Peripheral T-cell lymphomas: analysis of histology, staging and response to treatment of 208 cases at a single institution

Abstract

Peripheral T-cell lymphomas are characterized by a poor clinical outcome. We retrospectively analyzed 208 adults treated in our institution between 2000 and 2011. Median age at diagnosis was 55 years. Fifty-one percent had B symptoms and 51% serum elevated lactate dehydrogenase (LDH) levels. Eastern Cooperative Oncology Group (ECOG) performance status (PS) was 0-1 in 63% and 2-4 in 37%. According to Ann Arbor classification, 16% were at stage I-II and 84% at stage III-IV. Histological subtypes were: 39% peripheral T-cell non-Hodgkin lymphoma (NHL) unspecified (PTCL-U), 19.5% anaplastic large cell lymphoma (ALCL), with 9.5% ALK+ and 10% ALK-, and 25% angioimmunoblastic lymphoma (AILT). Primary extranodal lymphoma represented 17%, and 8% were diagnosed with hemophagocytosis. Induction chemotherapy was CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) in 87% of patients. The median number of chemotherapy cycles was 2 (1-7). A complete response was obtained in 57% of the patients. Among them, 32% had an autologous stem cell transplant (ASCT) and 10% allogeneic SCT, while 38% were primary refractory. Five-year overall survival (OS) was 28.5% (22.3-36.3), and 5-year event-free survival (EFS) was 18.4% (13.4-25.3). A multivariate analysis showed that ALCL-ALK+ (p = 0.004), AILT (p < 0.01), extranodal involvement (p = 0.001), PS > 1 (p = 0.04), LDH < normal (p = 0.003) and hemophagocytosis (p = 0.001) were independent adverse factors for OS. We conclude that conventional chemotherapy with intensive treatment is not sufficient to improve the response rate. Optimal management is required.

Peripheral T-Cell Lymphomas: A Review of Current Approaches and Hopes for the Future

“…Commonly, CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) is the “go-to” chemotherapy regimen of choice for PTCL (Broussais-Guillaumot et al, 2013), despite evidence that, except for ALCL, ALK+, it is largely ineffective, as evidenced by a large retrospective analysis from the German High-Grade Non-Hodgkin Lymphoma Study Group (Schmitz et al, 2010). In this analysis, 343 patients with a diagnosis of PTCL were treated with six to eight cycles of CHOP or CHOP plus etoposide (CHOEP).…”

The prognostic role of 18F-FDG PET/CT baseline quantitative metabolic parameters in peripheral T-cell lymphoma

“…CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) or CHOP-like regimens are most commonly used first-line treatments in patients with PTCL. However, outcomes are poor with complete remission (CR) of about 50% and 5-year overall survival of only 25-45% 1,2. Although prognostic indicators such as the international prognostic index (IPI) and the prognostic index for T-cell lymphoma (PIT) have been proposed in PTCL, their prognostic values are not well established 3-6.…”

Expression of telomerase reverse transcriptase in peripheral T‐cell lymphoma

“…This trend was not observed for AITL and ATLL. Since the international prognostic index (IPI), presence of B-symptoms, and the expression of cytotoxic molecules are currently recognized as prognostic factors in PTCL-NOS, [35][36][37][38] we simultaneously integrated these known prognostic markers and TERT expression in a multivariate analysis to show the risk of each factor (Table 2). The analysis found that IPI was an independent poor prognostic factor; however, other factors, including TERT expression, were not independent prognostic factors.…”