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. 2020;143(1):40-50.
doi: 10.1159/000500666. Epub 2019 Jul 17.

Outcomes for Relapsed and Refractory Peripheral T-Cell Lymphoma Patients after Front-Line Therapy from the COMPLETE Registry

Frederick Lansigan  1 , Steven M Horwitz  2 , Lauren C Pinter-Brown  3 , Steven T Rosen  4 , Barbara Pro  5 , Eric D Hsi  6 , Massimo Federico  7 , Christian Gisselbrecht  8 , Marc Schwartz  9 , Lisa A Bellm  10 , Mark Acosta  11 , Andrei R Shustov  12 , Ranjana H Advani  13 , Tatyana Feldman  14 , Mary Jo Lechowicz  15 , Sonali M Smith  16 , Anil Tulpule  17 , Michael D Craig  18 , John P Greer  19 , Brad S Kahl  20 , Joseph W Leach  21 , Neil Morganstein  22 , Carla Casulo  23 , Steven I Park  24 , Francine M Foss  25
Affiliations

Outcomes for Relapsed and Refractory Peripheral T-Cell Lymphoma Patients after Front-Line Therapy from the COMPLETE Registry

Frederick Lansigan et al. Acta Haematol. 2020.

Abstract

Background: Outcomes for patients with peripheral T-cell lymphoma (PTCL) who fail to achieve complete response (CR) or relapse after front-line therapy are poor with lack of prospective outcomes data.

Objectives: COMPLETE is a prospective registry of 499 patients enrolled at academic and community sites in the United States detailing patient demographics, treatment and outcomes for patients with aggressive T cell lymphomas. We report results for patients with primary refractory and relapsed disease.

Methods: Primary refractory disease was defined as an evaluable best response to initial treatment (induction ± maintenance or consolidation/transplant) other than CR, and included a partial response, progressive disease, or no response/stable disease. Relapsed disease was defined as an evaluable best response to initial treatment of CR, followed by disease progression at a later date, irrespective of time to progression. Patients were included in the analysis if initial treatment began within 30 days of enrollment and treatment duration was ≥4 days.

Results: Of 420 evaluable patients, 97 met the definition for primary refractory and 58 with relapsed disease. In the second-line setting, relapsed patients received single-agent therapies more often than refractory patients (52 vs. 28%; p = 0.01) and were more likely to receive single-agent regimens (74 vs. 53%; p = 0.03). The objective response rate to second-line therapy was higher in relapsed patients (61 vs. 40%; p = 0.04) as was the proportion achieving a CR (41 vs. 14%; p = 0.002). Further, relapsed patients had longer overall survival (OS) compared to refractory patients, with a median OS of 29.1 versus 12.3 months.

Conclusions: Despite the availability of newer active single agents, refractory patients were less likely to receive these therapies and continue to have inferior outcomes compared to those with relapsed disease. PTCL in the real world remains an unmet medical need, and improvements in front-line therapies are needed.

Keywords: Combination; Drug therapy; Peripheral T-cell lymphoma; Prospective cohort studies; Salvage therapy.

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