BACKGROUND:

Optimal frontline therapy for peripheral T-cell lymphoma (PTCL) in the modern era remains unclear.

PATIENTS AND METHODS:

We examined patient characteristics, treatment, and outcomes among 341 newly-diagnosed PTCL patients from 2000-2011. Outcome was compared to a matched cohort of DLBCL patients, and prognostic factors were assessed using univariate and multivariate analyses. PTCL subtypes included peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) (31%), anaplastic large cell lymphoma (ALCL) (26%), angioimmunoblastic T-cell lymphoma (AITL) (23%), NK/T-cell lymphoma (NKTCL) (7%), acute T-cell leukemia/lymphoma (ATLL) (6%), and other (7%). Median age was 62 years (range 18-95), and 74% had stage III-IV disease. Twenty-three (7%) patients received only palliative care whereas 318 received chemotherapy: CHOP-like regimens (70%), hyperCVAD/MA (6%), or other (18%). Thirty-three patients (10%) underwent stem cell transplantation (SCT) in 1st remission.

RESULTS:

The overall response rate was 73% (61% complete); 24% had primary refractory disease. With 39-month median follow-up, 3-year progression-free survival (PFS) and overall survival (OS) were 32% and 52%. PFS and OS for PTCL patients were significantly inferior to matched patients with DLBCL. On multivariate analysis, stage I-II disease was the only significant pre-treatment prognostic factor (PFS: HR 0.54 (95% CI 0.34-0.85), p=0.007; OS: HR 0.42 (95% CI 0.22-0.78), p=0.006). ALK positivity in ALCL was prognostic on univariate analysis, but lost significance on multivariate analysis. The most dominant prognostic factor was response to initial therapy (complete response versus other), including adjustment for stage and SCT (PFS HR 0.19 (95% CI 0.14-0.28), p<0.0001; OS HR 0.26 (95% CI 0.17-0.40), p<0.0001). No overall survival difference was observed based on choice of upfront regimen or SCT in 1st remission.

CONCLUSIONS:

This analysis identifies early-stage disease and initial treatment response as dominant prognostic factors in PTCL. No clear benefit is observed for patients undergoing consolidative SCT. Novel therapeutic approaches for PTCL are critically needed.

© The Author 2014. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.