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. 2022 Sep 1;140(9):1009-1019.
doi: 10.1182/blood.2021015114.

Impact of etoposide and ASCT on survival among patients aged <65 years with stage II to IV PTCL: a population-based cohort study

Mirian Brink  1 , Frederik O Meeuwes  2   3 , Marjolein W M van der Poel  4 , Marie José Kersten  5 , Mariëlle Wondergem  5 , Pim G N J Mutsaers  6 , Lara H Böhmer  7 , F J Sherida H Woei-A-Jin  8 , Otto Visser  9 , Rimke Oostvogels  10 , Patty M Jansen  11 , Wouter Plattel  3 , Gerwin A Huls  3 , Joost S P Vermaat  12 , Marcel Nijland  3
Affiliations

Impact of etoposide and ASCT on survival among patients aged <65 years with stage II to IV PTCL: a population-based cohort study

Mirian Brink et al. Blood. .

Abstract

Patients aged <65 years with peripheral T-cell lymphoma (PTCL) are treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). Although the addition of etoposide (CHOEP) and consolidation with autologous stem cell transplantation (ASCT) are preferred in some countries, randomized trials are lacking. This nationwide population-based study assessed the impact of etoposide and ASCT on overall survival (OS) among patients aged 18 to 64 years with stage II to IV anaplastic large-cell lymphoma (ALCL), angioimmunoblastic T-cell lymphoma (AITL), or PTCL not otherwise specified (NOS) diagnosed between 1989 and 2018 using the Netherlands Cancer Registry. Patients were categorized into 2 calendar periods, representing pre- and post-eras of etoposide and ASCT, respectively. A total of 1427 patients were identified (ALCL, 35%; AITL, 21%; and PTCL NOS, 44%). OS increased from 39% in the period from 1989 to 2009 to 49% in the period of 2009 to 2018 (P < .01). Five-year OS was superior for patients treated with CHOEP vs CHOP (64% and 44%, respectively; P < .01). When adjusted for subtype, International Prognostic Index score, and ASCT, the risk of mortality was similar between the 2 groups, except for patients with ALK+ ALCL, for whom the risk of mortality was 6.3 times higher when treated with CHOP vs CHOEP. Patients undergoing consolidation with ASCT had superior 5-year OS of 81% compared with 39% for patients not undergoing ASCT (P < .01), regardless of whether complete remission was achieved. In patients aged <65 years with advanced-stage ALK- ALCL, AITL, or PTCL, the use of ASCT consolidation, but not the addition of etoposide, was associated with improved OS.

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Figures

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Graphical abstract
Figure 1.
Figure 1.
OS in patients aged <65 years with stage II to IV PTCL. (A-B) OS according to 2 calendar periods (1989-2008 and 2009-2018) (A) and according to histologic subtypes ALK− ALCL, ALK+ ALCL, ALCL NOS, AITL, and PTCL NOS (B).
Figure 2.
Figure 2.
Best tumor response in patients with ALK+ ALCL aged <65 years with stage II to IV disease. (A-B) Best response in patients who received CHOP with or without etoposide (A) and in those with ALK− ALCL, AITL, or PTCL NOS regardless of subsequent ASCT (B). Denominators include patients with ALK+ ALCL diagnosed in the period from 2014 to 2018 and treated with either CHOP of CHOEP (A) and patients with ALK− ALCL, AITL, or PTCL NOS diagnosed in the period from 2014 to 2018 and treated with either CHOP or CHOEP (B). PD, progressive disease; PR, partial remission; SD, stable disease; UNK, unknown.
Figure 3.
Figure 3.
OS in patients aged <65 years with stage II to IV disease. (A-D) OS in patients with ALK+ ALCL (A) and in those with ALK− ALCL, AITL, or PTCL NOS treated with CHOP or CHOEP in the first-line setting (C), with corresponding forest plots of HRs and 95% CIs (B,D), using multivariable Cox regression analysis.
Figure 4.
Figure 4.
OS in patients aged <65 years with stage II to IV disease. (A-B) OS in patients with ALCL, AITL, or PTCL NOS treated with or without consolidation with ASCT after chemotherapy in the first-line setting, measured in months after the 9-month landmark (LM) (A), and in patients who achieved CR in the first-line setting after induction chemotherapy with or without consolidation with ASCT (B).
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