Characteristics, treatment patterns, prognostic determinants and outcome of peripheral T cell lymphoma and natural killer/T cell non-Hodgkin Lymphoma in older patients: The result of the nationwide multi-institutional registry Thai Lymphoma Study Group

Abstract

Introduction: Peripheral T cell NHL (PTCL) and natural killer/T cell NHL (NKTCL) are relatively rare disorders. Data on clinical presentation, treatment and outcome are limited especially in older age groups. Methods: We identified 127 patients with PTCL and NKTCL, excluding cutaneous T/NK cell lymphoma, aged over 60 years old from Thailand nationwide multicenter registry. Results: Of 127 patients, median age of diagnosis was 67 years old. Patients aged older than 75 years old had similar characteristics to younger (60-74 years old) but higher comorbidity index. Seventy-nine patients (62.2%) received intensive/definite multi-agent chemotherapy, however, the proportion was significant lower in older patients (70.4% vs 34.5%, p b .001). After a median follow up duration of 17.3 months, 2-year progression free survival and overall survival were 38.1% and 48.5%. Univariate and multivariable analysis demonstrated older age, poor performance status and absence of definite multi-agent chemotherapy were associated with inferior survival. Definite multi-agent lymphoma specific chemotherapy was an independent factor for overall survival after adjustment for age, comorbidity index, performance status and prognostic index for T cell lymphoma. Conclusion: Despite overall poor prognosis of PTCL and NKTCL in older adults, chemotherapy could result in objective response and long-term survival in selected patients of this vulnerable age group thus emphasizing the importance of comprehensive geriatric evaluation.

All-oral metronomic DEVEC schedule in elderly patients with peripheral T cell lymphoma

“…In fact, it was reported that patients who receive low-intensity treatment performed worse than those who are treated with standard dose IV schedules. However, the "lower intensity" group received either the cyclophosphamide-vincristine-prednisolone (CVP) intravenous schedule or a single-agent chemotherapy with palliative intent [19]. We acknowledge our study on this rare disease has a small sample size, which limits the relevance of our findings and, thus, no definitive conclusions can be drawn.…”

Controversies in the Treatment of Peripheral T‐cell Lymphoma

“…The authors concluded that multi-agent chemotherapy (largely CHOP) should be given whenever possible and that a comprehensive geriatric assessment is useful. 67 A Korean study in 44 patients over 70 or between 65 and 70 but with co-morbidities (median age 74) gave very similar outcome data. Patients received dose-attenuated CHOP (cyclophosphamide: 562.5 mg/m 2 , doxorubicin: 37.5 mg/m 2 , vincristine: 1.4 mg/m 2 , and prednisolone: 100 mg for five days; 25% reduced dose of cyclophosphamide and doxorubicin) as first-line therapy.…”

“…The choice of chemotherapy remained significant even after adjusting for age, comorbidity, performance status and IPI. The authors concluded that multi‐agent chemotherapy (largely CHOP) should be given whenever possible and that a comprehensive geriatric assessment is useful 67 . A Korean study in 44 patients over 70 or between 65 and 70 but with co‐morbidities (median age 74) gave very similar outcome data.…”