymphoma. Twelve (32%) of the patients in the study received the EPOCH (etoposide, doxorubicin, cyclophosphamide, vincristine, and prednisone) protocol at their own centers, and 9 of the 12 patients completed the treatment. Three of the patients who received EPOCH treatment received autologous hematopoietic stem cell transplantation (auto-SCT), and the other received allogeneic hematopoietic stem cell transplantation (allo-SCT). Five (14%) of the patients in the centers participating in the study received CHOP (doxorubicin, cyclophosphamide, vincristine, and prednisone) treatment. Four of the patients who received CHOP treatment were able to complete the treatment, and one could not complete the treatment due to disease progression. Two of the patients who received CHOP treatment received allogeneic stem cell transplantation. Eleven (30%) patients received the HYPERCVAD (doxorubicin, cyclophosphamide, vincristine, dexamethasone, methotrexate, and cytarabine) protocol, and all patients who received this treatment completed the treatment. Four of these patients had auto-SCT, and four had allo-SCT. Three (7%) of the patients included in the study received the BFM (doxorubicin, cyclophosphamide, vincristine, dexamethasone, methotrexate, cytarabine, L-asparaginase, 6-mercaptopurine) protocol; two of these patients completed the treatment, and the patients who completed the treatment underwent auto-SCT. Three patients (7%) received the GMALL (daunorubicin, cyclophosphamide, vincristine, dexamethasone, methotrexate, cytarabine, L-asparaginase, and 6-mercaptopurine) protocol, and two patients who completed treatment underwent allo-SCT, and one patient underwent auto-SCT. Two patients (5%) received CALGB (daunorubicin, cyclophosphamide, vincristine, prednisolone, methotrexate, cytarabine, pegasparaginase, and 6-mercaptopurine) treatment, and one patient who completed treatment underwent allo-SCT, and one patient was followed up without transplantation. Finally, two patients (5%) received CHOEP (etoposide, doxorubicin, cyclophosphamide, vincristine, and prednisone) treatment, and two patients who completed treatment were followed up without transplantation. The treatments received by the 38 patients included in the study were summarised, and no statistical significance was observed between the treatments received by the patients and the median OS (p < 0.05). The median OS related to the treatments is shown in Table 3 . Table 3 Treatments received by patients included in the study and median OS times LBL Median OS (month) T-LBL Median OS (month) B-LBL Median OS (month) EPOCH 23 22 30 CHOP 20 18 56 HYPERCVAD 57 24 - BFM 10 9 10 GMALL 21 21 - CALGB 34 34 - CHOEP 17 17 - Total 23 21 56 LBL : Lymphoblastıc lymphoma ,T-LBL : T-cell lymphoblastıc lymphoma, B-LBL : B-cell T-cell lymphoblastıc lymphoma. Overall survival could not be determined as three patients who underwent the HYPERCVAD regimen in the B-LBL cohort were still alive. Among the patients in the study, 10 underwent autologous stem cell transplantation (7 with T-LBL and 3 with B-LBL), whereas 11 received allogeneic stem cell transplantation (9 with T-LBL and 2 with B-LBL), resulting in a total of 21 individuals who underwent transplantation. When assessing auto-SCT and allo-SCT patients independently, median OS was determined to be 23 months for auto-SCT patients and 53 months for allo-SCT patients. Despite the median OS of patients who underwent allogeneic stem cell transplantation (allo-SCT) being 53 months, the median OS of transplanted patients was not statistically substantially greater (p > 0.05). Nevertheless, when auto-SCT and allo-SCT patients were assessed individually, no significant difference in median OS was seen (p > 0.05). Thirteen patients (34%) achieved remission after the first course of treatment, 15 patients (39%) had partial remission, 3 patients (8%) had stable disease, and 7 patients (19%) had progressive disease. Nine of the 13 patients who achieved remission were diagnosed with T-LBL and 4 with B-LBL. The proportion of patients with T-LBL and B-LBL who entered remission was statistically similar (p > 0.05). The median OS was 57 months in patients who achieved complete remission after first-line treatment, 21 months in patients in partial remission, 13 months in those with stable disease, and 10 months in those with progressive disease. median OS was significantly higher in patients with both T-LBL and B-LBL who entered remission after the first course of treatment compared to those who did not (p < 0.05). Twenty-eight patients (74%) required second-line therapy because of disease progression. Three patients (8%) were refractory to first-line therapy and died. Eighteen patients (47%) received at least third-line therapy. Among the patients in the study, 22 (58%) exhibited involvement of three or more lymph nodes or organs, whereas 16 (42%) did not demonstrate involvement in three or more distinct anatomical locations. Median overall survival (OS) was established at 18 months for patients exhibiting lymph node or organ involvement in three or more distinct regions, while median OS was determined to be 56 months for those without such involvement. Statistically, it was demonstrated that involvement of three or more different anatomical regions significantly reduced survival (p < 0.05). Seventeen patients with three or more lymph node or organ involvements were classified in the T-LBL grouping, whereas five were categorized in the LBL subgroup. While the frequency of three or more lymph node or organ involvement was similar in the two subgroups (p > 0.05), median OS decreased significantly in the presence of three or more lymph node or organ involvement in both subgroups (p < 0.05). Bone marrow involvement was identified in 21 (55%) of the patients in the research, whereas it was absent in 17 (45%). The median OS of patients with bone marrow involvement was 22 months, while that of patients without involvement was 30 months, with no statistically significant difference noted (p > 0.05). Bone marrow involvement was noted in 19 patients with T-LBL and in 2 patients with B-LBL, with no statistically significant difference in the frequency of bone marrow involvement or overall survival between the two groups (p > 0.05). Nineteen patients (50%) exhibited extra-organ involvement beyond lymph nodes and bone marrow, with an median OS of 18 months for these individuals, compared to 33 months for those without organ involvement. No statistically significant difference in organ involvement was observed, despite the variation in median OS (p > 0.05). Eleven individuals with extra-organ involvement were identified with T-LBL, whereas eight were diagnosed with B-LBL. No substantial difference was observed in the prevalence of extra-organ involvement between the two subtypes (p > 0.05), nor was there a statistically significant difference in overall survival among patients with extra-organ involvement in both groupings (p > 0.05). Median overall survival (OS) was determined to be 11 months in 6 patients (15%) with central nervous system (CNS) involvement, compared to 30 months in 32 patients (85%) without CNS involvement, with CNS involvement significantly diminishing median OS (p < 0.05). Five patients with CNS involvement were diagnosed with T-LBL and one with B-LBL. Statistical analysis revealed that CNS involvement was more prevalent in the T-LBL cohort (p < 0.05), and overall survival was reduced in the T-LBL group (p < 0.05). Thirty patients (79%) with cervical lymphadenopathy involvement were discovered, and their overall survival was determined to be 23 months. Among the patients with cervical involvement, 25 were identified with T-LBL, with an median OS of 21 months, while 5 were diagnosed with B-LBL, with an median OS of 56 months. A statistically significant difference in median OS was observed between the two groups (p < 0.05). The median OS of individuals with cervical lymphadenopathy involvement was considerably reduced compared to those without such involvement (p < 0.05); however, no impact of lymphadenopathy in other locations on overall survival was noted. The locations exhibiting lymphadenopathy and the incidence were statistically comparable in the T-LBL and B-LBL subtypes. The factors influencing median OS are encapsulated in Table 4 . Upon analysis of the LDH average among 38 LBL patients involved in the study, it was found that the median LDH value was 600, with a range of 156 to 1790. The median LDH value was 660 in individuals with T-LBL and 445 in patients with B-LBL. No significant difference in LDH values was seen between the two groups; nevertheless, a statistically significant negative correlation was established between elevated LDH levels in patients and overall survival length (p 0.05 No 17 16 18 Transplantation Auto-SCT 23 21 - > 0.05 Allo-SCT 56 24 56 None 17 17 32 Involvement of three or more regions Yes 18 18 18 0.05 No 30 21 56 CNS involvement Yes 11 3 < 0.05 No 30 Presence of cervical LAP Yes 20 21 18 < 0.05 No . Auto-SCT : autologous hematopoietic stem cell transplantation, allo-SCT : allogeneic hematopoietic stem cell transplantation, LAP : lymphadenopathy, CNS : central nervous system Discussion In our first retrospective study of LBL, which is quite rare, conducted with data from centres in Turkey between 2018 and 2024, country data is presented. The 5-year average survival was determined to be 6% (Fig. 2 ). As a result of the study, it was seen that different treatments are applied in our country according to the general condition of the patient and the surface markers of the disease. The data from our study indicate that elevated LDH levels, central nervous system involvement, involvement in three or more regions, cervical lymph node involvement, achieving remission after the initial treatment, and male gender (with no significant difference observed in the T-LBL subgroup) adversely affect prognosis. The present study determined median OS as 23 months and PFS as 6 months, while Chen et al.'s research investigating the factors affecting OS in 43 patients with T-LBL in China found median OS as 37.0 months and PFS as 27.1 months ( 16 ). In this study, similar to our study, LDH, the treatments received by the patient, and their effects on median OS were investigated, while unlike our study, the effects of circulating tissue DNA and genetic markers on median OS were also investigated. As a result of this study, similar to our study, the negative effects of high LDH values ​​on median OS were shown, while the effect of treatment protocols on median OS could not be shown. CNS involvement was detected in 6 (16%) of the patients included in our study, while in the study conducted by Chen et al., CNS involvement was seen in 16% of the patients, and similar to our study, CNS involvement was evaluated as a poor risk factor. In this study, unlike our study, the effects of other parameters such as lymph node involvement area and bone marrow involvement on median OS were not investigated. In our study, 34 (89.5%) of the patients had mediastinal lymph node involvement, while pleural or pericardial fluid formation was detected in 29 (76%), and 29 of the patients were evaluated as stage 4. These rates were similar to those in the study conducted by Hoelzer et al. In this study, in which the effects of ALL treatment protocols on treatment and the factors affecting median OS were evaluated in 45 patients diagnosed with T-LBL, mediastinal involvement was detected in 91% of the 45 patients, while pleural or pericardial effusion was observed in 40%. Stage III/IV disease was observed in 73% of the patients in this study. ( 17 ). Similar to our study, it was not shown that the treatment protocols were more effective than each other, and similar to our study, the negative effects of high LDH were shown. The median LDH value in the patients included in the study was evaluated as 604, which was slightly higher than the study conducted by Hoelzer et al. This high value may be due to the fact that the patients included in our study included a higher proportion of advanced-stage patients. Unlike our study, the survival of patients with high-stage disease was found to be low. The reason for this difference may be that most of the patients included in our study were in advanced stage disease. Cortelazzo et al. investigated whether MRD has a place in the treatment of 30 patients diagnosed with LBL ( 14 ). It was observed that MRD positivity before transplantation treatment in patients reduced median OS from 80–60% in a 5-year period. As seen in our study, mediastinal lymph node involvement was detected in 84% of the patients. Bone marrow involvement was detected in 40% of the patients, while this rate was 55% in our study, and similar to our study, the effect of bone marrow involvement on the survey could not be shown in this study. Unlike our study, only approximately 50% of the patients were detected as stage 4, and unlike our study, no patients with CNS involvement were detected in this study. In this study, median OS was evaluated as 72% for 5 years, and the reasons for the higher detection compared to our study may be that more patients with low stage were included in the study and no patients with CNS involvement were included in the study. Conclusion In conclusion, we reported the clinic features of adult LBL in the Turkish population. The overall prognosis of these patients was poor. It was observed that there was no consensus on the treatment of LBL, but the application of transplantation therapies in patients may increase the surveillance. Although our study is valuable in terms of presenting data from Turkey and contributing to the literature for LBL, a rare disease, further research will be necessary to evaluate the effects on disease outcomes, considering the sample size and retrospective nature of the study. Declarations Conflicts of Interests Our unique article, clinicopathological features of adult lymphoblastic lymphoma patients: data from Türkiye, has not been peer-reviewed or published anywhere before. All authors have read and approved the article. There is no conflict of interest in this article, so there is nothing to disclose. In this study, we aimed to retrospectively investigate patients diagnosed and treated for lymphoblastic lymphoma, a very rare disease, and to investigate the risk factors for the disease and factors affecting survival. Ethics approval statement : The study received approval from the Konya Selçuk University Research Ethics Committee, number 2024/586, and was conducted in accordance with the Declaration of Helsinki. Funding Statement Disclaimer on financial support (grants): None All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors indicate no financial support or financial conflict of interest. The authors have indicated they have no financial relationships with any company and no external funding. Author Contribution C.S. wrote the article, collected data, wrote the figures and tables, prepared the statistics.R.Ç. collected the data, checked the text.D.G. is responsible for finalizing the article, collecting data, and checking the spelling.K.F. is responsible for finalizing the article, collecting data, and checking the spelling.A.Ü. is responsible for finalizing the article, collecting data, and checking the spelling.H.B.A.Ö. responsible for finalizing the article, collecting data, and checking the spelling.M.A. is responsible for finalizing the article, collecting data, and checking the spelling.M.U.M. collected the da a, checked the text.I.A. responsible for finalizing the article, collecting data, and checking the spelling.E.İ. collected the data, checked the text.G.Ö. collected the data, checked the text.E.B.A. came up with the idea of ​​the article, collected data and created the article scheme, Check out the article. Data Availability All patient data is obtained from the Ministry of Health of the Republic of Turkey. If requested by helpful editors, all necessary information will be sent to the editors. All information requests and other contacts will be with the Corresponding Author, cem selim (mail: [email protected] ). References Arber, D. A. et al. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood 127 (20), 2391–2405 (2016). Çiftçiler, R., Önner, H. & Selim, C. Peripheral T-cell Lymphoma, Not Otherwise Specified, Diagnosed From Prostate Tissue: A Rare Case. Turkish J. haematology: official J. Turkish Soc. Haematol. , (2025). Intermesoli, T. et al. Lymphoblastic lymphoma: a concise review. Curr. Oncol. Rep. 24 (1), 1–12 (2022). Dores, G. M., Devesa, S. S., Curtis, R. E., Linet, M. S. & Morton, L. M. Acute leukemia incidence and patient survival among children and adults in the United States, 2001–2007. Blood 119 , 34–43 (2012). 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Clinicopathological characteristics and mutational profiling of adult T-cell lymphoblastic lymphoma in a Chinese population. Cancer Manage. Res. , ; 3003–3012. (2020). Hoelzer, D. et al. Outcome of adult patients with T-lymphoblastic lymphoma treated according to protocols for acute lymphoblastic leukemia. Blood J. Am. Soc. Hematol. , 99 (12), 4379–4385 . Additional Declarations No competing interests reported. Supplementary Files floatimage1.png Visual abstract Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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SELİM","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3ElEQVRIiWNgGAWjYDCCA1Caj5mB8QGQ5uEjWgsbMwOzAUgLG/FagEgCysAP+G4fYPzwMadOjo2dO63ya46dDBsD88NHN/BokTyXwCw5c9thYzZm3m23ZbclAx3GZmycg0eLwRkGkOIDiW0gLZLbmIFaeNikCWr5u62uHqSlWHJbPZFaGLcxJ4DsYvy47TBhLZJnGJsle7cdNgTaslmacdtxHjZmAn7hO8N88MPPbXXy/PxnN378ua3anp+9+eFjfFoYGBgb4ExmHjCJVzm67h+kqB4Fo2AUjIIRAwCsGD7F7myazgAAAABJRU5ErkJggg==","orcid":"","institution":"Selçuk Üniversitesi Tıp Fakültesi Hastanesi","correspondingAuthor":true,"prefix":"","firstName":"Cem","middleName":"","lastName":"SELİM","suffix":""},{"id":531790290,"identity":"05de2c88-7157-476c-aa8d-cd3ad16b675e","order_by":1,"name":"Rafiye Çiftçiler","email":"","orcid":"","institution":"Selçuk Üniversitesi Tıp Fakültesi 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19:22:49","extension":"xml","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":91302,"visible":true,"origin":"","legend":"","description":"","filename":"2bc4a828c61e4ad7ae6551bb21c820aa1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-6814198/v1/c978fad46cb90be0e2010547.xml"},{"id":94138894,"identity":"29d0c1d0-ae80-4002-abc3-4edcb63ae52c","added_by":"auto","created_at":"2025-10-22 19:30:49","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":103137,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-6814198/v1/3dcebddfc63d21f7d6bf69fb.html"},{"id":94138888,"identity":"d6f0bc6a-15d3-47bb-bd9e-ea6fd8beb6f4","added_by":"auto","created_at":"2025-10-22 19:30:49","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":252747,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan–Meier curves for progression-free and overall survival. (A) Overall survival of the whole study population. (B) Progression-free survival of the whole study population. LBL : Lymphoblastıc lymphoma ,T-LBL : T-cell lymphoblastıc lymphoma, B-LBL : B-cell T-cell lymphoblastıc lymphoma.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6814198/v1/db9e4ca8b24e2f3bbcbcee2c.jpeg"},{"id":94138892,"identity":"8cabd8d2-0245-430f-9431-030085f900c8","added_by":"auto","created_at":"2025-10-22 19:30:49","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":446961,"visible":true,"origin":"","legend":"\u003cp\u003ePrognostic factors related to the study (A) treatment protocols and relationship to median OS. (B) Transplantation and relationship to median OS. (C) Involvement of three or more sites and relationship to OS. (D) Response to first-line therapy and relationship to median OS. (E) Cervical lymph node involvement and relationship to OS. (F) CNS involvement and effect on median OS. OS: overall survival\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6814198/v1/2bc87783ad1ff09fd0b24a33.jpeg"},{"id":98780672,"identity":"30e89085-209c-41bc-a845-5ad272784672","added_by":"auto","created_at":"2025-12-22 12:31:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1487054,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6814198/v1/96e0622d-d0f2-4b40-b7dc-fc821fcab3cb.pdf"},{"id":94137282,"identity":"a793853b-9a67-49c3-804d-ce778a731afd","added_by":"auto","created_at":"2025-10-22 19:22:49","extension":"png","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":184953,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eVisual abstract\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6814198/v1/228d4327649b9367b133e856.png"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eClinicopathological Features of Adult Lymphoblastic Lymphoma Patients: Data from Turkiye\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLymphoblastic lymphoma (LBL) is a highly malignant tumour composed of immature lymphocytes that originate from B or T cells and, less commonly, from killer (NK) cells. It shares similar biological and morphological characteristics with acute lymphoblastic leukaemia (ALL). Although the 2017 and 2022 WHO classification groups these entities together, LBL is often distinguished from ALL by the presence of fewer than 20% marrow-invading blasts (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Extraorgan involvement and lymphadenopathy are more prevalent in LBL compared to ALL and has prognostic significance (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Despite being clinically identical, LBL ALL should be considered distinct clinically due to their significant differences in clinical presentation, as well as certain variations in prognostic variables and therapeutic approaches (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eLBL is an uncommon disease, and precise incidence data are insufficient; in significant research and epidemiological surveys, LBL is frequently categorised with ALL (with an estimated incidence of 1.3 per 100,000 annually) or Burkitt lymphoma (1.46 per 100,000 annually) (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). LBL constitutes 2\u0026ndash;4% of non-Hodgkin lymphomas or ALL's in adults and under 30% in children. The prevalence of LBL seems to be rising alongside heightened disease awareness. LBL is primarily detected in young males aged 10 to 30 years, and unlike ALL, it occurs more commonly with a T-cell immunophenotype, causing greater lymph node and solid organ involvement. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eB-LBL is consistently positive for at least two B-cell markers among CD19, CD79, and CD22. CD10, CD24, PAX5, and TdT are expressed in most cases, while the expression of CD20 and the stem cell antigen CD34 is variable, and CD45 may be absent (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). T-LBL often expresses a cortical CD1a\u0026thinsp;+\u0026thinsp;phenotype; early-T phenotypes are rare, confer a lower risk of mediastinal involvement, but a higher risk of bone marrow dissemination. An early thymic precursor (ETP) phenotype, originally described in T-ALL, is sometimes present in LBL. These cases express very early T-lymphoid markers without CD1a, CD8, and CD antigens (CD5-negative or dim) and normally co-express stem/myeloid cell markers (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe International Prognostic Index (IPI), which includes age, extranodal sites, LDH levels, stage, and performance status, was not predictive for LBL. Historically, LBL stage IV patients with bone marrow or CNS involvement and high LDH levels (\u0026gt;\u0026thinsp;300 IU/L) had only a 19% five-year relapse-free probability, compared to 94% in low-risk patients (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Recent studies suggest that older age, Black ethnicity, and advanced disease stage may worsen prognosis.\u003c/p\u003e\u003cp\u003eGenetic changes such as t(9;17) (q34;q32) and loss of heterozygosity at 6q could also negatively impact outcomes (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The GRAAL-LYSA study developed an oncogenetic-based prognostic score for T-LBL, where NOTCH1/FBXW7 mutations, in the absence of RAS/PTEN alterations, indicated a favourable prognosis (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). In contrast, adult patients with ETP LBL treated with standard chemotherapy had significantly poorer outcomes than those without ETP. This T-LBL variant is considered very high-risk, similar to ETP ALL (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Additionally, CT/PET responses and analyses of minimally disseminated disease (MDD)/measurable residual disease (MRD) may be crucial for prognosis (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe execution of intensive ALL-like protocols has resulted in considerable progress in the treatment of adult LBL (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Moreover, significant advancements have resulted from diverse treatment protocols, distinct pediatric regimens, radiation, allogeneic hematopoietic stem cell transplantation, and intrathecal therapy, particularly for patients at elevated risk of central nervous system involvement (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eConsensus on various aspects, such as prognostic factors and treatment of LBL, a rare disease, remains elusive. The limited patient population hinders the formation of a unified consensus. Our study examined the data of LBL patients diagnosed and treated at centers within our country.\u003c/p\u003e"},{"header":"Material method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003ePatient Selection\u003c/h2\u003e\u003cp\u003eThis retrospective study selected 38 patients from seven separate tertiary adult hematology clinics from 2018 to June 2024. Patients who were 18 years or older, had a confirmed diagnosis of LBL from lymph nodes or other areas, had less than 20% blasts in their bone marrow from a biopsy, had imaging tests for staging, and had at least one round of chemotherapy were included in the study. The principal endpoint of the trial was identified as patient mortality. Due to the retrospective nature of our investigation, the varied treatment and follow-up regimens implemented by the participating sites augmented the data diversity.\u003c/p\u003e\u003cp\u003e Participants were informed in accordance with the principles stated in the Declaration of Helsinki and their written consent was obtained. The study received approval from the Konya Sel\u0026ccedil;uk University Research Ethics Committee, number 2024/586, and was conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEvaluation and Follow-up\u003c/h3\u003e\n\u003cp\u003eAll patients at the study centers underwent enhanced computed tomography (CT) or positron emission tomography/computed tomography (PET/CT) for evaluation and staging purposes. All participants in the study received a bone marrow biopsy. Treatment response was evaluated based on the updated efficacy assessment criteria set forth by the International Working Group (IWG) for malignant lymphoma (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Following treatment, patients at the participating centers were monitored every three months for the initial two years if in remission, every six months from years three to five, and annually thereafter. Patients not in remission were scheduled for follow-up more frequently based on clinical and laboratory findings, and hospitalization was requested when necessary. Patients in remission were assessed at each evaluation, with parameters including blood cell count, serum lactate dehydrogenase (LDH) levels, and imaging techniques such as ultrasonography when clinical suspicion arose.\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eStatistical analyses were performed using SPSS version 25 software. Survival was examined using univariate analyses using the log-rank test. In multivariate analysis, independent factors in predicting survival were examined using Cox regression analysis with the backward selection method using possible factors determined in previous analyses. Survival rates were calculated using the Kaplan-Meier method. Clinically significant parameters were selected from the interrelated parameters that had similar effects on survival. Model fit and periodic risk proportionality assumptions were evaluated using residual (Schoenfeld and Martingale) analyses. Situations with a Type-1 error level below 5% were interpreted as statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe median age of 38 patients with LBL included in the study was 37\u0026thinsp;\u0026plusmn;\u0026thinsp;13 years; 24 (63%) were male, and 14 (37%) were female. The ages of patients diagnosed with T-LBL and B-LBL were statistically similar (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), and no statistical association was found between increasing age and OS (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eThe median follow-up period of the patients was determined as 23 months (range 1 to 64 months). Among the 38 patients in the study, 10 (26%) were identified with B-LBL using tissue biopsy and flow cytometry, whereas 28 (74%) were classified as T-LBL based on the same diagnostic methods. The overall survival (OS) was determined to be 23 months for all patients, 21 months for those with T-LBL, and 56 months for individuals with B-LBL. Despite a notable disparity in median OS between patients diagnosed with T-LBL and those with B-LBL, no significant difference in median OS was detected between the two groups, attributable to the limited number of patients with a B-LBL diagnosis (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The average progression-free survival (PFS) of the patients was determined to be 6 months. Progression-free survival (PFS) was seen to be 4 months in individuals diagnosed with T-LBL, but it was 12 months in those diagnosed with B-LBL. No statistically significant difference was observed in the PFS values between the two groups. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates the data pertaining to median overall survival (OS) and progression-free survival (PFS).\u003c/p\u003e\u003cp\u003eTwenty patients diagnosed with T-LBL were male and eight were female, while four patients identified with B-LBL were male and six were female. Despite a higher prevalence of women among those diagnosed with B-LBL, no statistically significant difference in gender was seen between the two groupings (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The median OS for men diagnosed with T-LBL was 20 months, whereas for women it was 24 months, with no statistically significant difference observed between the two groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The median OS for men diagnosed with B-LBL was 13 months, whereas for women it was 56 months, revealing a statistically significant difference between the two groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Upon examination of all patients diagnosed with LBL, the median OS for men was 18 months, while for women it was 56 months, revealing a statistically significant difference between the two groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Information on the laboratory values ​​of the patients is given in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eWhile 19 (50%) of the patients were diagnosed with mediastinal lymph node biopsy, 10 (26%) were diagnosed with cervical lymph node biopsy. Mediastinal lymph node involvement was present in 34 (89.5%) of the patients, while 30 (79%) had cervical lymph node involvement. Pleural or pericardial fluid formation was detected in 29 (76%) of the patients, and bone marrow involvement was detected in 21 (55%). Central nervous system involvement was detected in 6 (16%) patients, involvement of three or more anatomic regions in 22 (58%) patients, and extra organ involvement in 19 (50%) patients.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eTwenty-nine patients, constituting 76% of the study cohort, were classified as stage 4. Nine (24%) of the patients included in the study underwent auto-SCT and 11 (29%) underwent allo-SCT, while the remaining 18 patients did not receive transplantation. Second-line treatment was applied to 28 (73.7%) patients, while 18 (47%) required third-line treatment. The median survival of the patients was determined to be 23 months. General information about the patients participating in the study is given in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of patients in study\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLBL\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eT-LBL\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eB-LBL\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSedimentation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLDH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e604\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e660\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e440\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePlatelet (mcL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e213800\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e200000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e250800\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWBC (mcL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8970\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8990\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5050\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLymphocyte (mcL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3320\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3800\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4300\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHemoglobin (g/dl)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedian OS (month)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eOS : Overall survival\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDetails of the patients included in the study\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLBL\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eT-LBL\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eB-LBL\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24 (63%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14 (37%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eCervical LAP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30 (79%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eMediastinal LAP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34 (89.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eAxillary LAP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15 (39.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eSupraclavicular LAP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (32%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eAbdominal LAP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16 (42%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eIngunal LAP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9 (24%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003ePleural \u0026ndash; Pericardial fluid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29 (76%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eBone marrow involvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21 (55%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eCNS involvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (16%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003ePresence of involvement in three or more anatomical regions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22 (58%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eExtra organ involvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19 (50%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eT cell marker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28 (74%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eB cell marker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10 (26%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eMyeloid marker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (16%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"3\" nameend=\"c2\" namest=\"c1\" rowspan=\"4\"\u003e\u003cp\u003eStage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (11%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29 (76%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"6\" nameend=\"c2\" namest=\"c1\" rowspan=\"7\"\u003e\u003cp\u003eFirst line treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEPOCH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (31.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCHOP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (13%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHYPERCVAD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11 (29%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBFM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGMALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCALGB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCHOEP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"3\" nameend=\"c2\" namest=\"c1\" rowspan=\"4\"\u003e\u003cp\u003eResponse to first-line therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eComplete Remission\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13 (34%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePartial remission\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15 (39.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eProgressive disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (18.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e\u003cp\u003eTransplantation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAuto-SCT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10 (26%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAllo-SCT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11 (29%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17 (45%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u003cp\u003ePatient status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLiving\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15 (39.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExitus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23 (60.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAuto-SCT : autologous hematopoietic stem cell transplantation, allo-SCT : allogeneic hematopoietic stem cell transplantation, LAP : lymphadenopathy, T-LBL : T-cell lymphoblastıc lymphoma, B-LBL : B-cell T-cell lymphoblastıc lymphoma.\u003c/p\u003e\u003cp\u003eTwelve (32%) of the patients in the study received the EPOCH (etoposide, doxorubicin, cyclophosphamide, vincristine, and prednisone) protocol at their own centers, and 9 of the 12 patients completed the treatment. Three of the patients who received EPOCH treatment received autologous hematopoietic stem cell transplantation (auto-SCT), and the other received allogeneic hematopoietic stem cell transplantation (allo-SCT). Five (14%) of the patients in the centers participating in the study received CHOP (doxorubicin, cyclophosphamide, vincristine, and prednisone) treatment. Four of the patients who received CHOP treatment were able to complete the treatment, and one could not complete the treatment due to disease progression. Two of the patients who received CHOP treatment received allogeneic stem cell transplantation. Eleven (30%) patients received the HYPERCVAD (doxorubicin, cyclophosphamide, vincristine, dexamethasone, methotrexate, and cytarabine) protocol, and all patients who received this treatment completed the treatment. Four of these patients had auto-SCT, and four had allo-SCT. Three (7%) of the patients included in the study received the BFM (doxorubicin, cyclophosphamide, vincristine, dexamethasone, methotrexate, cytarabine, L-asparaginase, 6-mercaptopurine) protocol; two of these patients completed the treatment, and the patients who completed the treatment underwent auto-SCT. Three patients (7%) received the GMALL (daunorubicin, cyclophosphamide, vincristine, dexamethasone, methotrexate, cytarabine, L-asparaginase, and 6-mercaptopurine) protocol, and two patients who completed treatment underwent allo-SCT, and one patient underwent auto-SCT. Two patients (5%) received CALGB (daunorubicin, cyclophosphamide, vincristine, prednisolone, methotrexate, cytarabine, pegasparaginase, and 6-mercaptopurine) treatment, and one patient who completed treatment underwent allo-SCT, and one patient was followed up without transplantation. Finally, two patients (5%) received CHOEP (etoposide, doxorubicin, cyclophosphamide, vincristine, and prednisone) treatment, and two patients who completed treatment were followed up without transplantation.\u003c/p\u003e\u003cp\u003eThe treatments received by the 38 patients included in the study were summarised, and no statistical significance was observed between the treatments received by the patients and the median OS (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The median OS related to the treatments is shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eTreatments received by patients included in the study and median OS times\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLBL\u003c/p\u003e\u003cp\u003eMedian OS (month)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eT-LBL Median OS (month)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eB-LBL Median OS (month)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEPOCH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCHOP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHYPERCVAD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBFM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGMALL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCALGB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCHOEP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eLBL : Lymphoblastıc lymphoma ,T-LBL : T-cell lymphoblastıc lymphoma, B-LBL : B-cell T-cell lymphoblastıc lymphoma. Overall survival could not be determined as three patients who underwent the HYPERCVAD regimen in the B-LBL cohort were still alive.\u003c/p\u003e\u003cp\u003eAmong the patients in the study, 10 underwent autologous stem cell transplantation (7 with T-LBL and 3 with B-LBL), whereas 11 received allogeneic stem cell transplantation (9 with T-LBL and 2 with B-LBL), resulting in a total of 21 individuals who underwent transplantation. When assessing auto-SCT and allo-SCT patients independently, median OS was determined to be 23 months for auto-SCT patients and 53 months for allo-SCT patients. Despite the median OS of patients who underwent allogeneic stem cell transplantation (allo-SCT) being 53 months, the median OS of transplanted patients was not statistically substantially greater (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Nevertheless, when auto-SCT and allo-SCT patients were assessed individually, no significant difference in median OS was seen (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eThirteen patients (34%) achieved remission after the first course of treatment, 15 patients (39%) had partial remission, 3 patients (8%) had stable disease, and 7 patients (19%) had progressive disease. Nine of the 13 patients who achieved remission were diagnosed with T-LBL and 4 with B-LBL. The proportion of patients with T-LBL and B-LBL who entered remission was statistically similar (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The median OS was 57 months in patients who achieved complete remission after first-line treatment, 21 months in patients in partial remission, 13 months in those with stable disease, and 10 months in those with progressive disease. median OS was significantly higher in patients with both T-LBL and B-LBL who entered remission after the first course of treatment compared to those who did not (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Twenty-eight patients (74%) required second-line therapy because of disease progression. Three patients (8%) were refractory to first-line therapy and died. Eighteen patients (47%) received at least third-line therapy.\u003c/p\u003e\u003cp\u003eAmong the patients in the study, 22 (58%) exhibited involvement of three or more lymph nodes or organs, whereas 16 (42%) did not demonstrate involvement in three or more distinct anatomical locations. Median overall survival (OS) was established at 18 months for patients exhibiting lymph node or organ involvement in three or more distinct regions, while median OS was determined to be 56 months for those without such involvement. Statistically, it was demonstrated that involvement of three or more different anatomical regions significantly reduced survival (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Seventeen patients with three or more lymph node or organ involvements were classified in the T-LBL grouping, whereas five were categorized in the LBL subgroup. While the frequency of three or more lymph node or organ involvement was similar in the two subgroups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), median OS decreased significantly in the presence of three or more lymph node or organ involvement in both subgroups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eBone marrow involvement was identified in 21 (55%) of the patients in the research, whereas it was absent in 17 (45%). The median OS of patients with bone marrow involvement was 22 months, while that of patients without involvement was 30 months, with no statistically significant difference noted (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Bone marrow involvement was noted in 19 patients with T-LBL and in 2 patients with B-LBL, with no statistically significant difference in the frequency of bone marrow involvement or overall survival between the two groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eNineteen patients (50%) exhibited extra-organ involvement beyond lymph nodes and bone marrow, with an median OS of 18 months for these individuals, compared to 33 months for those without organ involvement. No statistically significant difference in organ involvement was observed, despite the variation in median OS (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Eleven individuals with extra-organ involvement were identified with T-LBL, whereas eight were diagnosed with B-LBL. No substantial difference was observed in the prevalence of extra-organ involvement between the two subtypes (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), nor was there a statistically significant difference in overall survival among patients with extra-organ involvement in both groupings (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eMedian overall survival (OS) was determined to be 11 months in 6 patients (15%) with central nervous system (CNS) involvement, compared to 30 months in 32 patients (85%) without CNS involvement, with CNS involvement significantly diminishing median OS (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Five patients with CNS involvement were diagnosed with T-LBL and one with B-LBL. Statistical analysis revealed that CNS involvement was more prevalent in the T-LBL cohort (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and overall survival was reduced in the T-LBL group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eThirty patients (79%) with cervical lymphadenopathy involvement were discovered, and their overall survival was determined to be 23 months. Among the patients with cervical involvement, 25 were identified with T-LBL, with an median OS of 21 months, while 5 were diagnosed with B-LBL, with an median OS of 56 months. A statistically significant difference in median OS was observed between the two groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The median OS of individuals with cervical lymphadenopathy involvement was considerably reduced compared to those without such involvement (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05); however, no impact of lymphadenopathy in other locations on overall survival was noted. The locations exhibiting lymphadenopathy and the incidence were statistically comparable in the T-LBL and B-LBL subtypes. The factors influencing median OS are encapsulated in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eUpon analysis of the LDH average among 38 LBL patients involved in the study, it was found that the median LDH value was 600, with a range of 156 to 1790. The median LDH value was 660 in individuals with T-LBL and 445 in patients with B-LBL. No significant difference in LDH values was seen between the two groups; nevertheless, a statistically significant negative correlation was established between elevated LDH levels in patients and overall survival length (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eImpact of Findings on Overall Survival in Study Participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMedian OS (month)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eT-LBL median OS (month)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eB-LBL median OS (month)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP score\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eExtraorgan involvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eTransplantation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAuto-SCT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAllo-SCT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eInvolvement of three or more regions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eBone marrow involvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCNS involvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePresence of cervical LAP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eAuto-SCT : autologous hematopoietic stem cell transplantation, allo-SCT : allogeneic hematopoietic stem cell transplantation, LAP : lymphadenopathy, CNS : central nervous system\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn our first retrospective study of LBL, which is quite rare, conducted with data from centres in Turkey between 2018 and 2024, country data is presented. The 5-year average survival was determined to be 6% (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). As a result of the study, it was seen that different treatments are applied in our country according to the general condition of the patient and the surface markers of the disease. The data from our study indicate that elevated LDH levels, central nervous system involvement, involvement in three or more regions, cervical lymph node involvement, achieving remission after the initial treatment, and male gender (with no significant difference observed in the T-LBL subgroup) adversely affect prognosis.\u003c/p\u003e\u003cp\u003eThe present study determined median OS as 23 months and PFS as 6 months, while Chen et al.'s research investigating the factors affecting OS in 43 patients with T-LBL in China found median OS as 37.0 months and PFS as 27.1 months (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). In this study, similar to our study, LDH, the treatments received by the patient, and their effects on median OS were investigated, while unlike our study, the effects of circulating tissue DNA and genetic markers on median OS were also investigated. As a result of this study, similar to our study, the negative effects of high LDH values ​​on median OS were shown, while the effect of treatment protocols on median OS could not be shown. CNS involvement was detected in 6 (16%) of the patients included in our study, while in the study conducted by Chen et al., CNS involvement was seen in 16% of the patients, and similar to our study, CNS involvement was evaluated as a poor risk factor. In this study, unlike our study, the effects of other parameters such as lymph node involvement area and bone marrow involvement on median OS were not investigated.\u003c/p\u003e\u003cp\u003eIn our study, 34 (89.5%) of the patients had mediastinal lymph node involvement, while pleural or pericardial fluid formation was detected in 29 (76%), and 29 of the patients were evaluated as stage 4. These rates were similar to those in the study conducted by Hoelzer et al. In this study, in which the effects of ALL treatment protocols on treatment and the factors affecting median OS were evaluated in 45 patients diagnosed with T-LBL, mediastinal involvement was detected in 91% of the 45 patients, while pleural or pericardial effusion was observed in 40%. Stage III/IV disease was observed in 73% of the patients in this study. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Similar to our study, it was not shown that the treatment protocols were more effective than each other, and similar to our study, the negative effects of high LDH were shown. The median LDH value in the patients included in the study was evaluated as 604, which was slightly higher than the study conducted by Hoelzer et al. This high value may be due to the fact that the patients included in our study included a higher proportion of advanced-stage patients. Unlike our study, the survival of patients with high-stage disease was found to be low. The reason for this difference may be that most of the patients included in our study were in advanced stage disease.\u003c/p\u003e\u003cp\u003eCortelazzo et al. investigated whether MRD has a place in the treatment of 30 patients diagnosed with LBL (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). It was observed that MRD positivity before transplantation treatment in patients reduced median OS from 80\u0026ndash;60% in a 5-year period. As seen in our study, mediastinal lymph node involvement was detected in 84% of the patients. Bone marrow involvement was detected in 40% of the patients, while this rate was 55% in our study, and similar to our study, the effect of bone marrow involvement on the survey could not be shown in this study. Unlike our study, only approximately 50% of the patients were detected as stage 4, and unlike our study, no patients with CNS involvement were detected in this study. In this study, median OS was evaluated as 72% for 5 years, and the reasons for the higher detection compared to our study may be that more patients with low stage were included in the study and no patients with CNS involvement were included in the study.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, we reported the clinic features of adult LBL in the Turkish population. The overall prognosis of these patients was poor. It was observed that there was no consensus on the treatment of LBL, but the application of transplantation therapies in patients may increase the surveillance. Although our study is valuable in terms of presenting data from Turkey and contributing to the literature for LBL, a rare disease, further research will be necessary to evaluate the effects on disease outcomes, considering the sample size and retrospective nature of the study.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eConflicts of Interests\u003c/h2\u003e\u003cp\u003eOur unique article, clinicopathological features of adult lymphoblastic lymphoma patients: data from T\u0026uuml;rkiye, has not been peer-reviewed or published anywhere before. All authors have read and approved the article. There is no conflict of interest in this article, so there is nothing to disclose. In this study, we aimed to retrospectively investigate patients diagnosed and treated for lymphoblastic lymphoma, a very rare disease, and to investigate the risk factors for the disease and factors affecting survival.\u003c/p\u003e\u003cp\u003e\u003cb\u003eEthics approval statement\u003c/b\u003e: The study received approval from the Konya Sel\u0026ccedil;uk University Research Ethics Committee, number 2024/586, and was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding Statement\u003c/h2\u003e\u003cp\u003eDisclaimer on financial support (grants): None All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors indicate no financial support or financial conflict of interest. The authors have indicated they have no financial relationships with any company and no external funding.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eC.S. wrote the article, collected data, wrote the figures and tables, prepared the statistics.R.\u0026Ccedil;. collected the data, checked the text.D.G. is responsible for finalizing the article, collecting data, and checking the spelling.K.F. is responsible for finalizing the article, collecting data, and checking the spelling.A.\u0026Uuml;. is responsible for finalizing the article, collecting data, and checking the spelling.H.B.A.\u0026Ouml;. responsible for finalizing the article, collecting data, and checking the spelling.M.A. is responsible for finalizing the article, collecting data, and checking the spelling.M.U.M. collected the da a, checked the text.I.A. responsible for finalizing the article, collecting data, and checking the spelling.E.İ. collected the data, checked the text.G.\u0026Ouml;. collected the data, checked the text.E.B.A. came up with the idea of ​​the article, collected data and created the article scheme, Check out the article.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAll patient data is obtained from the Ministry of Health of the Republic of Turkey. If requested by helpful editors, all necessary information will be sent to the editors. All information requests and other contacts will be with the Corresponding Author, cem selim (mail: [email protected] ).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eArber, D. A. et al. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. \u003cem\u003eBlood\u003c/em\u003e \u003cb\u003e127\u003c/b\u003e (20), 2391\u0026ndash;2405 (2016).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e\u0026Ccedil;ift\u0026ccedil;iler, R., \u0026Ouml;nner, H. \u0026amp; Selim, C. Peripheral T-cell Lymphoma, Not Otherwise Specified, Diagnosed From Prostate Tissue: A Rare Case. \u003cem\u003eTurkish J. haematology: official J. Turkish Soc. Haematol.\u003c/em\u003e, (2025).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIntermesoli, T. et al. Lymphoblastic lymphoma: a concise review. \u003cem\u003eCurr. Oncol. Rep.\u003c/em\u003e \u003cb\u003e24\u003c/b\u003e (1), 1\u0026ndash;12 (2022).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDores, G. M., Devesa, S. S., Curtis, R. E., Linet, M. S. \u0026amp; Morton, L. M. Acute leukemia incidence and patient survival among children and adults in the United States, 2001\u0026ndash;2007. \u003cem\u003eBlood\u003c/em\u003e \u003cb\u003e119\u003c/b\u003e, 34\u0026ndash;43 (2012).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSant, M. et al. Incidence of hematologic malignancies in Europe by morphologic subtype: results of the HAEMACARE project. \u003cem\u003eBlood\u003c/em\u003e \u003cb\u003e116\u003c/b\u003e, 3724\u0026ndash;3734 (2010).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePatel, J. L. et al. The immunophenotype of T-lymphoblastic lymphoma in children and adolescents: a Children\u0026rsquo;s Oncology Group report. \u003cem\u003eBr. J. Haematol.\u003c/em\u003e \u003cb\u003e159\u003c/b\u003e, 454\u0026ndash;461 (2012).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCoustan-Smith, E. et al. Early T-cell precursor leukaemia: a subtype of very high-risk acute lymphoblastic leukaemia. \u003cem\u003eLancet Oncol.\u003c/em\u003e \u003cb\u003e10\u003c/b\u003e, 147\u0026ndash;156 (2009).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eColeman, C. N. et al. Treatment of lymphoblastic lymphoma in adults. \u003cem\u003eJ. Clin. Oncol. Off J. Am. Soc. Clin. Oncol.\u003c/em\u003e \u003cb\u003e4\u003c/b\u003e (11), 1628\u0026ndash;1637 (1986).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSandlund, J. T. et al. Results of treatment of advanced-stage lymphoblastic lymphoma at St Jude Children's Research Hospital from 1962 to 2002. \u003cem\u003eAnn. Oncol.\u003c/em\u003e \u003cb\u003e24\u003c/b\u003e (9), 2425\u0026ndash;2429 (2013).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLepretre, S. et al. Pediatric-like acute lymphoblastic leukemia therapy in adults with lymphoblastic lymphoma: the GRAALL-LYSA LL03 study. \u003cem\u003eJ. Clin. Oncol.\u003c/em\u003e \u003cb\u003e34\u003c/b\u003e (6), 572\u0026ndash;580 (2016).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMorita, K. et al. Outcome of T-cell acute lymphoblastic leukemia/lymphoma: focus on near‐ETP phenotype and differential impact of nelarabine. \u003cem\u003eAm. J. Hematol.\u003c/em\u003e \u003cb\u003e96\u003c/b\u003e (5), 589\u0026ndash;598 (2021).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThomas, D. A. et al. Outcome with the hyper-CVAD regimens in lymphoblastic lymphoma. \u003cem\u003eBlood\u003c/em\u003e \u003cb\u003e104\u003c/b\u003e (6), 1624\u0026ndash;1630 (2004).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHoelzer, D., Zwolinski, J. \u0026amp; Walewski, J. Outcome of adult patients with T-lymphoblastic lymphoma treated according to protocols for acute lymphoblastic leukemia. \u003cem\u003eBlood\u003c/em\u003e \u003cb\u003e99\u003c/b\u003e (12), 4379\u0026ndash;4385 (2002).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCortelazzo, S. et al. Results of a lymphoblastic leukemia-like chemotherapy program with risk-adapted mediastinal irradiation and stem cell transplantation for adult patients with lymphoblastic lymphoma. \u003cem\u003eAnn. Hematol.\u003c/em\u003e \u003cb\u003e91\u003c/b\u003e, 73\u0026ndash;82 (2012).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCheson, B. D. et al. Report of an internationalworkshop to standardize response criteria for non-Hodgkin\u0026rsquo;s lympho-mas. \u003cem\u003eNCI Sponsored Int. Working Group. J. clin. oncol.\u003c/em\u003e \u003cb\u003e17\u003c/b\u003e (4), 1244 (1999).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen, F. et al. Clinicopathological characteristics and mutational profiling of adult T-cell lymphoblastic lymphoma in a Chinese population. \u003cem\u003eCancer Manage. Res.\u003c/em\u003e, ; 3003\u0026ndash;3012. (2020).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHoelzer, D. et al. Outcome of adult patients with T-lymphoblastic lymphoma treated according to protocols for acute lymphoblastic leukemia. \u003cem\u003eBlood J. Am. Soc. Hematol.\u003c/em\u003e, \u003cb\u003e99\u003c/b\u003e(12), 4379\u0026ndash;4385 .\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Lymphoblastic Lymphoma, Diagnosis, Risk Factors, Treatment","lastPublishedDoi":"10.21203/rs.3.rs-6814198/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6814198/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e\u003cp\u003eLymphoblastic lymphoma (LBL) is a highly malignant tumor composed of immature lymphocytes derived from B or T cells. LBL is usually distinguished from ALL by the presence of less than 25% of bone marrow-invading blasts. Our study examined the data of LBL patients diagnosed and treated at centers within our country.\u003c/p\u003e\u003ch2\u003eMaterial method\u003c/h2\u003e\u003cp\u003eThirty-eight patients from seven distinct tertiary adult hematology clinics were chosen for this investigation. Individuals aged 18 and older with a pathologically confirmed diagnosis of LBL, who had radiological assessments for clinical staging and received a minimum of one chemotherapy regimen, were included in the study.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOverall survival (OS) for all patients was 23 months, 21 months for patients with T-LBL, and 56 months for individuals with B-LBL. Despite a significant difference in overall survival (OS) between patients diagnosed with T-LBL and those diagnosed with B-LBL, no significant difference in OS was found between the two groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The median progression-free survival (PFS) of the patients was determined as 6 months.\u003c/p\u003e\u003ch2\u003eDiscussion\u003c/h2\u003e\u003cp\u003eThe data from our study indicate that elevated LDH levels, central nervous system involvement, involvement in three or more regions, cervical lymph node involvement, achieving remission after the initial treatment, and male gender (with no significant difference observed in the T-LBL subgroup) adversely affect prognosis.\u003c/p\u003e","manuscriptTitle":"Clinicopathological Features of Adult Lymphoblastic Lymphoma Patients: Data from Turkiye","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-22 19:22:45","doi":"10.21203/rs.3.rs-6814198/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0cd095d5-396d-443d-9cc6-2da3645a2ec2","owner":[],"postedDate":"October 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":56698754,"name":"Biological sciences/Cancer"},{"id":56698755,"name":"Health sciences/Oncology"}],"tags":[],"updatedAt":"2025-12-22T10:09:57+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-22 19:22:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6814198","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6814198","identity":"rs-6814198","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}