Peripheral T-Cell Lymphomas Respond Well to Vincristine, Adriamycin, Cyclophosphamide, Prednisone and Etoposide (VACPE) and Have a Similar Outcome as High-Grade B-Cell Lymphomas

Abstract

Peripheral T-cell lymphomas (PTCL) represent a heterogeneous group of T-cell malignancies including subentities with favourable (large cell anaplastic) or unfavourable (pleomorphic) prognosis. The clinical outcome of PTCL has been controversially discussed, but a worse prognosis than high-grade B-cell Non-Hodgkin's lymphomas (NHL) has been postulated by most authors. In this report we summarize the results of a prospective comparative study investigating the therapy outcome of 27 patients (pts) with PTCL and 55 pts. with high grade B-cell NHL and give an overview of therapy studies in PTCL. The histological subtypes were 14 pleomorphic, 8 large-cell anaplastic (Ki-1+), 2 angioimmunoblastic (AILD) and 3 other PTCL. In three patients the PTCL was associated with non-tropical sprue (11%). Nineteen patients presented with an advanced stage of disease (stage III and IV, 70%), 17 (63%) pts. had B-symptoms. The patients were treated with vincristine 2 mg d1, adriamycin 25 mg/m2 d1-3, cyclophosphamide 800 mg/m2 d1, prednisone 60 mg/m2 d1-7 and etoposide 120 mg/m2 d1-3 (VACPE). In 77% of pts. with PTCL and 84% of patients with high-grade B-cell NHL a complete remission (CR) was achieved. 75% of the complete responders with PTCL and 70% with B-NHL are still in ongoing CR. The subgroup of large-cell anaplastic attained a CR in 88%. The median observation time is 44 months (1(+)-77+). The probability of 1-, 3- and 5-year overall and disease-free survival for the T-cell group were 76%, 54%, 48% and 76%, 62%, 62%, respectively according to Kaplan-Meier. There was no significant difference regarding the remission rate, the overall-, event-free or disease-free survival compared to high-grade B-cell lymphomas. In conclusion, the VACPE regimen is an effective and feasible regimen in the management of PTCL achieving complete remissions in a large proportion of patients.

Comparison of peripheral T‐cell lymphomas and diffuse large B‐cell lymphoma

“…4 In a subgroup analysis of patients with PTCLu, although patients with AITL had more advanced disease and less bulky masses than those observed in patients with PTCLu, the other characteristics of these patients were similar. Furthermore, the rates of CR/CRu, OS, PFS, and DFS did not Regarding the effect of immunophenotype on patient outcomes, although some earlier studies that were based on the older classification systems reported similar prognoses between patients with Band T-cell lymphomas, [11][12][13][14] most recent studies consistently have demonstrated a negative impact of the T-cell phenotype on OS. 5,15,16 This may be caused in part by the inclusion of patients with ALCL in the earlier studies.…”

Peripheral T‐cell lymphomas, unspecified (or not otherwise specified): a review

“…Indeed, the disappointing results of CHOP-like regimens [4,55,56,62,64,65,82], demonstrating a limited success of anthracycline-containing regimens, led some groups to investigate alternative approaches, old and new combinations. These include the primary use of platinum-based regimens such as the ESHAP, or very intensive regimens, such as the HyperCVAD [83,84].…”

Aggressive Peripheral T-Cell Lymphomas (Specified and Unspecified Types)

“…The large intergroup trial comparing CHOP to second and third generation regimens in diffuse large-cell lymphoma failed to reveal any survival differences among the regimens but unfortunately, as immunophenotyping was not widely available at the time of the study analysis, the impact of the specific treatment regimens in the subgroup of patients with T-cell lymphomas was not assessable. 32 Some groups have specifically evaluated more dose-intensive regimens in PTCL 6,[33][34][35] with no firm conclusions demonstrating superiority to CHOP chemotherapy.…”