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Multicenter Study
. 2021 Jul;38(7):3789-3802.
doi: 10.1007/s12325-021-01764-0. Epub 2021 May 26.

Systemic ALCL Treated in Routine Clinical Practice: Outcomes Following First-Line Chemotherapy from a Multicentre Cohort

Nicolas Martinez-Calle  1 , Amy A Kirkwood  2 , Maxine Lamb  3 , Alex Smith  3 , Jahanzaib Khwaja  4 , Kate Manos  5 , Caroline Shrubsole  6 , Nicola Gray  7 , Katharine Lewis  8 , Ann Tivey  9 , Mark J Bishton  10 , Eliza Hawkes  11 , Matthew J Ahearne  12 , Wendy Osborne  6 , Graham P Collins  7 , Timothy Illidge  9 , Kim M Linton  9 , Kate Cwynarski  4 , Cathy Burton  13 , Christopher P Fox  10
Affiliations
Multicenter Study

Systemic ALCL Treated in Routine Clinical Practice: Outcomes Following First-Line Chemotherapy from a Multicentre Cohort

Nicolas Martinez-Calle et al. Adv Ther. 2021 Jul.

Abstract

Introduction: Brentuximab vedotin (BV)-CHP is the new standard regimen for first-line treatment of systemic anaplastic large cell lymphoma (sALCL). We undertook a retrospective analysis of consecutive patients diagnosed with sALCL, treated in routine practice, to serve as a benchmark analysis for comparison BV-CHP efficacy in routine practice.

Methods: Patients aged 16 years or older with sALCL treated in seven UK and Australian centres and from 14 additional centres from the UK Haematological Malignancy Research Network database (n = 214). Treatment allocation was clinician choice and included best supportive care (BSC). Main outcomes were time to treatment failure (TTF) and overall survival (OS). Multivariable analysis for predictors of both TTF and OS was also undertaken.

Results: The median age 52 years (range 16-93), 18% ECOG ≥ 3 and 40% of cases were ALK positive. CHOP (cyclophosphamide, adriamycin, vincristine, prednisolone) was employed in 152 (71%) of patients and CHOEP (CHOP + etoposide) in 4% of patients. For CHOP-treated patients overall response rate (ORR) was 65% and complete response (CR) 47%. Only 9% of patients underwent autologous stem cell transplant (ASCT). With 57 months median follow-up, 4-year TTF and OS were 41.2% (95% CI 33.1-49.1) and 58.9% (95% CI 50.3-66.5) respectively. Multivariable analysis showed ALK+ status was independently associated with superior TTF (HR 0.36, 95% CI 0.21-0.63) but not OS (0.44, 95% CI 0.18-1.07).

Discussion: We present a retrospective analysis with mature follow-up of one of the largest multicentre populations of sALCL available, comparable to similar large retrospective studies. ALK status remains a strong predictor of outcomes.

Conclusion: These data serve as a robust benchmark for BV-CHP as the new standard of care for sALCL. Similar real-world evidence with BV-CHP will be desirable to confirm the findings of ECHELON-2.

Keywords: Adcetris; Autologous stem cell transplantation; Brentuximab vedotin; CHOEP; CHOP.

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Figures

Fig. 1
Fig. 1
TTF and OS Kaplan–Meier curves of complete cohort (a, b) and CHOP-treated cohort (c, d)
Fig. 2
Fig. 2
TTF and OS in CHOP-treated cohort, Kaplan–Meier curves stratified by ALK status
See this image and copyright information in PMC

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