Peripheral T cell lymphomas (PTLs) have a globally poor prognosis. The CHOP regimen shows insufficient efficacy; first-line consolidation with autologous stem cell transplantation (auto-SCT) is a promising strategy but has never been confirmed by randomized data. We analyzed retrospectively 906 patients diagnosed with PTL between 1999 and 2015. Chemotherapy was given to 862 patients, and 412 of them were < 60 years. In this subset, we compared induction with CHOP (n = 113) vs. CHOEP (n = 68) and tested auto-SCT (n = 79) vs. no SCT (n = 73) in the intent-to-treat analysis. The median age of the whole cohort at diagnosis was 60 years (range; 18–91); the median follow-up was 4.3 years (range; 0.1–17.8). A shorter overall survival (OS) was associated with the male gender, age ≥ 60 years, stage III/IV, performance status ≥ 2, bulky tumor ≥ 10 cm, and elevated LDH. CHOEP induction showed a better 5-year PFS (25.0% vs. 32.9%; p.001), and 5-year OS (65.6% vs. 47.6%; p.008) than CHOP. Auto-SCT compared to no SCT brought a 5-year OS of 49.2% vs. 59.5% (p.187). Auto-SCT did not influence the OS in low-risk or low-intermediate risk PTLs. The high-intermediate and high-risk IPIs displayed a worse 5-year OS in auto-SCT arm (17.7% vs.46.2%; p.049); however, 73.9% of the patients never received planned auto-SCT. Our population-based analysis showed the superiority of CHOEP over CHOP in first-line treatment. We confirm the 5-year OS of around 50% in PTLs undergoing auto-SCT. However, the intended auto-SCT could not be given in 73.9% of the high-risk PTLs.
T cell lymphoma Auto-SCT Etoposide Prognosis
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This work was supported by research grants from the Ministry of Education and Youth of the Czech Republic AZV CR 16-31092A. On behalf of CLSG.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
Foss FM, Zinzani PL, Vose JM et al (2011) Peripheral T cell lymphoma. Blood 117(25):6756–6767CrossRefGoogle Scholar
Adams SV, Newcomb PA, Shustov AR (2016) Racial Patterns of Peripheral T cell Lymphoma Incidence and Survival in the United States. J Clin Oncol 34(9):963–971CrossRefGoogle Scholar
Ellin F, Landström J, Jerkeman M, Relander T (2014) Real-world data on prognostic factors and treatment in peripheral T cell lymphomas: a study from the Swedish Lymphoma Registry. Blood 124(10):150–1577CrossRefGoogle Scholar
Schmitz N, Trümper L, Ziepert M et al (2010) Treatment and prognosis of mature T cell and NK-cell lymphoma: an analysis of patients with T cell lymphoma treated in studies of the German High-Grade Non-Hodgkin Lymphoma Study Group. Blood 116(18):3418–3425CrossRefGoogle Scholar
Weisenburger DD, Savage KJ, Harris NL et al (2011) Peripheral T cell lymphoma, not otherwise specified: a report of 340 cases from the International Peripheral T cell Lymphoma Project. Blood 117:3402–3408CrossRefGoogle Scholar
Federico M, Rudiger T, Bellei M et al (2013) Clinicopathologic characteristics of angioimmunoblastic T cell lymphoma: analysis of the International Peripheral T cell lymphoma Project. J Clin Oncol 31(2):240–246CrossRefGoogle Scholar
Sibon D, Fournier M, Briere J et al (2012) Long-term outcome of adults with systemic anaplastic large-cell lymphoma treated within the Groupe d’Etude des Lymphomes de l’Adulte Trials. J Clin Oncol 30:3939–3946CrossRefGoogle Scholar
Tse E, Kwong YL (2016) Diagnosis and management of extranodal NK/T cell lymphoma nasal type. Expert Rev Hematol 9:861–871CrossRefGoogle Scholar
Petrich AM, Helenowski IB, Bryan LJ et al (2015) Factors predicting survival in peripheral T cell lymphoma in the USA: a population-based analysis of 8802 patients in the modern era. Br J Hematol 168:708–718CrossRefGoogle Scholar
Vazquez A, Khan MN, Blake DM et al (2014) Extranodal natural killer/T cell lymphoma: a population based comparison of sinonasal and extranasal disease. Laryngoscope 124(4):888–895CrossRefGoogle Scholar
Wang YQ, Yang Y, Zhuo HY et al (2015) Trial of LVDP regimen (L-asparaginase, etoposide, dexamethasone, and cisplatin, followed by radiotherapy) as first-line treatment for newly diagnosed, stage III/IV extranodal natural killer/T cell lymphoma. Med Oncol 32:9CrossRefGoogle Scholar
D’Amore F, Relander T, Lauritzsen GF et al (2012) Up-front autologous stem-cell transplantation in peripheral T cell lymphoma: NLG-T-01. J Clin Oncol 30:3093–3099CrossRefGoogle Scholar
D’Amore F, Relander T, Lauritzsen G et al (2015) Ten years median follow-up of the Nordic NLG-T-01 trial on CHOEP and upfront autologous transplantation in peripheral T cell lymphomas. Hematol Oncol 33(Suppl 1):139 (Abstract No 074)Google Scholar
Swerdlow SH, Campo E, Harris NL et al (2008) WHO Classification of tumors of hematopoietic and lymphoid tissues, 4th edn. International Agency for Research on cancer (IARC), LyonGoogle Scholar
Carbone PP, Kaplan HS, Musshoff K, Smithers DW, Tubiana M (1971) Report of the Committee on no Hodgkin’s Disease Staging Classification. Cancer Res 31:1860–1861Google Scholar
Sykorova A, Belada D, Smolej L et al (2010) Staging of non-Hodgkin’s lymphoma –recommendations of the Czech Lymphoma Study Group. Klin Onkol 23:146–154Google Scholar
Cheson BD, Horning SJ, Coiffier B et al (1999) Report of an international workshop to standardize response criteria for non-Hodgkin’s lymphomas. NCI Sponsored International Working Group. J Clin Oncol 17(4):1244CrossRefGoogle Scholar
Cheson BD, Pfistner B, Juweid ME et al (2007) International Harmonization Project on Lymphoma. Revised response criteria for malignant lymphoma. J Clin Oncol 25(5):579–586CrossRefGoogle Scholar
Shipp MA (1994) Prognostic factors in aggressive non-Hodgkin’s lymphoma: who has “high-risk” disease? Blood 83(5):1165–1173Google Scholar
Gallamini A, Stelitano C, Calvi R et al (2004) Intergruppo Italiano Linfomi. Peripheral T cell lymphoma unspecified (PTCL-U): a new prognostic model from a retrospective multicentric clinical study. Blood 103(7):2474–2479CrossRefGoogle Scholar
Chiu BC, Hou N (2015) Epidemiology and etiology of non-hodgkin lymphoma. Cancer Treat Res 165:1–25CrossRefGoogle Scholar
Haverkos BM, Pan Z, Gru AA et al (2016) Extranodal NK/T cell lymphoma, nasal type (ENKTL-NT): An update on epidemiology, clinical presentation, and natural history in North American and European cases. Curr Hematol Malig Rep 11(6):514–527CrossRefGoogle Scholar
Pedersen MB, Hamilton-Dutoit SJ, Bendix K et al (2015) Evaluation of clinical trial eligibility and prognostic indices in a population-based cohort of systemic peripheral T cell lymphomas from the Danish Lymphoma Registry. Hematol Oncol 33:120–128CrossRefGoogle Scholar
Laurent C, Baron M, Amara N et al (2017) Impact of expert pathologic review of lymphoma diagnosis: study of patients from the French Lymphopath Network. JCO 35(18):2008–2017CrossRefGoogle Scholar
Bellei M, Sabattini E, Pesce EA et al (2017) Pitfalls and major issues in the histologic diagnosis of peripheral T cell lymphomas: results of the central review of 573 cases from the T cell Project, an international, cooperative study. Hematol Oncol 35(4):630–636CrossRefGoogle Scholar
Iqbal J, Wright G, Wang C et al (2014) Gene expression signatures delineate and prognostic subgroups in peripheral T cell lymphoma. Blood 123(19):2915–2923CrossRefGoogle Scholar
Siaghani PJ, Song JY (2018) Updates of peripheral T cell lymphomas based on the 2017 WHO classification. Curr Hematol Malig Rep 13:25–36CrossRefGoogle Scholar
Ambramson JS, Feldman T, Kroll-Desrosiers AR et al (2014) Peripheral T cell lymphoma in a large US multicenter cohort: prognostication in the modern era including impact of frontline therapy. Ann Oncol 25(11):2211–2217CrossRefGoogle Scholar
Federico M, Bellei M, Marcheselli L et al (2018) Peripheral T cell lymphoma, not otherwise specified (PTCL-NOS). A new prognostic model developed by the International T cell Project Network. Br J Hematol 181:760–769CrossRefGoogle Scholar
Cederleuf H, Bjerregard Pedersen M, Jerkeman M et al (2017) The addition of etoposide to CHOP is associated with improved outcome in ALK+ adult anaplastic large cell lymphoma: a Nordic Lymphoma Group study. Br J Hematol 178(5):739–746CrossRefGoogle Scholar
Kharfan-Dabaja MA, Kumar A, Ayala E et al (2017) Clinical practice recommendations on indication and timing of hematopoietic cell transplantation in mature T cell and NK/T cell lymphomas: an International Collaborative Effort on Behalf of the Guidelines Comitee of the American Society for Blood and Marrow Transplantation; 23:1826–1838Google Scholar
Wilhelm M, Smetak M, Reimer P et al (2016) First-line therapy of peripheral T cell lymphoma: extension and long-term follow-up of a study investigating the role of autologous stem cell transplantation. Blood Cancer J 6:e 452CrossRefGoogle Scholar
Rohlfing S, Dietrich S, Witzens-Harig M et al (2018) The impact of stem cell transplantation on the natural course of peripheral T cell lymphoma: a real-world experience. Ann Hematol 97(7):1241–1250CrossRefGoogle Scholar
Park SI, Horwitz SM, Foss FM et al (2019) The role of autologous stem cell transplantation in patients with nodal peripheral T cell lymphomas in first complete remission: Report from COMPLETE, a prospective, multicenter cohort study. Cancer. https://doi.org/10.1002/cncr.31861
Mercadal S, Briones J, Xicoy B et al (2008) Intensive chemotherapy (high-dose CHOP/ESHAP regimen) followed by autologous stem-cell transplantation in previously untreated patients with peripheral T cell lymphoma. Ann Oncol 19:958–963CrossRefGoogle Scholar
Corradini P, Tarella C, Zallio F et al (2006) Long-term follow-up of patients with peripheral T cell lymphomas treated up-front with high-dose chemotherapy followed by autologous stem cell transplantation. Leukemia 20:1533–1538CrossRefGoogle Scholar