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. 2024 Jul 23;8(14):3619-3628.
doi: 10.1182/bloodadvances.2023012531.

Treatment strategies and outcome in relapsed peripheral T-cell lymphoma: results from the Netherlands Cancer Registry

Mirian Brink  1 , Francien Huisman  2   3 , Frederik O Meeuwes  2   3 , Marjolein W M van der Poel  4 , Marie José Kersten  5 , Mariëlle Wondergem  5 , Lara Böhmer  6 , F J Sherida H Woei-A-Jin  7 , Otto Visser  8 , Rimke Oostvogels  9 , Patty M Jansen  10 , Arjan Diepstra  11 , Tjeerd J F Snijders  12 , Gerwin Huls  2 , Joost S P Vermaat  13 , Wouter J Plattel  2 , Marcel Nijland  2
Affiliations

Treatment strategies and outcome in relapsed peripheral T-cell lymphoma: results from the Netherlands Cancer Registry

Mirian Brink et al. Blood Adv. .

Abstract

Optimal treatment in patients with refractory or relapsed peripheral T-cell lymphomas (R/R T-NHLs) is unknown. In this population-based study, outcomes in R/R peripheral T-cell lymphoma not otherwise specified (PTCL NOS), angioimmunoblastic T-cell lymphoma (AITL), and anaplastic lymphoma kinase-positive (ALK+) and ALK-negative (ALK-) anaplastic large cell lymphoma (ALCL) were evaluated. Patients with PTCL NOS, AITL, ALK+ ALCL, and ALK- ALCL (≥18 years) diagnosed in 2014 to 2019 were identified using the Netherlands Cancer Registry. End points were overall response rate (ORR), progression-free survival (PFS), and overall survival (OS). The 2-year PFS of 821 patients was 57%. Among 311 patients with a relapse, 243 received second-line treatment: 44% received salvage chemotherapy, 20% received brentuximab vedotin (BV), and 36% received other treatment. In third-line treatment, BV was most commonly used (38%). ORR after second-line treatment was 47%. Two-year PFS and OS after relapse were 25% and 34%, respectively. The risk of second relapse was negatively affected by early relapse (<12 months after diagnosis), whereas BV reduced this risk compared with salvage chemotherapy. Reduced risk of relapse was independent of histological subtype. The best outcomes were observed for patients treated with salvage chemotherapy receiving consolidative autologous and allogeneic stem cell transplantation (SCT) (2-year OS 68%), patients treated with BV achieving a second complete remission (2-year OS 74%) and patients with allogeneic SCT (2-year OS 60%). The risk of second relapse was significantly lower for patients with R/R T-NHL treated with BV compared with patients treated with salvage chemotherapy, and this was irrespective of subtype. Therefore, the use of salvage chemotherapy for patients with R/R T-NHL is challenged.

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Conflict of interest statement

Conflict-of-interest disclosure: The authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
PFS and OS among 821 patients with PTCL NOS, AITL, and ALCL.
Figure 2.
Figure 2.
Treatment strategies among 821 patients with PTCL NOS, AITL, and ALCL in first-, second-, and third-line treatment.
Figure 3.
Figure 3.
PFS and OS among 243 relapsed patients with T-NHL treated with chemotherapy in second-line.
Figure 4.
Figure 4.
Forest plot of multivariable analysis for risk of mortality and risk of relapse among 243 patients relapsed T-NHL.
Figure 5.
Figure 5.
Survival curves among 107 patients with relapsed T-NHL treated with DHAP/GDP in second-line. (A) 5-year OS and PFS curves are presented. (B) 5-year OS and PFS are presented for 33 patients who received autologous or allogeneic SCT after DHAP/GDP, using a landmark analysis.
Figure 6.
Figure 6.
Survival curves among 77 patients with relapsed T-NHL treated with BV in second- and third-line. (A) 5-year OS and PFS curves are presented. (B) The 5-year OS curves according to response outcome are presented.
See this image and copyright information in PMC

References

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