Comparison of four prognostic scores in peripheral T-cell lymphoma

Gutiérrez-García, Gonzalo; García‐Herrera, Adriana; Cardesa, Teresa; Martı́nez, Antonio; Villamor, Neus; Ghita, Gabriela; Martínez‐Trillos, Alejandra; Colomo, Luís; Setoaín, Xavier; Rodríguez, Sónia; Giné, Eva; Campo, Elı́as; López‐Guillermo, Armando

doi:10.1093/annonc/mdq359

Cited by 91 publications

(75 citation statements)

References 38 publications

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“…First, platelet count at diagnosis has been consistently shown to have prognostic implications, both individually and as a component of the IPTCLP in patients with PTCL [8, 20, 21]. Specifically, the presence or absence of thrombocytopenia was reported to further stratify patients classified into overlapping risk groups by IPI [21].…”

Section: Discussionmentioning

confidence: 99%

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Prognostic Value of Platelet Count in Patients with Peripheral T Cell Lymphoma

et al. 2019

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Background: Peripheral T cell lymphoma (PTCL) is a heterogeneous entity with poor survival. We evaluated the neutrophil-to-lymphocyte ratio (NLR), absolute lymphocyte count (ALC), and platelet count as new prognostic factors for PTCL. Patients and Methods: We retrospectively analyzed 77 patients with PTCL initially treated with anthracycline-based chemotherapy. Survival curves were compared between groups with different initial NLR (iNLR), end-point NLR (eNLR), initial ALC, and platelet counts. Cox regression was used to analyze the risk factor for survival. Results: Patients with a higher eNLR (≥3), lymphopenia (< 1,000/μL), and thrombocytopenia (< 150 K/μL) had an inferior progression-free survival (PFS) and overall survival (OS) compared to their counterparts, while a higher iNLR (≥3) was predictive of a shorter OS but not PFS. Among these, thrombocytopenia was an independent poor prognostic factor for both PFS and OS, with a hazard ratio of 2.42 (p = 0.012) for PFS and 4.21 (p = 0.006) for OS. The presence of thrombocytopenia further stratified patients with a worse prognosis within overlapping risk-groups by the prognostic index for PTCL. Conclusions: Our study showed that thrombocytopenia at diagnosis was an independent prognostic factor for survival in patients with PTCL.

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Section: Discussionmentioning

confidence: 99%

“…PIT was specifically designed for patients with PTCL, not-otherwise-specified (NOS) subtype, and includes age, PS, LDH, and bone marrow (BM) involvement [7]. Both have demonstrated their relevance in treatment response and survival of patients with PTCL [8]. …”

Section: Introductionmentioning

confidence: 99%

Prognostic Value of Platelet Count in Patients with Peripheral T Cell Lymphoma

et al. 2019

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“…23 Importantly, all of these prognostic scores have been validated in subpopulations treated with cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP), or at least an anthracycline-containing regimen. The 4 scores divide PTCL-NOS patients in 3 (m-PIT, ITCLP) or 4 (IPI, PIT) prognostic categories: the lower risk group, whichever score is used (score 0/1 for IPI and m-PIT, score 0 for PIT and ITCLP), emerges as a clearly separated category and shows better outcomes than all the other risk groups [20][21][22][23][24][25][26][27] (Table 2). Whether the approach to lower risk patients should be more conservative, however, is matter of discussion, because at least 60% to 70% of these patients are likely to relapse within the first 5 years.…”

Section: Prognostic Scoresmentioning

confidence: 99%

Peripheral T-cell lymphoma, not otherwise specified

Broccoli

Zinzani

2017

Blood

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Peripheral T-cell lymphoma, not otherwise specified, is a broad category of biologically and clinically heterogeneous diseases that cannot be further classified into any other of the existing entities defined by the World Health Organization classification. Anthracycline-containing regimens, namely cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), nowadays represent the standard first-line treatment; for patients who achieve a satisfactory response, a consolidation by means of autologous stem cell transplantation may offer a greater chance of long-term survival. Several patients, however, display treatment refractoriness or relapse soon after obtaining a response, and just a few of them are suitable transplant candidates. This is why several new agents, with innovative mechanisms of action, have been investigated in this context: pralatrexate, romidepsin, belinostat, and brentuximab vedotin have been approved for relapsed and refractory peripheral T-cell lymphomas based on their activity, although they do not significantly affect survival rates. The incorporation of such new drugs within a CHOP backbone is under investigation to enhance response rates, allow a higher proportion of patients to be transplanted in remission, and prolong survival.

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“…8,35 Other prognostic indices such as the modified Prognostic Index for T-cell lymphoma and international peripheral T-cell lymphoma project score have been suggested for PTCL, and each has some value, although none of them provide a significant improvement over IPI in terms of impacting treatment strategies. 36 Although we track the IPI in our daily practice, it rarely alters therapy, as even low-risk PTCL patients based on IPI have disappointing outcomes. For example, in the ITCP, the 5-year FFS for patients with 0 or 1 IPI risk factors was only 33% and 34% for PTCL-NOS and AITL, respectively.…”

Section: Investigational Approachesmentioning

confidence: 99%

How I treat the peripheral T-cell lymphomas

Moskowitz

Lunning

Horwitz

2014

Blood

137

102

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The peripheral T-cell lymphomas (PTCLs) encompass a heterogeneous group of diseases that have generally been associated with poor prognosis. The most common PTCLs, peripheral T-cell lymphoma, not otherwise specified, angioimmunoblastic T-cell lymphoma, and anaplastic lymphoma kinase (ALK)-negative anaplastic large cell lymphoma (ALK-negative), despite their unique presentations and histologies, are currently treated similarly. Here we discuss our general approach to the treatment of the most common PTCLs. Based on the best data currently available, which include retrospective analyses and phase 2 prospective studies, our approach has involved cyclophosphamide, doxorubicin, vincristine, prednisone-based therapy followed by consolidation in first remission with autologous stem cell transplant. This treatment strategy likely improves the outcome for patients compared with historical series; however, progression-free survival rates remain disappointing, ranging from 40% to 50%. This is currently an exciting time in the treatment of PTCL due to the advent of recently approved drugs as well as new targeted agents currently under investigation. In addition, gene expression profiling is allowing for a better understanding of underlying disease biology, improved diagnostic accuracy, and prognostication in PTCL. As a result, over the next few years, we expect a significant shift in our management of these diseases with a move toward more individualized therapy leading to improved outcomes.

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Comparison of four prognostic scores in peripheral T-cell lymphoma

Abstract: All the scores demonstrated their usefulness to assess the outcome of patients with PTCL, with IPTCLP being the most significant to predict OS.

Cited by 91 publications

References 38 publications

Prognostic Value of Platelet Count in Patients with Peripheral T Cell Lymphoma

Prognostic Value of Platelet Count in Patients with Peripheral T Cell Lymphoma

Peripheral T-cell lymphoma, not otherwise specified

How I treat the peripheral T-cell lymphomas

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