The outcome of peripheral T-cell lymphoma patients failing first-line therapy: a report from the prospective, International T-Cell Project

Abstract

This analysis explored factors influencing survival of patients with primary refractory and relapsed peripheral T-cell lymphomas enrolled in the prospective International T-cell Project. We analyzed data from 1020 patients with newly diagnosed disease, enrolled between September 2006 and December 2015. Out of 937 patients who received first-line treatment, 436 (47%) were identified as refractory and 197 (21%) as relapsed. Median time from the end of treatment to relapse was 8 months (range 2-73). Overall, 75 patients (8%) were consolidated with bone marrow transplantation, including 12 refractory and 22 relapsed patients. After a median follow up of 38 months (range 1-96 months) from documentation of refractory/relapsed disease, 440 patients had died. The median overall survival (OS) was 5.8 months; 3-year overall survival rates were 21% and 28% for refractory and relapsed patients, respectively (P<0.001). Patients receiving or not salvage bone marrow transplantation had a 3-year survival of 48% and 18%, respectively (P<0.001). In a univariate Cox regression analysis, refractory disease was associated with a higher risk of death (HR=1.43, P=0.001), whereas late relapse (>12 months, HR 0.57, P=0.001) and salvage therapy with transplantation (HR=0.36, P<0.001) were associated with a better OS. No difference was found in OS with respect to histology. This study accurately reflects outcomes for patients treated according to standards of care worldwide. Results confirm that peripheral T-cell lymphomas patients had dismal outcome after relapse or progression. Patients with chemotherapy sensitive disease who relapsed after more than 12 months might benefit from consolidation bone marrow transplantation.

Trial registration: ClinicalTrials.gov NCT01142674.

Figure 1.

Flow chart of patients included in the analysis. CR: complete remission.

Figure 2.

Survival after relapse (SAR). (A) SAR curve of 633 refractory/relapsed patients. (B) SAR by status: refractory versus relapse. Refractory patients are those with primary refractoriness.

Figure 3.

Outcomes for refractory/relapsed patients depending on histological subtypes. PTCL-NOS: peripheral T-cell lymphoma not otherwise specified; AITL: angioimmunoblastic T-cell lymphoma; ALCL (−): anaplastic large cell lymphoma, anaplastic lymphoma kinase negative; ALCL (+): anaplastic large cell lymphoma, anaplastic lymphoma kinase positive; NKTCL: extranodal NK/T-cell lymphoma.

Figure 4.

Survival after relapse (SAR) by salvage therapy including or not hematopoietic cell transplantation (HCT). Elig: eligible; Not elig: not eligible; CR: complete remission; PR: partial remission.