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Multicenter Study
. 2014 Nov;25(11):2211-2217.
doi: 10.1093/annonc/mdu443. Epub 2014 Sep 5.

Peripheral T-cell lymphomas in a large US multicenter cohort: prognostication in the modern era including impact of frontline therapy

J S Abramson  1 , T Feldman  2 , A R Kroll-Desrosiers  3 , L S Muffly  4 , E Winer  5 , C R Flowers  6 , F Lansigan  7 , C Nabhan  4 , L J Nastoupil  6 , R Nath  3 , A Goy  2 , J J Castillo  8 , D Jagadeesh  3 , B Woda  3 , S T Rosen  9 , S M Smith  4 , A M Evens  10
Affiliations
Multicenter Study

Peripheral T-cell lymphomas in a large US multicenter cohort: prognostication in the modern era including impact of frontline therapy

J S Abramson et al. Ann Oncol. 2014 Nov.

Abstract

Background: Optimal frontline therapy for peripheral T-cell lymphoma (PTCL) in the modern era remains unclear.

Patients and methods: We examined patient characteristics, treatment, and outcomes among 341 newly diagnosed PTCL patients from 2000 to 2011. Outcome was compared with a matched cohort of diffuse large B-cell lymphoma (DLBCL) patients, and prognostic factors were assessed using univariate and multivariate analyses.

Results: PTCL subtypes included PTCL, not otherwise specified (PTCL-NOS) (31%), anaplastic large T-cell lymphoma (ALCL) (26%), angioimmunoblastic T-cell lymphoma (23%), NK/T-cell lymphoma (7%), acute T-cell leukemia/lymphoma (6%), and other (7%). Median age was 62 years (range 18-95 years), and 74% had stage III-IV disease. Twenty-three (7%) patients received only palliative care whereas 318 received chemotherapy: CHOP-like regimens (70%), hyperCVAD/MA (6%), or other (18%). Thirty-three patients (10%) underwent stem-cell transplantation (SCT) in first remission. The overall response rate was 73% (61% complete); 24% had primary refractory disease. With 39-month median follow-up, 3-year progression-free survival (PFS) and overall survival (OS) were 32% and 52%. PFS and OS for PTCL patients were significantly inferior to matched patients with DLBCL. On multivariate analysis, stage I-II disease was the only significant pretreatment prognostic factor [PFS: hazard ratio (HR) 0.54, 95% confidence interval (CI) 0.34-0.85, P = 0.007; OS: HR 0.42, 95% CI 0.22-0.78, P = 0.006]. ALK positivity in ALCL was prognostic on univariate analysis, but lost significance on multivariate analysis. The most dominant prognostic factor was response to initial therapy (complete response versus other), including adjustment for stage and SCT [PFS: HR 0.19, 95% CI 0.14-0.28, P < 0.0001; OS: HR 0.26, 95% CI 0.17-0.40, P < 0.0001]. No overall survival difference was observed based on choice of upfront regimen or SCT in first remission.

Conclusions: This analysis identifies early-stage disease and initial treatment response as dominant prognostic factors in PTCL. No clear benefit was observed for patients undergoing consolidative SCT. Novel therapeutic approaches for PTCL are critically needed.

Keywords: PTCL; anaplastic large-cell lymphoma; angioimmunoblastic T-cell lymphoma; peripheral T-cell lymphoma; stem-cell transplantation.

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Figures

Figure 1.
Figure 1.
PFS and OS for all patients (A) and for only patients treated with chemotherapy (B). Among chemotherapy-treated patients, PFS (C) and OS (D) by Ann Arbor stage.
Figure 2.
Figure 2.
PFS (A) and OS (B) of peripheral T-cell lymphoma patient population compared with matched DLBCL patients.
Figure 3.
Figure 3.
OS for all patients by histology. Only histologies with >10 subjects are included in this analysis.
Figure 4.
Figure 4.
PFS (A) and OS (B) by consolidative SCT in all patients, and PFS (C) and OS (D) by SCT limited to patients in CR following induction chemotherapy.
See this image and copyright information in PMC

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