Angioimmunoblastic T-cell lymphoma, now called nodal T-follicular helper cell lymphoma of angioimmunoblastic type, is one of the commonest T-cell lymphomas and mostly affects people over 60. It presents with widespread swollen nodes, fever, rash and immune upsets such as anaemia; about four in ten people are alive five years after chemotherapy, more after a transplant in first remission.
WHO-HAEM5 groups angioimmunoblastic T-cell lymphoma with follicular and not-otherwise-specified T-follicular helper lymphomas as nodal T-follicular helper cell lymphoma, angioimmunoblastic type being the commonest, defined by TFH markers (PD1, CXCL13, ICOS, BCL6, CD10), a polymorphous infiltrate with arborising venules and expanded follicular dendritic cell meshworks, EBV-positive B cells, and recurrent TET2, DNMT3A, RHOA G17V and IDH2 R172 mutations (Alaggio 2022). In the International Project, 76 percent presented with generalised lymphadenopathy and 89 percent with stage III or IV disease; rash occurred in 21 percent, haemolytic anaemia in 13 percent and hypergammaglobulinaemia in 30 percent; five-year overall and failure-free survival were 33 and 18 percent (Federico 2013). In the prospective T-cell Project, 282 patients had a median age of 64, 81 percent received anthracycline-based regimens, 13 percent had autologous transplant in first complete remission with improved outcomes, five-year overall and progression-free survival were 44 and 32 percent, and age 60 or over, poor performance status, raised C-reactive protein and raised beta-2 microglobulin predicted worse outcome (Advani 2021).
How it differs from its parent: the peripheral T-cell lymphoma page covers the group; this type is defined by its TFH origin and epigenetic mutations, which make it the T-cell lymphoma most responsive to histone deacetylase inhibitors and hypomethylating agents, and by its immune manifestations (autoimmune haemolysis, polyclonal hypergammaglobulinaemia, rashes) that can precede the diagnosis.
How common: 18.5 percent of peripheral T-cell lymphomas (Federico 2013).
Treatment: CHOP-based chemotherapy (with etoposide in younger patients) and autologous transplant in first remission for fit patients, as on the parent page; romidepsin, belinostat, pralatrexate, and azacitidine with or without romidepsin in relapsed disease, with the TFH-phenotype trial of duvelisib (TERZO) linked here; brentuximab vedotin when CD30 is expressed (Advani 2021 for the transplant data).
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
18.5 percent of peripheral T-cell and NK-cell lymphomas: 243 of 1,314 patients in the International Peripheral T-cell Lymphoma Project, making it one of the two commonest types (Federico 2013).
Leukaemias, myeloma and MDS live in the marrow and blood; lymphomas grow in lymph nodes and spleen. The node stations are the disease map, not a route of spread, and staging counts them.
In lymphoma the node stations are the disease itself; staging (Ann Arbor / Lugano) counts how many regions and sides of the diaphragm are involved.
Same organ: High-grade B-cell lymphoma with MYC and BCL2 rearrangements (double-hit lymphoma), Mediastinal grey zone lymphoma, Primary effusion lymphoma, Plasmablastic lymphoma, T-cell/histiocyte-rich large B-cell lymphoma, EBV-positive diffuse large B-cell lymphoma, Primary large B-cell lymphoma of the testis, Gastric MALT lymphoma, Ocular adnexal MALT lymphoma, Extranodal NK/T-cell lymphoma, Adult T-cell leukaemia/lymphoma, ALK-positive anaplastic large cell lymphoma, ALK-negative anaplastic large cell lymphoma, Breast implant-associated anaplastic large cell lymphoma, Primary cutaneous anaplastic large cell lymphoma, Lymphomatoid papulosis, Mycosis fungoides, Enteropathy-associated T-cell lymphoma, Monomorphic epitheliotropic intestinal T-cell lymphoma, Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma), Splenic marginal zone lymphoma, Nodal marginal zone lymphoma, Primary cutaneous marginal zone lymphoma, Primary cutaneous follicle centre lymphoma, Sezary syndrome, Hepatosplenic T-cell lymphoma, Intravascular large B-cell lymphoma, Lymphomatoid granulomatosis, T-cell prolymphocytic leukaemia, Splenic B-cell lymphoma/leukaemia with prominent nucleoli (formerly B-cell prolymphocytic leukaemia and hairy cell leukaemia variant), T-cell large granular lymphocytic leukaemia, Mixed-phenotype acute leukaemia, Myeloid leukaemia of Down syndrome, Burkitt leukaemia, Marginal zone lymphoma, Cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome), Primary mediastinal (thymic) large B-cell lymphoma, Leukaemia (all types), Acute myeloid leukaemia, Acute lymphoblastic leukaemia, Chronic lymphocytic leukaemia, Chronic myeloid leukaemia (CML), Diffuse large B-cell lymphoma, Follicular lymphoma, Hodgkin lymphoma, Mantle cell lymphoma, Multiple myeloma, Non-Hodgkin lymphoma (all types), Myelodysplastic syndromes / neoplasms (MDS), Myeloproliferative neoplasms (PV, ET, myelofibrosis), Polycythaemia vera (PV), Essential thrombocythaemia (ET), Waldenström macroglobulinaemia, Hairy cell leukaemia, Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma), Blastic plasmacytoid dendritic cell neoplasm (BPDCN), Burkitt lymphoma, HIV-associated (AIDS-related) lymphomas, Chronic myelomonocytic leukaemia and MDS/MPN overlap neoplasms, Systemic mastocytosis, Erdheim-Chester disease, Rosai-Dorfman disease and other histiocytic neoplasms, Langerhans cell histiocytosis (LCH), Post-transplant lymphoproliferative disorder (PTLD), FLT3-mutated acute myeloid leukaemia, IDH1- and IDH2-mutated acute myeloid leukaemia, NPM1-mutated and KMT2A-rearranged acute myeloid leukaemia, Secondary and therapy-related acute myeloid leukaemia, Acute promyelocytic leukaemia, Acute myeloid leukaemia in older or unfit patients, Smouldering multiple myeloma, Newly diagnosed multiple myeloma, transplant-eligible, Newly diagnosed multiple myeloma, transplant-ineligible, Relapsed or refractory multiple myeloma, Plasma cell leukaemia, Lower-risk myelodysplastic syndromes, Higher-risk myelodysplastic syndromes, Chronic lymphocytic leukaemia, first treatment, Relapsed or refractory chronic lymphocytic leukaemia, Richter transformation of chronic lymphocytic leukaemia, Chronic myeloid leukaemia, chronic phase, Chronic myeloid leukaemia, accelerated and blast phase, Primary myelofibrosis, Standard-risk B-cell acute lymphoblastic leukaemia in children, High-risk acute lymphoblastic leukaemia in children (high-risk B-ALL and T-ALL), Philadelphia chromosome-positive acute lymphoblastic leukaemia in children (Ph-positive ALL), Philadelphia chromosome-like acute lymphoblastic leukaemia (Ph-like or BCR::ABL1-like ALL), Infant acute lymphoblastic leukaemia (KMT2A-rearranged, under one year), Relapsed and refractory acute lymphoblastic leukaemia in children, Acute myeloid leukaemia in children, Erdheim-Chester disease, Rosai-Dorfman-Destombes disease, Single-system Langerhans cell histiocytosis (bone, skin or one other organ), Multisystem Langerhans cell histiocytosis (with or without risk-organ involvement), Indolent and smouldering systemic mastocytosis, Advanced systemic mastocytosis (aggressive SM, SM with an associated haematological neoplasm, mast cell leukaemia), Early-stage classical Hodgkin lymphoma (stage I to II), Advanced-stage classical Hodgkin lymphoma (stage III to IV), Nodular lymphocyte-predominant Hodgkin lymphoma (nodular lymphocyte-predominant B-cell lymphoma), Relapsed and refractory classical Hodgkin lymphoma
Nothing recorded yet.
Nothing recorded yet.
Also on OnCo: Symptoms and red flags · Early detection roadmap.
CHOP-based chemotherapy, with etoposide in younger patients, and autologous transplant in first complete remission for fit patients (T-cell Project data).
Romidepsin, belinostat or pralatrexate; azacitidine with romidepsin; duvelisib in the TFH-phenotype trial TERZO; brentuximab vedotin when CD30-positive.
First line is CHOP or CHOEP, with brentuximab vedotin substituted for vincristine where the tumour expresses CD30, and autologous transplant consolidation of a first remission in patients fit for it, exactly as for other nodal T-cell lymphomas. Two things are specific. The presentation is often autoimmune rather than oncological: rash, polyclonal hypergammaglobulinaemia, autoimmune haemolytic anaemia, arthritis and a positive Coombs test in a systemically unwell older person. Corticosteroids produce a rapid response that can be mistaken for a diagnosis, and the lymphoma returns as soon as they are reduced. Infection risk is high because the immune system is already disordered, so prophylaxis against Pneumocystis and herpes is given from the start. The mutational profile, TET2, DNMT3A, IDH2 and RHOA G17V, is the same set that produces clonal haematopoiesis, and it is the reason hypomethylating agents such as azacitidine and histone deacetylase inhibitors have more activity here than in other T-cell lymphomas. They are not yet a standard first-line option and belong in a trial.
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Query for this cancer: (TITLE:"Nodal T-follicular helper cell lymphoma, angioimmunoblastic type" OR ABSTRACT:"Nodal T-follicular helper cell lymphoma, angioimmunoblastic type" OR TITLE:"angioimmunoblastic T-cell lymphoma" OR ABSTRACT:"angioimmunoblastic T-cell lymphoma" OR TITLE:"Angioimmunoblastic T-cell lymphoma" OR ABSTRACT:"Angioimmunoblastic T-cell lymphoma" OR TITLE:"AITL" OR ABSTRACT:"AITL" OR TITLE:"Nodal TFH lymphoma" OR ABSTRACT:"Nodal TFH lymphoma" OR TITLE:"Nodal TFH lymphoma angioimmunoblastic type" OR ABSTRACT:"Nodal TFH lymphoma angioimmunoblastic type") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Nodal T-follicular helper cell lymphoma, angioimmunoblastic type (angioimmunoblastic T-cell lymphoma), not a curated reading list.
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Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
Breathing very fast, confusion or slurred speech, blue, pale or blotchy skin, a very high or very low temperature, shivering, or a rash that does not fade when pressed: the NHS says call 999 or go to A and E, and do not drive yourself.
A rising potassium level can disturb the heart rhythm, which is the reason blood is checked frequently during the first cycle. The triage standard sends chest pain or tightness straight to 999 whatever the cause.
Any new neurological symptom that is not explained. Brentuximab vedotin carries a boxed warning for progressive multifocal leukoencephalopathy, a brain infection; the label says to hold the drug and investigate at the first suspicion.
Macmillan lists difficulty passing urine, loss of bladder or bowel control and constipation among the signs of spinal cord compression and says to contact the hospital straight away. If you cannot reach anyone, go to A and E and say you have lymphoma and symptoms of spinal cord compression.
Temperature of 38 C or higher, or feeling shivery and unwell even without a fever. Antibody-drug conjugates suppress the bone marrow, and several carry a boxed warning for severe neutropenia.
See all on the product pages:AzacitidineBrentuximab vedotinCentral venous access (port, PICC line)CyclophosphamideDoxorubicinEtoposideFebrile neutropeniaHypogammaglobulinaemia and infection risk after B-cell therapiesMetastatic spinal cord compression (MSCC)NeutropeniaPralatrexateTumour lysis syndrome (TLS)Tumour lysis syndrome in lymphoma: who is at risk, and rasburicaseVincristine·Printable cards in the navigator
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