Outcome of limited‐stage peripheral T‐Cell lymphoma after CHOP(−like) therapy: A population based study of 239 patients from the Nordic lymphoma epidemiology group

Abstract

Peripheral T-Cell Lymphomas (PTCLs) are rare, aggressive lymphomas with poor outcomes, but limited-stage disease is infrequent and not well-described. This study reports outcomes and prognostic factors in limited-stage nodal PTCLs in a binational population-based setting. Patients were identified from the Danish and Swedish lymphoma registries. Adults diagnosed with limited-stage nodal PTCL (stage I-II) and treated with CHOP(Àlike) therapy ±radiotherapy between 2000 and 2014 were included. Medical records were reviewed by local investigators. A total of 239 patients with a median age of 62 years were included; 67% received 6-8 cycles of CHOP(Àlike) therapy and 22% received 3-4 cycles, of which 59% also received radiotherapy. Autologous stem cell transplant consolidation was administered to 16% of all patients. Median follow-up was 127 months with 5-years overall survival (OS) of 58% (95% CI: 53-65) and progression-free survival (PFS) of 53% (95% CI: 47-59). In multivariable analysis, age ≥ 60 years and B-symptoms were unfavorable and ALK+ anaplastic large cell T-Cell lymphoma was favorable for survival outcomes.There was no difference in treatment-specific outcome (3-4 cycles vs. 6-8 cycles of CHOP(Àlike) ± radiotherapy). Low-risk patients (age < 60 without B-symptoms) had a 5-year OS of 77% (95% CI 67-89%). In the present study of limited-stage nodal PTCL, survival after curative intent chemotherapy +/À radiotherapy was inferior to that of limited-stage diffuse large B-cell lymphoma, but a subgroup of young patients Ahmed Ludvigsen Al-Mashhadi and Henrik Cederleuf contributed equally. Fredrik Ellin and Tarec Christoffer El-Galaly contributed equally.

Outcome of combined modality treatment in first-line for stage I(E) peripheral T-cell lymphoma; a nationwide population-based cohort study from the Netherlands

“… 3 , 6 , 20 , 21 The incidence of stage I(E) disease is reported to be 9.5-11%. 15 , 22 The incidence of stage I(E) PT-CL in this cohort as compared to advanced-stage disease varies per subtype, i.e., patients with AITL rarely have limited-stage disease, which is in line with previous studies. 23 , 24 There has been a remarkable shift in diagnoses between the two time periods from predominantly PTCL NOS to a more or less equal divide between PTCL NOS and ALCL.…”

“…The favorable 5-year OS of patients with stage I(E) PTCL in the current study, as compared to advanced-stage disease previously reported by our group, confirms the results of the Nordic Lymphoma Epidemiology Group that reported on patients with limited-stage (I-II) AITL, ALCL and PTCL NOS (n=239) and found a similar 5-year OS (58%, including stage II patients) compared to 28% for patients with advanced-stage disease in the same time period. 8 , 15 It is unclear whether there was a difference in outcome between stage I and II patients. One might expect a better outcome in our cohort since it only reports on patients with stage I disease, however the Nordic Lymphoma Epidemiology Group only included patients that were treated with at least one cycle of CHOP-like therapy whereas we included all patients with stage I(E) disease.…”

“…[3][4][5] A recent population-based study conducted in Denmark and Sweden indicated that the outcome in patients with limited-stage disease is superior to to those with extensive disease. 15 Clinical trials on the optimal treatment of patients with limited stage are lacking. Derived from its use in aggressive B-cell lymphoma, an abbreviated treatment regimen with three cycles of CHO(E)P combined with radiotherapy (combined modality treatment [CMT]) has been adapted in daily practice of stage I(E) PTCL, but only sporadically in stage II.…”

Late toxicities in lymphoma: Real-world data on cardiotoxicity, diabetes mellitus, and second malignancies

“…and of these, 16% received HDT-ASCT. Median age was 62 years, 5-year OS was 58%, and PFS was 53% (60). As the life expectancy for lymphomas is high and to varying degrees is near that of the background population, it is imperative to shift the research focus from OS alone to an investigation and understanding of treatmentrelated late toxicities.…”