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Ruan J, Zain J, Palmer B, Jovanovic B, Mi X, Swaroop A, Winter JN, Gordon LI, Karmali R, Moreira J, Petrich AM, Pro B. Multicenter phase 2 study of romidepsin plus lenalidomide for previously untreated peripheral T-cell lymphoma. Blood Adv 2023; 7:5771-5779. [PMID: 37327113 PMCID: PMC10561000 DOI: 10.1182/bloodadvances.2023009767] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/26/2023] [Accepted: 06/06/2023] [Indexed: 06/18/2023] Open
Abstract
Peripheral T-cell lymphomas (PTCLs) are associated with poor prognosis when treated with cytotoxic chemotherapy. We report the findings of a phase 2 study evaluating a chemotherapy-free combination of romidepsin plus lenalidomide as initial treatment for patients with PTCL who were aged >60 years or noncandidates for chemotherapy. Treatment was initiated with romidepsin 10 mg/m2 IV on days 1, 8, and 15 and lenalidomide 25 mg taken orally from days 1 to 21 of 28-day cycle for up to 1 year. The primary objective was overall response rate (ORR). Secondary objectives included safety and survival. The study enrolled 29 patients with a median age of 75 years, including 16 (55%) angioimmunoblastic T-cell lymphoma (AITL), 10 (34%) PTCL- not otherwise specified, 2 ATLL, and 1 EATL. Grade 3 to 4 hematologic toxicities included neutropenia (45%), thrombocytopenia (34%), and anemia (28%). Grade 3 to 4 nonhematologic toxicities included hyponatremia (45%), hypertension (38%), hypoalbuminemia (24%), fatigue (17%), hyperglycemia (14%), hypokalemia (14%), dehydration (10%), and infection (10%). At median follow-up of 15.7 months, 23 patients were evaluable and received a median treatment of 6 cycles. The ORR was 65.2% with complete response (CR) at 26.1%, including 78.6% ORR and 35.7% CR for AITL. Median duration of response was 10.7 months, with 27.1 months for patients achieving CR. The estimated 2-year progression-free survival was 31.5%, and 2-year overall survival was 49.5%. This study provides the first demonstration that the biologic combination of romidepsin and lenalidomide is feasible and effective as initial therapy for PTCL and warrants further evaluation. This trial was registered at www.clinicaltrials.gov as #NCT02232516.
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Affiliation(s)
- Jia Ruan
- Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | - Jasmine Zain
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Brett Palmer
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Borko Jovanovic
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Xinlei Mi
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alok Swaroop
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jane N. Winter
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Leo I. Gordon
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Reem Karmali
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jonathan Moreira
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Barbara Pro
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL
- Division of Hematology and Oncology, Columbia University Irving Medical Center, New York, NY
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Lage LADPC, Culler HF, Reichert CO, da Siqueira SAC, Pereira J. Angioimmunoblastic T-cell lymphoma and correlated neoplasms with T-cell follicular helper phenotype: from molecular mechanisms to therapeutic advances. Front Oncol 2023; 13:1177590. [PMID: 37182145 PMCID: PMC10169672 DOI: 10.3389/fonc.2023.1177590] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/13/2023] [Indexed: 05/16/2023] Open
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) is the second most frequent subtype of mature T-cell lymphoma (MTCL) in the Western world. It derives from the monoclonal proliferation of T-follicular helper (TFH) cells and is characterized by an exacerbated inflammatory response and immune dysregulation, with predisposition to autoimmunity phenomena and recurrent infections. Its genesis is based on a multistep integrative model, where age-related and initiator mutations involve epigenetic regulatory genes, such as TET-2 and DNMT3A. Subsequently, driver-mutations, such as RhoA G17V and IDH-2 R172K/S promote the expansion of clonal TFH-cells ("second-hit"), that finally begin to secrete cytokines and chemokines, such as IL-6, IL-21, CXCL-13 and VEGF, modulating a network of complex relationships between TFH-cells and a defective tumor microenvironment (TME), characterized by expansion of follicular dendritic cells (FDC), vessels and EBV-positive immunoblasts. This unique pathogenesis leads to peculiar clinical manifestations, generating the so-called "immunodysplastic syndrome", typical of AITL. Its differential diagnosis is broad, involving viral infections, collagenosis and adverse drug reactions, which led many authors to use the term "many-faced lymphoma" when referring to AITL. Although great advances in its biological knowledge have been obtained in the last two decades, its treatment is still an unmet medical need, with highly reserved clinical outcomes. Outside the setting of clinical trials, AITL patients are still treated with multidrug therapy based on anthracyclines (CHOP-like), followed by up-front consolidation with autologous stem cell transplantation (ASCT). In this setting, the estimated 5-year overall survival (OS) is around 30-40%. New drugs, such as hypomethylating agents (HMAs) and histone deacetylase inhibitors (HDAi), have been used for relapsed/refractory (R/R) disease with promising results. Such agents have their use based on a biological rationale, have significant potential to improve the outcomes of patients with AITL and may represent a paradigm shift in the therapeutic approach to this lymphoma in the near future.
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Affiliation(s)
- Luís Alberto de Pádua Covas Lage
- Department of Hematology, Hemotherapy & Cell Therapy, University of São Paulo (USP), São Paulo, SP, Brazil
- Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), University of São Paulo (USP), São Paulo, SP, Brazil
| | - Hebert Fabricio Culler
- Department of Hematology, Hemotherapy & Cell Therapy, University of São Paulo (USP), São Paulo, SP, Brazil
- Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), University of São Paulo (USP), São Paulo, SP, Brazil
| | - Cadiele Oliana Reichert
- Department of Hematology, Hemotherapy & Cell Therapy, University of São Paulo (USP), São Paulo, SP, Brazil
- Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), University of São Paulo (USP), São Paulo, SP, Brazil
| | | | - Juliana Pereira
- Department of Hematology, Hemotherapy & Cell Therapy, University of São Paulo (USP), São Paulo, SP, Brazil
- Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), University of São Paulo (USP), São Paulo, SP, Brazil
- Department of Hematology and Oncology, Hospital Alemão Oswaldo Cruz (HAOC), São Paulo, SP, Brazil
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Lage LADPC, Brito CV, Barreto GC, Culler HF, Reichert CO, Levy D, Costa RDO, Zerbini MCN, Rocha V, Pereira J. Up-front Therapy With CHOP Plus Etoposide in Brazilian nodal PTCL Patients: Increased Toxicity and No Survival Benefit Compared to CHOP Regimen-Results of a Real-Life Study From a Middle-Income Country. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:812-824. [PMID: 35869020 DOI: 10.1016/j.clml.2022.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/16/2022] [Accepted: 06/24/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Nodal peripheral T-cell lymphoma (nPTCL) constitute a heterogeneous group of neoplasms with aggressive behavior and poor-survival. They are more prevalent in Latin America and Asia, although data from Brazil are scarce. Its primary therapy is still controversial and ineffective. Therefore, we aim to describe clinical-epidemiological characteristics, outcomes, predictors factors for survival and compare the results of patients treated with CHOP and CHOEP regimens. METHODS Retrospective, observational and single-center study involving 124 nPTCL patients from Brazil treated from 2000 to 2019. RESULTS With a median follow-up of 23.7 months, the estimated 2-year overall survival (OS) and progression-free survival (PFS) were 59.2% and 37.3%, respectively. The median age was 48.5 years and 57.3% (71/124) were male, 81.5% (101/124) had B-symptoms, 88.7% (110/124) had advanced disease (stage III/IV) and 58.1% (72/124) presented International Prognostic Index (IPI) score ≥3, reflecting a real-life cohort. ORR to first-line therapy was 58.9%, 37.9% (N = 47) received CHOP-21 and 35.5% (N = 44) were treated with CHOEP-21; 30.1% (37/124) underwent to consolidation with involved field radiotherapy (IF-RT) and 32.3% (40/124) were consolidated with autologous hematopoietic stem cell transplantation (ASCT). The overall response rate (ORR) was similar for CHOP-21 (76.6%) and CHOEP-21 (65.9%), P = .259. Refractory disease was less frequent in the CHOEP-21 group (4.5% vs. 21.2%, P = .018). However, few patients were able to complete 6-cycles of CHOEP-21 (31.8%) than to CHOP-21 (61.7%), P = .003. Delays ≥2 weeks among the cycles of chemotherapy were more frequent for patients receiving CHOEP-21 (43.1% vs. 10.6%), P = .0004, as well as the toxicities, including G3-4 neutropenia (88% vs. 57%, P = .001), febrile neutropenia (70% vs. 38%, P = .003) and G3-4 thrombocytopenia (63% vs. 27%, P = .0007). The 2-year OS was higher for CHOP (78.7%) than CHOEP group (61.4%), P = .05, as well as 2-year PFS (69.7% vs. 25.0%, P < .0001). In multivariate analysis, high LDH (HR 3.38, P = .007) was associated with decreased OS. CR at first line (HR: 0.09, P < .001) and consolidation with ASCT (HR: 0.08, P = .015) were predictors of increased OS. CONCLUSION In the largest cohort of nPTCL from Latin America, patients had poor survival and high rate of chemo-resistance. In our cohort, the addition of etoposide to the CHOP-21 backbone showed no survival benefit and was associated with high-toxicity and frequent treatment interruptions. Normal LDH values, obtaintion of CR and consolidation with ASCT were independent factors associated with better outcomes.
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Affiliation(s)
- Luís Alberto de Pádua Covas Lage
- Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo, SP, Brazil; Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), University of São Paulo (USP), São Paulo, SP, Brazil.
| | - Cláudio Vinícius Brito
- Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Guilherme Carneiro Barreto
- Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Hebert Fabrício Culler
- Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo, SP, Brazil; Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), University of São Paulo (USP), São Paulo, SP, Brazil
| | - Cadiele Oliana Reichert
- Laboratory of Medical Investigation in Immunology and Histocompatibility (LIM-19), University of São Paulo (USP), São Paulo, SP, Brazil
| | - Débora Levy
- Laboratory of Medical Investigation in Immunology and Histocompatibility (LIM-19), University of São Paulo (USP), São Paulo, SP, Brazil
| | - Renata de Oliveira Costa
- Department of Hematology and Hemotherapy, Faculty of Medical Sciences Santos (FCMS), Centro Universitário Lusíada (Unilus), Santos, SP, Brazil
| | | | - Vanderson Rocha
- Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo, SP, Brazil; Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), University of São Paulo (USP), São Paulo, SP, Brazil; Fundação Pró-Sangue, Blood Bank of São Paulo, São Paulo, SP, Brazil; Churchill Hospital, Oxford University, Oxford, United Kingdom
| | - Juliana Pereira
- Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo, SP, Brazil; Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), University of São Paulo (USP), São Paulo, SP, Brazil
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Md S, Alhakamy NA, Sharma P, Ansari MS, Gorain B. Nanocarrier-based co-delivery approaches of chemotherapeutics with natural P-glycoprotein inhibitors in the improvement of multidrug resistance cancer therapy. J Drug Target 2022; 30:801-818. [DOI: 10.1080/1061186x.2022.2069782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Shadab Md
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Center of Excellence for Drug Research & Pharmaceutical Industries, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Nabil A. Alhakamy
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Center of Excellence for Drug Research & Pharmaceutical Industries, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Priyanka Sharma
- Center for Innovation in Personalized Medicine, King Fahad Medical Research Center, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
| | | | - Bapi Gorain
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi 835215, India
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Moskowitz AJ. Moving Beyond One Size Fits All for T-Cell Lymphoma. J Clin Oncol 2021; 40:221-224. [PMID: 34843408 DOI: 10.1200/jco.21.02463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kim J, Cho J, Byeon S, Kim WS, Kim SJ. Comparison of first-line treatments of peripheral T-cell lymphoma according to regimen: A systematic review and meta-analysis. Hematol Oncol 2021; 39:664-673. [PMID: 34487565 DOI: 10.1002/hon.2924] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/23/2021] [Accepted: 08/27/2021] [Indexed: 12/17/2022]
Abstract
Peripheral T-cell lymphomas (PTCLs) are known to have an aggressive clinical course and grave prognosis. Several recommended first-line treatment regimens are available, but identification of the superior treatment remain elusive. We conducted a systematic review and meta-analysis to determine which study-level factors and group of regimens affect survival outcomes. The MEDLINE, Embase, and Cochrane databases were searched from inception to January 2021, and phase II or III clinical studies evaluating the efficacy of chemotherapy regimens were included. Random effects models were used to estimate 3-year overall survival rate, complete remission rate, and subgroup differences. Meta-regressions were carried out with adjustments for relevant covariates. Overall, 34 cohorts from 28 studies comprising 1424 PTCL patients were included in the pooled analysis. Chemotherapy regimens were divided into four groups: cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP), CHOP plus etoposide, gemcitabine-based, and others. The pooled 3-year overall survival rate was 0.49 (95% confidence interval [CI] 0.43-0.54) for CHOP, 0.61 (95% CI 0.52-0.70) for CHOP plus etoposide, 0.39 (95% CI 0.30-0.47) for gemcitabine-based, and 0.61 (95% CI 0.44-0.78) for others. CHOP plus etoposide was significantly better than CHOP, with the latter used as a reference (coefficient of 0.11; p = 0.035), with adjustment for the proportion of International Prognostic Index score 4-5 in meta-regression analysis. Although grossly divided groups were pooled and analyzed, among four regimen groups for frontline PTCL treatment CHOP plus etoposide showed better survival than CHOP.
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Affiliation(s)
- Jinchul Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Hematology-Oncology, Inha University College of Medicine and Hospital, Incheon, Korea
| | - Jinhyun Cho
- Department of Hematology-Oncology, Inha University College of Medicine and Hospital, Incheon, Korea
| | - Seonggyu Byeon
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Won Seog Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Jin Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University School of Medicine, Seoul, Korea
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Wudhikarn K, Bennani NN. How to Sequence Therapies in Peripheral T Cell Lymphoma. Curr Treat Options Oncol 2021; 22:74. [PMID: 34213653 DOI: 10.1007/s11864-021-00873-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
OPINION STATEMENT Peripheral T cell lymphoma (PTCL) represents a heterogeneous group of rare lymphoproliferative disorders. Historically, there has been a lack of pathobiological understanding of PTCL. With the exception of ALK-positive anaplastic large cell lymphoma, patients with PTCL have less favorable outcomes, with most patients relapsing shortly after conventional anthracycline-containing multi-agent chemotherapy. The standard management approach for PTCL involves induction therapy followed by autologous stem cell transplantation. Patients with relapsed/refractory PTCL have dismal outcomes and limited treatment options despite the available novel agents, therefore remaining a critical unmet need. By virtue of advancement in cancer biology over the recent years, the treatment landscape of PTCL has gradually evolved from conventional chemotherapy based on solely morphological diagnosis toward more individualized therapies by integrating molecular attributes of PTCL to the traditional treatment paradigm. We are at the edge of witnessing a paradigm shift in PTCL management.
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Affiliation(s)
- Kitsada Wudhikarn
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA.,Division of Hematology and Research Unit in Translational Hematology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - N Nora Bennani
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA.
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Diagnosis, Risk Stratification, and Treatment of Peripheral T-Cell Lymphomas: Past and Present. ACTA ACUST UNITED AC 2021; 26:253-259. [PMID: 32496458 DOI: 10.1097/ppo.0000000000000452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Peripheral T-cell lymphomas represent an evolving class of aggressive T-cell malignancies that are generally refractory to conventional treatments and historically carry a poor prognosis. Recent advances in gene expression profiling have begun to unravel the specific molecular mechanisms of tumorigenesis in these disease processes, allowing for discrete classification schemes that help guide discussions regarding prognosis and therapy options. We outline here a review of the histopathology, epidemiology, clinical features, and treatment strategies currently used in the management of these diseases.
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Early central nervous system relapse of monomorphic epitheliotropic intestinal T-cell lymphoma after cord blood transplantation. Int J Hematol 2021; 114:129-135. [PMID: 33646526 DOI: 10.1007/s12185-021-03107-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/09/2021] [Accepted: 02/18/2021] [Indexed: 10/22/2022]
Abstract
Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) is a rare subtype of intestinal T-cell lymphoma that occurs mostly in Asia. CHOP-like therapy is usually selected, but the prognosis is very poor. This report concerns a 43-year-old woman with newly diagnosed stage IVA MEITL. The patient obtained a partial response after 4 cycles of GDP (gemcitabine, dexamethasone, cisplatin) and achieved a complete response (CR) after cord blood transplantation (CBT) conditioned with total body irradiation, cyclophosphamide, and cytarabine. Seven months after transplantation, the patient experienced cognitive impairment. Magnetic resonance imaging of the brain showed a high-intensity lesion in the right cerebral peduncle and internal capsule. A cerebrospinal fluid examination confirmed central nervous system (CNS) relapse of MEITL. After 3 cycles of MPV (methotrexate, procarbazine, vincristine) followed by whole-brain radiotherapy, her cognitive impairment improved. Due to disease progression, she died 6 months after CNS relapse. Given the CNS relapse after achieving a CR with GDP and CBT in this patient, CNS prophylaxis during first-line therapy may be beneficial in the treatment of MEITL.
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Bhurani M, Admojo L, Van Der Weyden C, Twigger R, Bazargan A, Quach H, Zimet A, Coyle L, Lindsay J, Radeski D, Hawkes E, Kennedy G, Irving I, Gutta N, Trotman J, Yeung J, Dunlop L, Hua M, Giri P, Yuen S, Panicker S, Moreton S, Khoo L, Scott A, Kipp D, McQuillan A, McCormack C, Dickinson M, Prince HM. Pralatrexate in relapsed/refractory T-cell lymphoma: a retrospective multicenter study. Leuk Lymphoma 2020; 62:330-336. [PMID: 33026266 DOI: 10.1080/10428194.2020.1827241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We present a retrospective multicenter study of pralatrexate treatment outcomes in an Australian practice setting for patients with relapsed/refractory T-cell lymphoma who had failed 1+ systemic therapies, treated via a compassionate access program. Endpoints assessed included response rates, toxicities, and subsequent therapies. Progression-free survival (PFS), time to next treatment (TTNT), event-free survival (EFS), overall survival (OS), and time to best response, were assessed by Kaplan-Meier analysis. The study included 31 patients, with median age 69 years. We demonstrated ORR of 35.5% (n = 11), including 4 complete responses (13%) and 7 partial responses (23%). The predicted median OS was 10 months, with EFS of 9 months, and PFS of 9 months. Median TTNT was 8 months. Mucositis was the most commonly observed toxicity. This study - the second largest real-world cohort reported to date - underscores the importance of pralatrexate in relapsed/refractory T-cell lymphoma, as well as its acceptable toxicity profile.
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Affiliation(s)
- Mansi Bhurani
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia.,Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Lorenz Admojo
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
| | - Carrie Van Der Weyden
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
| | - Robert Twigger
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
| | | | - Hang Quach
- St Vincent's Health, Melbourne, VIC, Australia
| | - Allan Zimet
- Epworth Healthcare, Melbourne, VIC, Australia
| | - Luke Coyle
- Royal North Shore Hospital, Sydney, NSW, Australia
| | | | - Dejan Radeski
- Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Eliza Hawkes
- Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, VIC, Australia
| | - Glen Kennedy
- Mater Cancer Care Centre, Brisbane, QLD, Australia
| | - Ian Irving
- Icon Cancer Care, Brisbane, QLD, Australia
| | | | | | - James Yeung
- Concord Hospital, Sydney, NSW, Australia.,Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Lindsay Dunlop
- Southern Highland Private Hospital, Liverpool, NSW, Australia
| | - Minh Hua
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | | | - Sam Yuen
- Calvary Mater, Newcastle, NSW, Australia
| | | | | | - Liane Khoo
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Ashleigh Scott
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia.,Sir Peter MacCallum Department of Surgical Oncology, Parkville, VIC, Australia
| | - David Kipp
- Barwon Health Cancer Services, Geelong, VIC, Australia
| | | | - Chris McCormack
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Surgical Oncology, Parkville, VIC, Australia
| | - Michael Dickinson
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
| | - Henry Miles Prince
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia.,Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, VIC, Australia.,Epworth Healthcare, Melbourne, VIC, Australia
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Tsukamoto Y, Kiyasu J, Choi I, Kozuru M, Uike N, Utsunomiya H, Hirata A, Fujioka E, Ohno H, Nakashima E, Nakashima Y, Miyashita K, Tachikawa Y, Narazaki T, Tsuda M, Haji S, Takamatsu A, Tanaka E, Goto T, Takatsuki H, Oyama M, Muta H, Yagi Y, Ikeda M, Matsushima T, Yufu Y, Suehiro Y. Efficacy and Safety of the Modified EPOCH Regimen (Etoposide, Vincristine, Doxorubicin, Carboplatin, and Prednisolone) for Adult T-cell Leukemia/Lymphoma: A Multicenter Retrospective Study. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:e445-e453. [PMID: 32312633 DOI: 10.1016/j.clml.2020.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/12/2020] [Accepted: 03/14/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND We retrospectively analyzed patients with untreated aggressive adult T-cell leukemia/lymphoma who received the modified EPOCH (mEPOCH) regimen. PATIENTS AND METHODS Patients received up to 6 mEPOCH cycles. Etoposide (50 mg/m2/day), doxorubicin (10 mg/m2/day), and vincristine (0.4 mg/m2/day) were each given as a continuous 96-hour infusion on days 1 to 4. Prednisolone (40 mg/m2/day) was given intravenously or orally on days 1 to 4 and then tapered and stopped on day 7, and carboplatin (dose calculated for each patient individually using Calvert's formula according to a target under the curve of 3 mg/mL/min) was given as a 2-hour intravenous infusion on day 6. RESULTS In 103 patients, overall response rate and complete response rate were 58% and 25%, respectively. With a median follow-up of 8.9 months, the median survival time was 9.8 months (95% confidence interval, 7.2-13.9 months). The median progression-free survival (PFS) was 4.2 months (95% confidence interval, 3.4-5.7 months). Patients who completed ≥ 4 cycles experienced significantly better overall survival and PFS compared with those who completed < 4 cycles. Twenty-eight patients underwent allogeneic hematopoietic stem cell transplantation after mEPOCH and demonstrated significantly prolonged overall survival and PFS compared with those who did not undergo transplantation. CONCLUSION The mEPOCH regimen is effective with tolerable adverse effects and may be an alternative treatment option for adult T-cell leukemia/lymphoma.
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Affiliation(s)
- Yasuhiro Tsukamoto
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan; Department of Hematology, Iizuka Hospital, Iizuka-city, Fukuoka, Japan
| | - Junichi Kiyasu
- Clinical Research Institute, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan; Department of Hematology, Iizuka Hospital, Iizuka-city, Fukuoka, Japan; Department of Pathology, Kurume University, Kurume-city, Fukuoka, Japan.
| | - Ilseung Choi
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Mitsuo Kozuru
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Naokuni Uike
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Hayato Utsunomiya
- Cell Therapy, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Akie Hirata
- Clinical Laboratory Medicine, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Eriko Fujioka
- Cell Therapy, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Hirofumi Ohno
- Cell Therapy, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Eriko Nakashima
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Yasuhiro Nakashima
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Kaname Miyashita
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Yoshimichi Tachikawa
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Taisuke Narazaki
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Mariko Tsuda
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Shojiro Haji
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Akiko Takamatsu
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Emi Tanaka
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Tatsuro Goto
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Hiroshi Takatsuki
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Makoto Oyama
- Department of Hematology, Iizuka Hospital, Iizuka-city, Fukuoka, Japan
| | - Hiroki Muta
- Department of Hematology, Iizuka Hospital, Iizuka-city, Fukuoka, Japan
| | - Yu Yagi
- Department of Hematology, Iizuka Hospital, Iizuka-city, Fukuoka, Japan
| | - Motohiko Ikeda
- Department of Hematology, Iizuka Hospital, Iizuka-city, Fukuoka, Japan
| | | | - Yuji Yufu
- Department of Hematology, Iizuka Hospital, Iizuka-city, Fukuoka, Japan
| | - Youko Suehiro
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan; Cell Therapy, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
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12
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STAT3 Mutation Is Associated with STAT3 Activation in CD30 + ALK - ALCL. Cancers (Basel) 2020; 12:cancers12030702. [PMID: 32188095 PMCID: PMC7140109 DOI: 10.3390/cancers12030702] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/10/2020] [Accepted: 03/13/2020] [Indexed: 12/21/2022] Open
Abstract
Peripheral T-cell lymphomas (PTCL) are a heterogeneous, and often aggressive group of non-Hodgkin lymphomas. Recent advances in the molecular and genetic characterization of PTCLs have helped to delineate differences and similarities between the various subtypes, and the JAK/STAT pathway has been found to play an important oncogenic role. Here, we aimed to characterize the JAK/STAT pathway in PTCL subtypes and investigate whether the activation of the pathway correlates with the frequency of STAT gene mutations. Patient samples from AITL (n = 30), ALCL (n = 21) and PTCL-NOS (n = 12) cases were sequenced for STAT3, STAT5B, JAK1, JAK3, and RHOA mutations using amplicon sequencing and stained immunohistochemically for pSTAT3, pMAPK, and pAKT. We discovered STAT3 mutations in 13% of AITL, 13% of ALK+ ALCL, 38% of ALK− ALCL and 17% of PTCL-NOS cases. However, no STAT5B mutations were found and JAK mutations were only present in ALK- ALCL (15%). Concurrent mutations were found in all subgroups except ALK+ ALCL where STAT3 mutations were always seen alone. High pY-STAT3 expression was observed especially in AITL and ALCL samples. When studying JAK-STAT pathway mutations, pY-STAT3 expression was highest in PTCLs harboring either JAK1 or STAT3 mutations and CD30+ phenotype representing primarily ALK− ALCLs. Further investigation is needed to elucidate the molecular mechanisms of JAK-STAT pathway activation in PTCL.
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13
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Brentuximab vedotin in the treatment of CD30+ PTCL. Blood 2019; 134:2339-2345. [DOI: 10.1182/blood.2019001821] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 08/27/2019] [Indexed: 12/22/2022] Open
Abstract
In this timely Blood Spotlight, Barta et al summarize for the practicing hematologist the strengths and limitations of current data on brentuximab vedotin–based treatment in peripheral T-cell lymphoma (PTCL).
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14
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Zain JM. Aggressive T-cell lymphomas: 2019 updates on diagnosis, risk stratification, and management. Am J Hematol 2019; 94:929-946. [PMID: 31119775 DOI: 10.1002/ajh.25513] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/17/2019] [Accepted: 05/21/2019] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Aggressive T-cell lymphomas continue to have a poor prognosis. There are over 27 different subtypes of peripheral T-cell lymphoma (PTCL) and we are now beginning to understand the differences between the various subtypes beyond histologic variations. MOLECULAR PATHOGENESIS OF VARIOUS SUBTYPES OF PTCL Gene expression profiling can help in diagnosis and prognostication of various subtypes including PTCL-nos and anaplastic large cell lymphoma. In addition, mutational analysis is now being incorporated in clinical trials of novel agents to evaluate various biomarkers of response to allow better therapeutic choices for patients. TARGETED THERAPIES There are many targeted agents currently in various stages of clinical trials for PTCL that take advantage of the differential expression of specific proteins or receptors in PTCL tumors. The most promising is the CD30 directed antibody drug conjugate brentuximab vedotin. This has recently been approved by the Food and Drug Administration for the upfront treatment of CD30 expressing PTCLs in combination with cyclophosphamide, doxorubicin, and prednisone chemotherapy. Other notable targets are CD25, CCR4 tag, PI3kinase inhibitors, and JAK/STAT inhibitors. Anaplastic lymphoma kinase (ALK) inhibitors are promising for ALK expressing tumors. IMMUNOTHERAPIES The use of checkpoint inhibitors in the treatment of PTCL is still controversial. The most promising results have been seen in cases of extranodal natural killer cell/T-cell lymphomas and cutaneous T-cell lymphomas. For all other subtypes, immune checkpoint inhibitors should be used with extreme caution and only in the context of a clinical trial. Allogeneic stem cell transplant continues to be the curative therapy for most aggressive subtypes of PTCL.
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Affiliation(s)
- Jasmine M. Zain
- Department of Hematology/Hematopoietic Cell TransplantationCity of Hope Medical Center Duarte California
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15
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Tian S, Li R, Wang T, Wang S, Tao R, Hu X, Ding H. Gemcitabine, dexamethasone, and cisplatin (GDP) chemotherapy with sandwiched radiotherapy in the treatment of newly diagnosed stage IE/IIE extranodal natural killer/T-cell lymphoma, nasal type. Cancer Med 2019; 8:3349-3358. [PMID: 31050212 PMCID: PMC6601591 DOI: 10.1002/cam4.2214] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 03/12/2019] [Accepted: 04/13/2019] [Indexed: 12/25/2022] Open
Abstract
Extranodal natural killer/T-cell lymphoma (ENKL), nasal-type is a rare but highly aggressive disease with poor prognosis. Optimal treatment strategies for newly diagnosed localized ENKL have not been fully defined. Here we retrospectively analyzed 72 patients with newly diagnosed stage IE/IIE ENKL treated with gemcitabine, dexamethasone, and cisplatin (GDP) regimen chemotherapy with sandwiched radiotherapy in our department between May 2012 and September 2014. After 2 cycles of GDP induction chemotherapy, the complete response rate (CRR) and overall response rate (ORR) were 30.6% (22/72) and 91.7% (66/72). After whole treatment completion, the CRR and ORR were 81.9% (59/72) and 91.7% (66/72), respectively. With a median follow-up of 57.8 months (Interquartile Range 54.0-64.5 months), the 5-year progression-free survival rate was 70.9% (95% CI, 60.1% to 81.7%), and the 5-year overall survival rate was 72.0% (95% CI, 61.6% to 82.4%), respectively. Patients with CRR after treatment had better prognosis than their counterparts. The major adverse events were myelosuppression, liver dysfunction, gemcitabine-related skin rash, and digestive tract toxicities. Grade 3 to 4 neutropenia and thrombocytopenia were 18.0% (13/72) and 15.3% (11/72), respectively. No treatment related deaths were observed. It is concluded that the GDP regimen with sandwiched radiotherapy was an effective and well-tolerated treatment for newly diagnosed stage IE/IIE ENKL, nasal-type.
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Affiliation(s)
- Shu Tian
- Department of Radiation Oncology, Eye Ear Nose and Throat HospitalFudan UniversityShanghaiChina
- Department of Medical OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of OncologyShanghai Medical College, Fudan UniversityShanghaiChina
| | - Ruichen Li
- Department of Radiation Oncology, Eye Ear Nose and Throat HospitalFudan UniversityShanghaiChina
| | - Tian Wang
- Department of Radiation Oncology, Eye Ear Nose and Throat HospitalFudan UniversityShanghaiChina
| | - Shengzi Wang
- Department of Radiation Oncology, Eye Ear Nose and Throat HospitalFudan UniversityShanghaiChina
| | - Rong Tao
- Department of HematologyXinhua Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Xichun Hu
- Department of Medical OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of OncologyShanghai Medical College, Fudan UniversityShanghaiChina
| | - Hao Ding
- Department of Radiation Oncology, Eye Ear Nose and Throat HospitalFudan UniversityShanghaiChina
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16
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Deng S, Lin S, Shen J, Zeng Y. Comparison of CHOP vs CHOPE for treatment of peripheral T-cell lymphoma: a meta-analysis. Onco Targets Ther 2019; 12:2335-2342. [PMID: 30992670 PMCID: PMC6445243 DOI: 10.2147/ott.s189825] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective To compare cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) and CHOP plus etoposide (CHOPE) with regard to outcomes including efficacy and safety for patients with peripheral T-cell lymphoma (PTCL). Methods Relevant literature was searched using PubMed, Embase, Wanfang, and CNKI for eligible trials comparing CHOP with CHOPE for treatment of PTCL. The following outcomes of PTCL patients were considered: complete response (CR), partial response (PR), overall response rate (ORR), and adverse events (AEs; grade >3). Risk ratios (RRs) were appropriately derived from fixed-effects or random-effects models. Results A total of five prospective or retrospective articles with 1,560 patients were elected for the meta-analysis. There were no significant differences in CR (RR =1.11, 95% CI: 0.73–1.67, P=0.632), PR (RR =1.40, 95% CI: 0.52–3.76, P=0.504), and ORR (RR =1.25, 95% CI: 0.93–1.69, P=0.146) between the CHOP and CHOPE groups. However, AEs including anemia (RR =1.69, 95% CI: 1.33–2.16, P<0.001) and thrombocytopenia (RR =1.43, 95% CI: 1.15–1.77, P=0.001) were significantly increased in CHOPE group compared to that in CHOP group. Conclusion Meta-analysis suggested that there were no differences in therapeutic effect for patients with PTCL between CHOP and CHOPE groups with regards to CR, PR, and ORR, whereas the CHOPE group had significantly increased AEs (anemia and thrombocytopenia) compared to CHOP group.
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Affiliation(s)
- Shu Deng
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou, Zhejiang 310006, China
| | - Shenyun Lin
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou, Zhejiang 310006, China
| | - Jianping Shen
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou, Zhejiang 310006, China
| | - Yuqing Zeng
- Department of Orthopedics, TongDe Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, China,
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17
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Moskowitz AJ. Practical Treatment Approach for Angioimmunoblastic T-Cell Lymphoma. J Oncol Pract 2019; 15:137-143. [PMID: 30861367 PMCID: PMC7850668 DOI: 10.1200/jop.18.00511] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2018] [Indexed: 12/30/2022] Open
Abstract
Patients with angioimmunoblastic T-cell lymphoma (AITL), one of the most common types of peripheral T-cell lymphoma (PTCL), typically present with advanced disease, systemic symptoms, and immune deregulation. Treatment can be challenging owing to frequent relapses after initial and subsequent therapy. The front-line treatment approach currently mirrors the approach used for other nodal PTCLs with cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy and consideration for autologous stem-cell transplant (SCT). In the relapsed and refractory settings, allogeneic SCT offers the chance for long-term remission. Choice of treatment of relapsed or refractory disease depends on whether an allogeneic SCT is planned. Agents with preferential activity in relapsed or refractory AITL include epigenetic modifiers such as histone deacetylase inhibitors and hypomethylating agents. Other targeted agents show promise in AITL, including brentuximab vedotin and phosphoinositide-3-kinase inhibitors. Ongoing studies are evaluating new potential targets for AITL, with particular focus on identifying markers of response and resistance. Additional studies are assessing incorporation of novel agents into the front-line treatment of AITL. These studies will lead to more individualized treatment approaches and, ultimately, improved outcomes for patients with AITL.
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Affiliation(s)
- Alison J. Moskowitz
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
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18
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Horwitz S, O'Connor OA, Pro B, Illidge T, Fanale M, Advani R, Bartlett NL, Christensen JH, Morschhauser F, Domingo-Domenech E, Rossi G, Kim WS, Feldman T, Lennard A, Belada D, Illés Á, Tobinai K, Tsukasaki K, Yeh SP, Shustov A, Hüttmann A, Savage KJ, Yuen S, Iyer S, Zinzani PL, Hua Z, Little M, Rao S, Woolery J, Manley T, Trümper L. Brentuximab vedotin with chemotherapy for CD30-positive peripheral T-cell lymphoma (ECHELON-2): a global, double-blind, randomised, phase 3 trial. Lancet 2019; 393:229-240. [PMID: 30522922 PMCID: PMC6436818 DOI: 10.1016/s0140-6736(18)32984-2] [Citation(s) in RCA: 458] [Impact Index Per Article: 91.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 10/31/2018] [Accepted: 11/08/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Based on the encouraging activity and manageable safety profile observed in a phase 1 study, the ECHELON-2 trial was initiated to compare the efficacy and safety of brentuximab vedotin, cyclophosphamide, doxorubicin, and prednisone (A+CHP) versus cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) for the treatment of CD30-positive peripheral T-cell lymphomas. METHODS ECHELON-2 is a double-blind, double-dummy, randomised, placebo-controlled, active-comparator phase 3 study. Eligible adults from 132 sites in 17 countries with previously untreated CD30-positive peripheral T-cell lymphomas (targeting 75% with systemic anaplastic large cell lymphoma) were randomly assigned 1:1 to receive either A+CHP or CHOP for six or eight 21-day cycles. Randomisation was stratified by histological subtype according to local pathology assessment and by international prognostic index score. All patients received cyclophosphamide 750 mg/m2 and doxorubicin 50 mg/m2 on day 1 of each cycle intravenously and prednisone 100 mg once daily on days 1 to 5 of each cycle orally, followed by either brentuximab vedotin 1·8 mg/kg and a placebo form of vincristine intravenously (A+CHP group) or vincristine 1·4 mg/m2 and a placebo form of brentuximab vedotin intravenously (CHOP group) on day 1 of each cycle. The primary endpoint, progression-free survival according to blinded independent central review, was analysed by intent-to-treat. This trial is registered with ClinicalTrials.gov, number NCT01777152. FINDINGS Between Jan 24, 2013, and Nov 7, 2016, 601 patients assessed for eligibility, of whom 452 patients were enrolled and 226 were randomly assigned to both the A+CHP group and the CHOP group. Median progression-free survival was 48·2 months (95% CI 35·2-not evaluable) in the A+CHP group and 20·8 months (12·7-47·6) in the CHOP group (hazard ratio 0·71 [95% CI 0·54-0·93], p=0·0110). Adverse events, including incidence and severity of febrile neutropenia (41 [18%] patients in the A+CHP group and 33 [15%] in the CHOP group) and peripheral neuropathy (117 [52%] in the A+CHP group and 124 [55%] in the CHOP group), were similar between groups. Fatal adverse events occurred in seven (3%) patients in the A+CHP group and nine (4%) in the CHOP group. INTERPRETATION Front-line treatment with A+CHP is superior to CHOP for patients with CD30-positive peripheral T-cell lymphomas as shown by a significant improvement in progression-free survival and overall survival with a manageable safety profile. FUNDING Seattle Genetics Inc, Millennium Pharmaceuticals Inc, a wholly owned subsidiary of Takeda Pharmacuetical Company Limited, and National Institutes of Health National Cancer Institute Cancer Center.
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Affiliation(s)
- Steven Horwitz
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | | | - Barbara Pro
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tim Illidge
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, National Institutes of Health and Research Biomedical Research Centre, Manchester Academic Health Sciences Centre, Christie Hospital National Health Service Foundation Trust, Manchester, UK
| | - Michelle Fanale
- MD Anderson Cancer Center, University of Texas, Houston, TX, USA; Seattle Genetics, Inc, Bothell, WA, USA
| | - Ranjana Advani
- Stanford Cancer Center, Blood and Marrow Transplant Program, Stanford, CA, USA
| | | | | | - Franck Morschhauser
- University of Lille, Centre Hospitalier Universitaire de Lille, Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
| | | | - Giuseppe Rossi
- Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italy
| | | | | | | | - David Belada
- 4th Department of Internal Medicine-Haematology, Charles University, Hospital and Faculty of Medicine, Hradec Králové, Czech Republic
| | - Árpád Illés
- University of Debrecen, Faculty of Medicine, Department of Hematology, Debrecen, Hungary
| | | | | | - Su-Peng Yeh
- China Medical University Hospital, Taichung, Taiwan
| | - Andrei Shustov
- University of Washington Medical Center, Seattle, WA, USA
| | | | - Kerry J Savage
- University of British Columbia and the Department of Medical Oncology, British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | - Sam Yuen
- Calvary Mater Newcastle Hospital, Waratah, NSW, Australia
| | - Swaminathan Iyer
- MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Pier Luigi Zinzani
- Institute of Hematology Seràgnoli, University of Bologna, Bologna, Italy
| | - Zhaowei Hua
- Millennium Pharmaceuticals, Inc, Cambridge, MA, USA, a wholly owned subsidiary of Takeda Pharmaceutical Company
| | - Meredith Little
- Millennium Pharmaceuticals, Inc, Cambridge, MA, USA, a wholly owned subsidiary of Takeda Pharmaceutical Company
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Oluwasanjo A, Kartan S, Johnson W, Alpdogan O, Gru A, Mishra A, Haverkos BM, Gong J, Porcu P. Peripheral T-Cell Lymphoma, not Otherwise Specified (PTCL-NOS). Cancer Treat Res 2019; 176:83-98. [PMID: 30596214 DOI: 10.1007/978-3-319-99716-2_4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) is a World Health Organization (WHO)-defined diagnostic category within the highly heterogeneous group of mature post-thymic T-cell neoplasms. It is the most common subtype of mature post-thymic T-cell neoplasms globally, accounting for up to 35% of PTCL cases in Europe and North America. PTCL-NOS is a diagnosis of exclusion, comprising several disease entities that differ in biology, clinical presentation, and outcome. The diagnosis of PTCL-NOS is made based on the presence of typical histopathological features of lymphoma, an aberrant T-cell immunophenotype, often with a loss of CD5 and CD7, and a clonal T-cell receptor (TCR) gene rearrangement, in the appropriate clinical context. Unlike other types of T-cell lymphoma, recurrent mutations to assist with the diagnosis have not been identified. Patients often present with advanced stage. Prognosis is poor, with a 5-year overall survival (OS) of 20-30%. Anthracycline-based combination chemotherapy remains the most frequently used frontline strategy, with overall response rates (ORR) of 50-60%, and complete response rates (CRR) of 20-30%. Prospective studies with intent-to-treat analyses have shown that consolidation with high-dose chemotherapy and autologous stem cell transplant (ASCT) results in progression-free survivals (PFS) that compare favorably with historical cohorts and may improve OS in selected patient populations. However, randomized data are still lacking. Over the past decade, therapeutic agents approved in the relapsed and refractory setting have produced response rates of up to 33% and median PFS up to 18 months. Overall, outcomes remain poor and there is a dire need for more effective treatments. This review discusses the latest information on the diagnosis and treatment of PTCL-NOS.
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Affiliation(s)
- Adetokunbo Oluwasanjo
- Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, 834 Chestnut Street, Suite 320, Philadelphia, PA, 19107, USA
| | - Saritha Kartan
- Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, 834 Chestnut Street, Suite 320, Philadelphia, PA, 19107, USA
| | - William Johnson
- Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, 834 Chestnut Street, Suite 320, Philadelphia, PA, 19107, USA
| | - Onder Alpdogan
- Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, 834 Chestnut Street, Suite 320, Philadelphia, PA, 19107, USA
| | - Alejandro Gru
- Department of Pathology, University of Virginia, Charlottesville, USA
| | - Anjali Mishra
- Department of Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, USA
| | | | - Jerald Gong
- Department of Pathology, Thomas Jefferson University, Philadelphia, USA
| | - Pierluigi Porcu
- Division of Hematology, University of Colorado, Denver, USA.
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20
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A retrospective study of the CHOP, CHOPE, and CHOPE/G regimens as the first-line treatment of peripheral T-cell lymphomas. Cancer Chemother Pharmacol 2018; 83:443-449. [PMID: 30511217 DOI: 10.1007/s00280-018-3744-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 11/27/2018] [Indexed: 01/02/2023]
Abstract
PURPOSE The standard treatment for peripheral T-cell lymphomas (PTCLs) is undetermined. We designed a CHOPE/G regimen (cyclophosphamide, pirarubicin, vincristine, prednisolone, and etoposide alternating with a gemcitabine-based regimen) as the first-line treatment of PTCLs and compared with CHOP (cyclophosphamide, pirarubicin, vincristine, and prednisolone) and CHOPE (CHOP plus etoposide) regimen to evaluate the optimal chemotherapy regimen. METHODS 116 previously untreated PTCL patients received CHOP (N = 46), CHOPE (N = 46), or CHOPE/G (N = 24) regimen at Peking University Cancer Hospital from 2009 to 2017 and were retrospectively analyzed. RESULTS The overall response rates (ORRs) of the CHOP, CHOPE, and CHOPE/G groups were 82.6%, 76.1%, and 75.0% (p = 0.673), with complete response (CR) rates of 32.6%, 56.5%, and 45.7% (p = 0.063), respectively. Within a median follow-up time of 35.5 months, the 3-year overall survival (OS) rates of the CHOP, CHOPE, and CHOPE/G groups were 37.0%, 47.0%, and 56.3% (p = 0.107), and the 3-year progression-free survival (PFS) rates were 19.9%, 29.9%, and 5.3% (p = 0.093), respectively. Compared with the CHOP regimen alone, CHOPE had a significantly higher CR rate (p = 0.021) with more favorable OS (p = 0.046). The CHOPE/G regimen did not improve the ORR, CR rate, or OS compared with either the CHOP or CHOPE, with a significantly poorer PFS compared with the CHOPE regimen (p = 0.029). Anemia and thrombocytopenia occurred most frequently in the CHOPE/G group (anemia 83.3%, p = 0.035; thrombocytopenia 50%, p = 0.015). CONCLUSIONS Compared with CHOP alone, CHOPE regimen improved the efficacy and survival; while the addition of gemcitabine in the front-line therapy resulted in more adverse events without benefit of survival.
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Reiman T, Savage KJ, Crump M, Cheung MC, MacDonald D, Buckstein R, Couban S, Piliotis E, Imrie K, Spaner D, Shivakumar S, Kuruvilla J, Villa D, Shepherd LE, Skamene T, Winch C, Chen BE, Hay AE. A phase I study of romidepsin, gemcitabine, dexamethasone and cisplatin combination therapy in the treatment of peripheral T-cell and diffuse large B-cell lymphoma; the Canadian cancer trials group LY.15 study†. Leuk Lymphoma 2018; 60:912-919. [PMID: 30301414 DOI: 10.1080/10428194.2018.1515937] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
We investigated GDP (gemcitabine, 1000 mg/m2 IV d1, d8; dexamethasone, 40 mg po d1-4; cisplatin, 75 mg/m2 IV d1) combined with romidepsin on days 1 and 8 every 21 days to a maximum of six cycles in a standard 3 + 3, phase I dose escalation trial for patients with relapsed/refractory peripheral T-cell (PTCL) or diffuse large B-cell (DLBCL) lymphoma (NCT01846390). After treating four patients, gemcitabine and romidepsin were given on days 1 and 15 every 28 days. On the 21-day schedule at 6 mg/m2 romidepsin, there were three dose-limiting toxicities (DLTs) among four patients. On the 28-day schedule, there were no DLTs at the 6, 8, or 10 mg/m2 dose. At 12 mg/m2, there were four observed grade 3 DLTs among six evaluable patients. Full doses of GDP can be combined with a recommended phase II romidepsin dose of 10 mg/m2 if given on a day 1, 15 every 28 days schedule.
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Affiliation(s)
- Tony Reiman
- a Department of oncology, Saint John Regional Hospital , Dalhousie University, and University of New Brunswick , Saint John , Canada
| | | | - Michael Crump
- c Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre , Toronto , Canada
| | - Matthew C Cheung
- d Division of Hematology, Sunnybrook Health Services Centre , Toronto , Canada
| | - David MacDonald
- e Department of Hematology, QEII Health Sciences Centre , Halifax , Canada
| | - Rena Buckstein
- d Division of Hematology, Sunnybrook Health Services Centre , Toronto , Canada
| | - Stephen Couban
- e Department of Hematology, QEII Health Sciences Centre , Halifax , Canada
| | - Eugenia Piliotis
- d Division of Hematology, Sunnybrook Health Services Centre , Toronto , Canada
| | - Kevin Imrie
- f Department of Hematology, Sunnybrook Health Services Centre , Toronto , Canada
| | - David Spaner
- d Division of Hematology, Sunnybrook Health Services Centre , Toronto , Canada
| | - Sudeep Shivakumar
- e Department of Hematology, QEII Health Sciences Centre , Halifax , Canada
| | - John Kuruvilla
- c Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre , Toronto , Canada
| | - Diego Villa
- g Canadian Cancer Trials Group, Cancer Research Institute , Queen's University , Kingston , Canada
| | - Lois E Shepherd
- g Canadian Cancer Trials Group, Cancer Research Institute , Queen's University , Kingston , Canada
| | - Tanya Skamene
- g Canadian Cancer Trials Group, Cancer Research Institute , Queen's University , Kingston , Canada
| | - Chad Winch
- g Canadian Cancer Trials Group, Cancer Research Institute , Queen's University , Kingston , Canada
| | - Bingshu E Chen
- g Canadian Cancer Trials Group, Cancer Research Institute , Queen's University , Kingston , Canada
| | - Annette E Hay
- g Canadian Cancer Trials Group, Cancer Research Institute , Queen's University , Kingston , Canada
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Zhang Y, Zhang W, Li J, Duan M, Han B, Zhu T, Zhuang J, Cai H, Cao X, Chen M, Zhou D. Gemcitabine, cisplatin, and dexamethasone (GDP) in combination with methotrexate and pegaspargase is active in newly diagnosed peripheral T cell lymphoma patients: a phase 2, single-center, open-label study in China. Ann Hematol 2018; 98:143-150. [PMID: 30209556 DOI: 10.1007/s00277-018-3488-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/25/2018] [Indexed: 01/08/2023]
Abstract
Peripheral T cell lymphomas (PTCL) are less responsive to anthracycline-containing regimen such as CHOP and carry a poor prognosis. In this prospective study, we investigated gemcitabine, cisplatin, and dexamethasone (GDP) combined with methotrexate (MTX) and pegaspargase (PEG-L) as front-line treatment in PTCL. Eligible newly diagnosed PTCL patients received 4 cycles of the GDP-ML chemotherapy every 28 days. After 4 cycles, responding patients continued to receive either autologous stem cell transplantation or the MTX/cytarabine (MA) regimen for consolidation. This trial is registered with www.chictr.org.cn (ChiCTR-ONC-12002055). A total of 65 patients were enrolled with a median follow-up of 38.5 months. The overall response rate (ORR) was 55.4%, and complete remission rate (CR) was 33.8%. The median overall survival (OS) was 16 months, and the 1-year and 2-year OS were 59.1% and 38.2%, respectively. The median PFS was only 8 months. The main adverse event was hematologic toxicity: 50% patients showed grade III/IV neutropenia. GDP-ML for the first-line treatment of PTCL patients is an effective induction regimen compared with standard CHOP, and the toxicity was more significant but acceptable. However, future studies exploring new drug combinations are warranted to overcome relapse after remission. ClinicalTrials.gov Identifier: NCT02987244.
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Affiliation(s)
- Yan Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Wei Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Jian Li
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Minghui Duan
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Bing Han
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Tienan Zhu
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Junling Zhuang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Huacong Cai
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Xinxin Cao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Miao Chen
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Daobin Zhou
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China.
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Laribi K, Alani M, Truong C, Baugier de Materre A. Recent Advances in the Treatment of Peripheral T-Cell Lymphoma. Oncologist 2018; 23:1039-1053. [PMID: 29674443 PMCID: PMC6192612 DOI: 10.1634/theoncologist.2017-0524] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/14/2018] [Indexed: 12/15/2022] Open
Abstract
Peripheral T-cell lymphoma (PTCL) is a heterogeneous group of clinically aggressive diseases associated with poor outcome. Despite progress in the last several years, resulting in a deeper understanding of the natural history and biology of PTCL based on molecular profiling and next-generation sequencing, there is a need for improvement in efficacy of chemotherapeutic regimens for newly diagnosed patients. Treatment in the front-line setting is most often cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or CHOP-like regimens, which are associated with a high failure rate and frequent relapses. Trials evaluating intensive chemotherapy have resulted in variable success in prolonging event-free survival, but overall survival has remained unchanged. Furthermore, this strategy is limited to patients who are in complete remission after initial anthracycline-based chemotherapy. Many patients are ineligible for hematopoietic stem cell transplantation because of age or failure to achieve remission. For relapsed disease, advances have been made in the therapeutic arsenal for PTCL. New drugs investigated in phase II studies have achieved response rates between 10% and 30%. However, to date the identification of new therapies has been largely empiric, and long-term remissions are the exception to the rule. Current patient outcomes suggest the need for the identification and development of active and biologically rational therapies to improve disease management and to extend the duration of response with iterative biomarker evaluation. This review covers the management of PTCL and focuses on new agents and therapeutic combinations, based on a better understanding of biology and pathogenesis of the disease. IMPLICATIONS FOR PRACTICE Recent progress in understanding of the biology and pathogenesis of peripheral T-cell lymphoma has led to the emergence of new drugs. Unfortunately, this has not been met with similar advances in outcome improvement. Anthracycline-containing regimens, mostly cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), are considered the standard of care, although the best first-line approach remains to be defined. In the relapsed and refractory settings, several new agents achieved response rates between 10% and 30%, although these drugs do not significantly affect survival rates. Therapeutic options based on better molecular characterization of various histological types and combinations with the CHOP regimen or synergic combinations of new drugs may lead to better outcomes.
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Affiliation(s)
- Kamel Laribi
- Department of Hematology, Centre Hospitalier Le Mans, Le Mans, France
| | - Mustapha Alani
- Department of Hematology, Centre Hospitalier Le Mans, Le Mans, France
| | - Catherine Truong
- Clinical Research Center, Centre Hospitalier Le Mans, Le Mans, France
| | - Alix Baugier de Materre
- Geriatric Department, Rothschild Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
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24
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Nemani S, Korula A, Agrawal B, Kavitha M, Manipadam MT, Sigamani E, George B, Srivastava A, Viswabandya A, Mathews V. Peripheral T cell lymphoma: Clinico-pathological characteristics & outcome from a tertiary care centre in south India. Indian J Med Res 2018; 147:464-470. [PMID: 30082570 PMCID: PMC6094517 DOI: 10.4103/ijmr.ijmr_1108_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Indexed: 01/21/2023] Open
Abstract
Background & objectives Peripheral T cell lymphomas (PTCLs) are a heterogeneous group of non-Hodgkin's lymphomas (NHLs), with universally poor outcome. This study was undertaken to provide data on demographics and outcomes of patients with PTCL who underwent treatment in a single tertiary care centre in southern India. Methods Retrospective study was done on all patients (age ≥18 yr) diagnosed with PTCL from January 2007 to December 2012. The diagnosis of PTCL was made according to the WHO Classification of Tumors of Hematopoietic and Lymphoid Tissues. Results A total of 244 adult patients were diagnosed with PTCL (non-cutaneous). The most common subtype was PTCL-not otherwise specified (35.7%), followed by anaplastic large cell lymphoma (ALCL), ALK negative (21.3%), natural killer/T cell lymphoma, angioimmunoblastic T-cell lymphoma (AITL), ALCL, ALK positive, hepatosplenic T cell lymphoma (HSTCL) and adult T cell leukaemia/lymphoma followed in frequency with 13.1, 11.5, 8.6, 8.2 and 1.6 per cent cases, respectively. The three-year Kaplan-Meier overall survival (OS) and event-free survival (EFS) for the patients who received chemotherapy (n=122) were 33.8±5.0 and 29.3±4.7 per cent, respectively. Various prognostic indices developed for T cell lymphomas were found to be useful. Interpretation & conclusions Except for ALCL, ALK positive, all other PTCLs showed poor long-term outcome with CHOP-based chemotherapy. Novel therapies are needed to improve the outcome.
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Affiliation(s)
- Sandeep Nemani
- Department of Clinical Hematology, Christian Medical College & Hospital, Vellore, India
| | - Anu Korula
- Department of Clinical Hematology, Christian Medical College & Hospital, Vellore, India
| | - Bhumi Agrawal
- Department of Pathology, Christian Medical College & Hospital, Vellore, India
| | - M.L. Kavitha
- Department of Clinical Hematology, Christian Medical College & Hospital, Vellore, India
| | | | | | - Biju George
- Department of Clinical Hematology, Christian Medical College & Hospital, Vellore, India
| | - Alok Srivastava
- Department of Clinical Hematology, Christian Medical College & Hospital, Vellore, India
| | - Auro Viswabandya
- Department of Clinical Hematology, Christian Medical College & Hospital, Vellore, India
| | - Vikram Mathews
- Department of Clinical Hematology, Christian Medical College & Hospital, Vellore, India
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25
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Gleeson M, Peckitt C, To YM, Edwards L, Oates J, Wotherspoon A, Attygalle AD, Zerizer I, Sharma B, Chua S, Begum R, Chau I, Johnson P, Ardeshna KM, Hawkes EA, Macheta MP, Collins GP, Radford J, Forbes A, Hart A, Montoto S, McKay P, Benstead K, Morley N, Kalakonda N, Hasan Y, Turner D, Cunningham D. CHOP versus GEM-P in previously untreated patients with peripheral T-cell lymphoma (CHEMO-T): a phase 2, multicentre, randomised, open-label trial. Lancet Haematol 2018; 5:e190-e200. [PMID: 29703335 PMCID: PMC5946805 DOI: 10.1016/s2352-3026(18)30039-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/09/2018] [Accepted: 03/11/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Outcomes with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) or CHOP-like chemotherapy in peripheral T-cell lymphoma are poor. We investigated whether the regimen of gemcitabine, cisplatin, and methylprednisolone (GEM-P) was superior to CHOP as front-line therapy in previously untreated patients. METHODS We did a phase 2, parallel-group, multicentre, open-label randomised trial in 47 hospitals: 46 in the UK and one in Australia. Participants were patients aged 18 years and older with bulky (tumour mass diameter >10 cm) stage I to stage IV disease (WHO performance status 0-3), previously untreated peripheral T-cell lymphoma not otherwise specified, angioimmunoblastic T-cell lymphoma, anaplastic lymphoma kinase-negative anaplastic large cell lymphoma, enteropathy-associated T-cell lymphoma, or hepatosplenic γδ T-cell lymphoma. We randomly assigned patients (1:1) stratified by subtype of peripheral T-cell lymphoma and international prognostic index to either CHOP (intravenous cyclophosphamide 750 mg/m2, doxorubicin 50 mg/m2, and vincristine 1·4 mg/m2 [maximum 2 mg] on day 1, and oral prednisolone 100 mg on days 1-5) every 21 days for six cycles; or GEM-P (intravenous gemcitabine 1000 mg/m2 on days 1, 8, and 15, cisplatin 100 mg/m2 on day 15, and oral or intravenous methylprednisolone 1000 mg on days 1-5) every 28 days for four cycles. The primary endpoint was the proportion of patients with a CT-based complete response or unconfirmed complete response on completion of study chemotherapy, to detect a 20% superiority of GEM-P compared with CHOP, assessed in all patients who received at least one cycle of treatment and had an end-of-treatment CT scan or reported clinical progression as the reason for stopping trial treatment. Safety was assessed in all patients who received at least one dose of study medication. This trial is registered with ClinicalTrials.gov (NCT01719835) and the European Clinical Trials Database (EudraCT 2011-004146-18). FINDINGS Between June 18, 2012, and Nov 16, 2016, we randomly assigned 87 patients to treatment, 43 to CHOP and 44 to GEM-P. A planned unmasked review of efficacy data by the independent data monitoring committee in November, 2016, showed that the number of patients with a confirmed or unconfirmed complete response with GEM-P was non-significantly inferior compared with CHOP and the trial was closed early. At a median follow-up of 27·4 months (IQR 16·6-38·4), 23 patients (62%) of 37 assessable patients assigned to CHOP had achieved a complete response or unconfirmed complete response compared with 17 (46%) of 37 assigned to GEM-P (odds ratio 0·52, 95% CI 0·21-1·31; p=0·164). The most common adverse events of grade 3 or worse in both groups were neutropenia (17 [40%] with CHOP and nine [20%] with GEM-P), thrombocytopenia (4 [10%] with CHOP and 13 [30%] with GEM-P, and febrile neutropenia (12 [29%] with CHOP and 3 [7%] with GEM-P). Two patients (5%) died during the study, both in the GEM-P group, from lung infections. INTERPRETATION The number of patients with a complete response or unconfirmed complete response did not differ between the groups, indicating that GEM-P was not superior for this outcome. CHOP should therefore remain the reference regimen for previously untreated peripheral T-cell lymphoma. FUNDING Bloodwise and the UK National Institute of Health Research.
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Affiliation(s)
- Mary Gleeson
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Clare Peckitt
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Ye Mong To
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Laurice Edwards
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | | | | | | | - Imene Zerizer
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | | | - Sue Chua
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Ruwaida Begum
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Ian Chau
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Peter Johnson
- Cancer Research UK Centre, University of Southampton, Southampton, UK
| | | | - Eliza A Hawkes
- Olivia Newton John Cancer Research Institute, Austin Health, Melbourne, VA, Australia; Eastern Health, Melbourne, VA, Australia
| | | | - Graham P Collins
- Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford, UK
| | - John Radford
- University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | | | | | - Pamela McKay
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Kim Benstead
- Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, UK
| | - Nicholas Morley
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Yasmin Hasan
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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26
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Allogeneic hematopoietic stem cell transplantation for T-cell lymphomas. Blood 2018; 132:245-253. [PMID: 29699989 DOI: 10.1182/blood-2018-01-791335] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 04/20/2018] [Indexed: 12/18/2022] Open
Abstract
Mature T- and natural killer (NK)-cell neoplasms comprise a group of morphologically, immunophenotypically, molecularly, and clinically heterogeneous disorders with generally unfavorable outcome. Results of first-line chemotherapy are unsatisfactory for the most common T-cell lymphomas (peripheral T-cell lymphoma, not otherwise specified; angioimmunoblastic T-cell lymphoma; anaplastic large cell lymphomas; anaplastic lymphoma tyrosine kinase-negative) as well as for many other entities. High-dose therapy followed by autologous hematopoietic stem cell transplantation (HSCT) is widely recommended for consolidation after a complete or partial remission is achieved. However, about one-third of patients never reach transplantation because of early relapse or refractoriness. Targeted therapies have recently been developed; combinations with chemotherapy may improve outcomes, but long-term results from prospective studies are largely missing. In this situation, allogeneic HSCT remains a valuable treatment option inducing long-lived remissions in about 30% to 50% of patients with relapsed and refractory T-cell lymphoma able to proceed to transplantation. Results of allogeneic transplantation for consolidation in first remission are less defined and its indications remain controversial. With growing evidence that haploidentical HSCT also works in lymphoma, more patients can be brought to transplantation. Decreasing the morbidity and mortality of allogeneic transplantation is a continuous challenge. Integrating new drugs into transplant concepts and setting up prospective studies involving allogeneic transplantation remain unmet needs that warrant urgent study in a group of disorders in which classical chemotherapy and new drugs have generated results, which are far from optimal until today.
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27
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Sorge C, Costa LJ, Taub JW, S. Cairo M, Xavier AC. Incidence and outcomes of rare paediatric non-hodgkin lymphomas. Br J Haematol 2018; 184:864-867. [DOI: 10.1111/bjh.15194] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Caryn Sorge
- Division of Hematology/Oncology; Department of Pediatrics; University of Kentucky; Lexington KY USA
| | - Luciano J. Costa
- Division of Hematology/Oncology; Department of Medicine; University of Alabama at Birmingham; Birmingham AL USA
| | - Jeffrey W. Taub
- Division of Hematology/Oncology; Department of Pediatrics; Children's Hospital of Michigan/Wayne State University; Detroit MI USA
| | - Mitchell S. Cairo
- Departments of Pediatrics, Pathology, Medicine, Immunology and Microbiology; Cell Biology and Anatomy; New York Medical College; Valhalla NY USA
| | - Ana C. Xavier
- Division of Hematology/Oncology; Department of Pediatrics; Children's of Alabama/University of Alabama at Birmingham; Birmingham AL USA
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28
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Zhang L, Jia S, Ma Y, Li L, Li X, Wang X, Fu X, Ma W, Qin Y, Li W, Wu J, Sun Z, Zhang X, Nan F, Chang Y, Li Z, Zhang D, Wang G, Yan J, Su L, Wang J, Xue H, Young KH, Zhang M. Efficacy and safety of cisplatin, dexamethasone, gemcitabine and pegaspargase (DDGP) regimen in newly diagnosed, advanced-stage extranodal natural killer/T-cell lymphoma: interim analysis of a phase 4 study NCT01501149. Oncotarget 2018; 7:55721-55731. [PMID: 27384676 PMCID: PMC5342448 DOI: 10.18632/oncotarget.10124] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 05/11/2016] [Indexed: 12/17/2022] Open
Abstract
To explore a more effective treatment for newly diagnosed, advanced-stage extranodal natural killer/T-cell lymphoma, nasal type (ENKTL), we conducted a phase 4 study of the cisplatin, dexamethasone, gemcitabine, pegaspargase (DDGP) regimen. The primary end point was the 2-year progression-free survival (PFS) after the protocol treatment. Secondary endpoints included response rate (RR), overall survival (OS) and median survival time (MST). The interim analysis included data only from March 2011 to September 2013, who received six cycles of DDGP chemotherapy. A total of 25 eligible patients were enrolled. Seventeen patients (17/24, 70.83%) achieved complete response (CR) and four (4/24, 16.67%) achieved partial response (PR), three (3/24, 12.50%) had progressive disease (PD). The RR after treatment was 87.50%. After a median follow-up duration of 24.67 months (range 4-48 months). The 2-year PFS and OS rate were 61.80% (95% CI, 42.00% to 81.60%) and 68.50 % (95% CI, 48.70% to 88.30%), respectively. The MST was 36.55 months (95% CI, 29.41 months to 43.70 months). Grade 3/4 leukopenia occurred in fourteen patients (58.33%) and grade 3/4 thrombocytopenia occurred in eleven patients (45.83%). Twelve patients (50.00%) experienced Activated Partial Phromboplastin Ptime (APTT) elongation and fourteen patients (58.33%) experienced hypofibrinogenemia. In conclusion, DDGP regimen is an effective and tolerated treatment for newly diagnosed, advanced-stage ENKTL. This trial was registered at www.ClinicalTrials.gov as #NCT01501149.
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Affiliation(s)
- Lei Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Sisi Jia
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Yangyang Ma
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Ling Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Xin Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Xinhua Wang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Xiaorui Fu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Wang Ma
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Yanru Qin
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Wencai Li
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Jingjing Wu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Zhenchang Sun
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Xudong Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Feifei Nan
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Yu Chang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Zhaoming Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Dandan Zhang
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Guannan Wang
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Jiaqin Yan
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Liping Su
- Department of Hematology, Shanxi Province Cancer Hospital, Taiyuan, Shanxi, China
| | - Jinghua Wang
- Department of Oncology, Nanjing General Hospital of Nanjing Military Command, Nanjing, Jiangsu, China
| | - Hongwei Xue
- Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Ken H Young
- Department of Hematology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mingzhi Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
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Abstract
Owing to the rarity of peripheral T-cell lymphoma (PTCL) and the heterogeneity of subtypes, there are no compelling data to guide the therapeutic approaches for such patients. Over the years, there have been remarkable advances in molecular subtyping and treatment of PTCL, although there are still many areas to be explored. In this review, we summarize recent updates on the evolution of understanding and treatment for PTCL.
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Affiliation(s)
- Jun Ho Yi
- Division of Hematology-Oncology, Department of Medicine, Chung-Ang University , Seoul, Korea, South
| | - Seok Jin Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea, South
| | - Won Seog Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea, South
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30
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Co-targeting aurora kinase with PD-L1 and PI3K abrogates immune checkpoint mediated proliferation in peripheral T-cell lymphoma: a novel therapeutic strategy. Oncotarget 2017; 8:100326-100338. [PMID: 29245981 PMCID: PMC5725023 DOI: 10.18632/oncotarget.22222] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 10/13/2017] [Indexed: 01/16/2023] Open
Abstract
Peripheral T-cell non-Hodgkin lymphoma (PTCL) are heterogeneous, rare, and aggressive diseases mostly incurable with current cell cycle therapies. Aurora kinases (AKs) are key regulators of mitosis that drive PTCL proliferation. Alisertib (AK inhibitor) has a response rate ∼30% in relapsed and refractory PTCL (SWOG1108). Since PTCL are derived from CD4+/CD8+ cells, we hypothesized that Program Death Ligand-1 (PD-L1) expression is essential for uncontrolled proliferation. Combination of alisertib with PI3Kα (MLN1117) or pan-PI3K inhibition (PF-04691502) or vincristine (VCR) was highly synergistic in PTCL cells. Expression of PD-L1 relative to PD-1 is high in PTCL biopsies (∼9-fold higher) and cell lines. Combination of alisertib with pan-PI3K inhibition or VCR significantly reduced PD-L1, NF-κB expression and inhibited phosphorylation of AKT, ERK1/2 and AK with enhanced apoptosis. In a SCID PTCL xenograft mouse model, alisertib displayed high synergism with MLN1117. In a syngeneic PTCL mouse xenograft model alisertib demonstrated tumor growth inhibition (TGI) ∼30%, whilst anti-PD-L1 therapy alone was ineffective. Alisertib + anti-PD-L1 resulted in TGI >90% indicative of a synthetic lethal interaction. PF-04691502 + alisertib + anti-PD-L1 + VCR resulted in TGI 100%. Overall, mice tolerated the treatments well. Co-targeting AK, PI3K and PD-L1 is a rational and novel therapeutic strategy for PTCL.
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31
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Redefining the role of etoposide in first-line treatment of peripheral T-cell lymphoma. Blood Adv 2017; 1:2138-2146. [PMID: 29296861 DOI: 10.1182/bloodadvances.2017010819] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 09/14/2017] [Indexed: 11/20/2022] Open
Abstract
Peripheral T-cell lymphomas (PTCLs) have an aggressive biological course and poor clinical outcomes. Despite producing somewhat less-than-satisfactory results, the combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) remains the de facto standard in PTCL treatment. Addition of etoposide to CHOP backbone to overcome such unsatisfactory results has yielded contradictory information. We aimed to thoroughly analyze the impact of incorporating etoposide into first-line treatment. Using merged data from the Korean National Health Insurance Service and National Cancer Registry, a total of 1933 patients (median age, 58 years) were evaluated for clinical characteristics and treatment outcomes. Thirty-eight percent (n = 748) of the 1933 patients received CHOP or CHOP-like regimen, 35.1% (n = 678) received CHOP-like regimen plus etoposide, 5.9% (n = 113) received other backbone chemotherapy plus etoposide, and 20.3% (394) received other treatments in the first-line setting. When we divided the patients into 3 groups according to regimen (group 1, CHOP or CHOP-like regimen; group 2, CHOP or CHOP-like regimen plus etoposide; group 3, all others), group 1 was associated with longest progression-free survival (PFS; P < .001) and overall survival (OS; P < .001). This lack of benefit with etoposide addition was observed across different PTCL subtypes and age groups. Adding etoposide led to longer hospitalizations and cytopenias requiring more transfusion. Upfront hematopoietic stem-cell transplantation led to better OS. Addition of etoposide to CHOP-like regimens does not result in better PFS or OS for patients with PTCL. Overall, Asian patients with PTCL do not benefit from chemotherapy intensification of first-line treatment. We hereby provide crucial information on establishing standardized PTCL treatment.
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32
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Yao X, Cheng X, Zhang L, Yu H, Bao J, Guan H, Lu R. Punicalagin from pomegranate promotes human papillary thyroid carcinoma BCPAP cell death by triggering ATM-mediated DNA damage response. Nutr Res 2017; 47:63-71. [PMID: 29241579 DOI: 10.1016/j.nutres.2017.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 09/04/2017] [Accepted: 09/05/2017] [Indexed: 02/04/2023]
Abstract
Punicalagin (PUN), a component derived from pomegranate, is well known for its anticancer activity. Our previous work revealed that PUN induces autophagic cell death in papillary thyroid carcinoma cells. We hypothesized that PUN triggers DNA damage associated with cell death because DNA damage was reported as an inducer of autophagy. Our results showed that PUN treatment caused DNA breaks as evidenced by the significant enhancement in the phosphorylation of H2A.X. However, reactive oxygen species and DNA conformational alteration, 2 common inducing factors in DNA damage, were not involved in PUN-induced DNA damage. The phosphorylation of ataxia-telangiectasia mutated gene-encoded protein (ATM) but not ataxia telangiectasia and Rad3-related protein (ATR) was up-regulated in a time- and dosage-dependent manner after PUN treatment. KU-55933, an inhibitor of ATM, inhibited the phosphorylation of ATM induced by PUN and reversed the decreased cell viability caused by PUN. Thus, we demonstrated that PUN induces cell death of papillary thyroid carcinoma cells by triggering ATM-mediated DNA damage response, which provided novel mechanisms and potential targets for the better understanding of the anticancer actions of PUN.
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Affiliation(s)
- Xin Yao
- Key Laboratory of Nuclear Medicine, Ministry of Health, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, Jiangsu, China; School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, China.
| | - Xian Cheng
- Key Laboratory of Nuclear Medicine, Ministry of Health, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, Jiangsu, China.
| | - Li Zhang
- Key Laboratory of Nuclear Medicine, Ministry of Health, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, Jiangsu, China; State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, Jiangsu, China.
| | - Huixin Yu
- Key Laboratory of Nuclear Medicine, Ministry of Health, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, Jiangsu, China.
| | - Jiandong Bao
- Key Laboratory of Nuclear Medicine, Ministry of Health, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, Jiangsu, China.
| | - Haixia Guan
- Department of Endocrinology and Metabolism and Institute of Endocrinology, the First Hospital of China Medical University, Shenyang, Liaoning, China.
| | - Rongrong Lu
- School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, China.
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33
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Li L, Duan W, Zhang L, Li X, Fu X, Wang X, Wu J, Sun Z, Zhang X, Chang Y, Nan F, Yan J, Li Z, Young KH, Zhang M. The efficacy and safety of gemcitabine, cisplatin, prednisone, thalidomide versus CHOP in patients with newly diagnosed peripheral T-cell lymphoma with analysis of biomarkers. Br J Haematol 2017; 178:772-780. [PMID: 28597542 DOI: 10.1111/bjh.14763] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 03/20/2017] [Indexed: 01/18/2023]
Abstract
We compared the efficacy and safety of gemcitabine, cisplatin, prednisone and thalidomide (GDPT) with standard CHOP regimen (cyclophosphamide, doxorubicin, vincristine, prednisone) for patients with newly diagnosed peripheral T-cell lymphoma (PTCL) in a prospective randomized controlled and open-label clinical trial. Between July 2010 and June 2016, 103 patients were randomly allocated into two groups, of whom 52 were treated with GDPT therapy and 51 with CHOP therapy. The 2-year progression-free survival (PFS) and overall survival (OS) rates were better in the GDPT group than in the CHOP group (57% vs. 35% for 2-year PFS, P = 0·0035; 71% vs 50% for 2-year OS, P = 0·0001). The complete remission rate (CRR) and the overall response rate (ORR) in the GDPT group were higher than in the CHOP group (52% vs. 33%, P = 0·044 for CRR; 67% vs. 49%, P = 0·046 for ORR). Haemocytopenia was the predominant adverse effect, and acute toxicity was moderate, tolerable and well managed in both arms. mRNA expression of ERCC1, RRM1, TUBB3 and TOP2A genes varied among patients but the difference did not reach statistical significance, mainly due to the relatively small sample size. The precise characters of these biomarkers remain to be identified. In conclusion, GDPT is a promising new regimen as potential first-line therapy against PTCL. This study was registered at www.clinicaltrials.gov as #NCT01664975.
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Affiliation(s)
- Ling Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Centre of Henan Province, Zhengzhou, Henan, China
| | - Wenjing Duan
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Centre of Henan Province, Zhengzhou, Henan, China
| | - Lei Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Centre of Henan Province, Zhengzhou, Henan, China
| | - Xin Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Centre of Henan Province, Zhengzhou, Henan, China
| | - Xiaorui Fu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Centre of Henan Province, Zhengzhou, Henan, China
| | - Xinhua Wang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Centre of Henan Province, Zhengzhou, Henan, China
| | - Jingjing Wu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Centre of Henan Province, Zhengzhou, Henan, China
| | - Zhenchang Sun
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Centre of Henan Province, Zhengzhou, Henan, China
| | - Xudong Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Centre of Henan Province, Zhengzhou, Henan, China
| | - Yu Chang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Centre of Henan Province, Zhengzhou, Henan, China
| | - Feifei Nan
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Centre of Henan Province, Zhengzhou, Henan, China
| | - Jiaqin Yan
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Centre of Henan Province, Zhengzhou, Henan, China
| | - Zhaoming Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Centre of Henan Province, Zhengzhou, Henan, China
| | - Ken H Young
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mingzhi Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Centre of Henan Province, Zhengzhou, Henan, China
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34
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Al-Zahrani M, Savage KJ. Peripheral T-Cell Lymphoma, Not Otherwise Specified. Hematol Oncol Clin North Am 2017; 31:189-207. [DOI: 10.1016/j.hoc.2016.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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35
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Wu F, Cao W, Xu H, Zhu M, Wang J, Ke X. Treatment with a selenium-platinum compound induced T-cell acute lymphoblastic leukemia/lymphoma cells apoptosis through the mitochondrial signaling pathway. Oncol Lett 2017; 13:1702-1710. [PMID: 28454312 PMCID: PMC5403366 DOI: 10.3892/ol.2017.5666] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 12/02/2016] [Indexed: 11/13/2022] Open
Abstract
T-cell acute lymphoblastic leukemia/lymphoma (T-ALL/LBL) is an aggressive hematological disorder that is sensitive to chemotherapy; however, it exhibits frequent relapse rates. Platinum-containing therapeutics are the first-line salvage regimens used in the treatment of relapsed or refractory T-ALL/LBL. The selenium-platinum compound EG-Se/Pt is obtained from the combination of selenium-containing molecules (EG-Se) with cisplatin (CDDP); however, its anticancer properties have been poorly investigated. In the present study, the Cell Counting Kit-8 assay was used to evaluate the inhibitory effect of treatment with EG-Se/Pt on cell viability. Cell cycle distribution, apoptosis, reactive oxygen species (ROS) content and the mitochondrial membrane potential were analyzed using flow cytometry. Intracellular platinum content was detected using inductively coupled plasma mass spectrometry. Caspase activity was determined using a colorimetric assay. The expression of several proteins associated with apoptosis was analyzed using western blotting. The results of the present study demonstrated that treatment with EG-Se/Pt increased the inhibition of Jurkat and Molt-4 T-ALL/LBL cell viability compared with CDDP, and induced apoptosis and cell cycle arrest. The intracellular platinum content of T-ALL/LBL cells treated with EG-Se/Pt was increased compared with that of T-ALL/LBL cells treated with CDDP. EG-Se/Pt-induced apoptosis was mediated by caspase and ROS levels through the activation of the mitochondrial signaling pathway. The results of the present study suggest that EG-Se/Pt is a potential therapeutic candidate for the treatment of T-ALL/LBL.
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Affiliation(s)
- Feifei Wu
- Department of Hematology and Lymphoma Research Center, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Wei Cao
- Key Laboratory of Organic Optoelectronics and Molecular Engineering, Department of Chemistry, Tsinghua University, Beijing 100084, P.R. China
| | - Huaping Xu
- Key Laboratory of Organic Optoelectronics and Molecular Engineering, Department of Chemistry, Tsinghua University, Beijing 100084, P.R. China
| | - Mingxia Zhu
- Department of Hematology and Lymphoma Research Center, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Jing Wang
- Department of Hematology and Lymphoma Research Center, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Xiaoyan Ke
- Department of Hematology and Lymphoma Research Center, Peking University Third Hospital, Beijing 100191, P.R. China
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36
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Angioimmunoblastic T-cell lymphoma: the many-faced lymphoma. Blood 2017; 129:1095-1102. [PMID: 28115369 DOI: 10.1182/blood-2016-09-692541] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 12/09/2016] [Indexed: 02/07/2023] Open
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) is an uncommon subtype of mature peripheral T-cell lymphoma (PTCL). The history of AITL is much longer and deeper than the literature would suggest given the many names that have preceded it. Advanced-stage disease is common with uncharacteristic laboratory and autoimmune findings that often slow or mask the diagnosis. Significant strides in the immunohistochemical and molecular signature of AITL have brought increased ability to diagnose this uncommon type of PTCL. The 2016 World Health Organization classification of lymphoid neoplasms recently acknowledged the complexity of this diagnosis with the addition of other AITL-like subsets. AITL now resides under the umbrella of nodal T-cell lymphomas with follicular T helper phenotype. Induction strategies continue to focus on increasing complete remission rates that allow more transplant-eligible patients to proceed toward consolidative high-dose therapy and autologous stem cell rescue with improving long-term survival. There are several clinical trials in which recently approved drugs with known activity in AITL are paired with induction regimens with the hope of demonstrating long-term progression-free survival over cyclophosphamide, doxorubicin, vincristine, and prednisone. The treatment of relapsed or refractory AITL remains an unmet need. The spectrum of AITL from diagnosis to treatment is reviewed subsequently in a fashion that may one day lead to personalized treatment approaches in a many-faced disease.
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37
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Peripheral T-cell lymphoma, not otherwise specified. Blood 2017; 129:1103-1112. [PMID: 28115372 DOI: 10.1182/blood-2016-08-692566] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 09/27/2016] [Indexed: 12/19/2022] Open
Abstract
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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38
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Casulo C, O'Connor O, Shustov A, Fanale M, Friedberg JW, Leonard JP, Kahl BS, Little RF, Pinter-Brown L, Advani R, Horwitz S. T-Cell Lymphoma: Recent Advances in Characterization and New Opportunities for Treatment. J Natl Cancer Inst 2016; 109:djw248. [PMID: 28040682 DOI: 10.1093/jnci/djw248] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/14/2016] [Accepted: 09/26/2016] [Indexed: 11/14/2022] Open
Abstract
Peripheral T-cell lymphomas (PTCLs) are uncommon, heterogeneous, and aggressive non-Hodgkin's lymphomas. Despite progress in the last several years resulting in a deeper understanding of PTCL biology and pathogenesis, there is currently no accepted single standard of care for newly diagnosed patients, and for those with relapsed or refractory disease, prognosis is dismal. The National Cancer Institute convened a Clinical Trials Planning Meeting to advance the national clinical trial agenda in lymphoma. The objective was to identify unmet needs specific to five major lymphoma subtypes and develop strategies to address them. This consensus statement reviews recent advances in the molecular and genetic characterization of PTCL that may inform novel treatments, proposes strategies to test novel therapies in the relapsed setting with the hopes of rapid advancement into frontline trials, and underscores the need for the identification and development of active and biologically rational therapies to cure PTCL at higher rates, with iterative biomarker evaluation.
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Affiliation(s)
- Carla Casulo
- Wilmot Cancer Center, University of Rochester, Rochester, NY, USA
| | - Owen O'Connor
- Columbia University Medical Center, New York, NY, USA
| | | | - Michelle Fanale
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - John P Leonard
- Department of Medicine, Weil Cornell University, New York, NY, USA
| | - Brad S Kahl
- Oncology Division, Washington University, St. Louis, MO, USA
| | - Richard F Little
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Lauren Pinter-Brown
- University of California-Irvine Chao Family Comprehensive Cancer Center in Orange, CA, USA
| | - Ranjani Advani
- Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Steven Horwitz
- Memorial Sloan-Kettering Cancer Center, New York, NY , USA
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39
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Schmitz N, de Leval L. How I manage peripheral T-cell lymphoma, not otherwise specified and angioimmunoblastic T-cell lymphoma: current practice and a glimpse into the future. Br J Haematol 2016; 176:851-866. [PMID: 27982416 DOI: 10.1111/bjh.14473] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Peripheral T-cell lymphoma (PTCL), not otherwise specified (NOS) and angioimmunoblastic T-cell lymphoma (AITL) are the most frequent of more than 20 mature PTCL entities featuring a broad spectrum of morphological, immunophenotypic, molecular and clinical characteristics. Unfortunately, recent progress in understanding the (epi)genetic background of PTCL has not been met with similar advances in treatment. Thus, CHO(E)P [cyclophosphamide, doxorubicin, vincristine, and prednisone (plus etoposide)] remains standard first-line therapy. Patients without comorbidities achieving complete or partial remission proceed to autologous stem cell transplantation. With this approach about 50% of patients survive long-term. Patients relapsing after or progressing during first-line therapy have a dismal prognosis. They receive salvage gemcitabine-therapy followed by allogeneic transplantation whenever possible. After allografting, approximately half of the patients survive long-term; any other treatment is palliative. New drugs investigated in phase II studies achieved response rates between 10% and 30%; long-term remissions are the exception to the rule. While most new drugs are not licensed and not readily available, a plethora of other innovative drugs targeting (epi-)genetic abnormalities are in early development. These, together with combinations of new and old drugs, will hopefully increase response to first-line therapy, bridge more patients to transplantation, and finally improve prognosis for all patients with PTCL.
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Affiliation(s)
- Norbert Schmitz
- Department of Haematology, Oncology and Stem Cell Transplantation, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Laurence de Leval
- Institute of Pathology, University Hospital Lausanne and University of Lausanne, Switzerland
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40
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Carson KR, Horwitz SM, Pinter-Brown LC, Rosen ST, Pro B, Hsi ED, Federico M, Gisselbrecht C, Schwartz M, Bellm LA, Acosta MA, Shustov AR, Advani RH, Feldman TA, Lechowicz MJ, Smith SM, Lansigan F, Tulpule A, Craig MD, Greer JP, Kahl BS, Leach JW, Morganstein N, Casulo C, Park SI, Foss FM. A prospective cohort study of patients with peripheral T-cell lymphoma in the United States. Cancer 2016; 123:1174-1183. [PMID: 27911989 DOI: 10.1002/cncr.30416] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 09/27/2016] [Accepted: 10/03/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Long-term survival in patients with aggressive peripheral T-cell lymphoma (PTCL) is generally poor, and there currently is no clear consensus regarding the initial therapy used for these diseases. Herein, the authors analyzed treatment patterns and outcomes in a prospectively collected cohort of patients with a new diagnosis of nodal PTCL in the United States. METHODS Comprehensive Oncology Measures for Peripheral T-cell Lymphoma Treatment (COMPLETE) is a prospective multicenter cohort study designed to identify the most common prevailing treatment patterns used for patients newly diagnosed with PTCL in the United States. Patients with nodal PTCL and completed records regarding baseline characteristics and initial therapy were included in this analysis. All statistical tests were 2-sided. RESULTS Of a total of 499 patients enrolled, 256 (51.3%) had nodal PTCL and completed treatment records. As initial therapy, patients received doxorubicin-containing regimens (41.8%), regimens containing doxorubicin plus etoposide (20.9%), other etoposide regimens (15.8%), other single-agent or combination regimens (19.2%), and gemcitabine-containing regimens (2.1%). Survival was found to be statistically significantly longer for patients who received doxorubicin (log-rank P = .03). After controlling for disease histology and International Prognostic Index, results demonstrated a trend toward significance in mortality reduction in patients who received doxorubicin compared with those who did not (hazard ratio, 0.71; 95% confidence interval, 0.48-1.05 [P = .09]). CONCLUSIONS To the authors' knowledge, there is no clear standard of care in the treatment of patients with PTCL in the United States. Although efforts to improve frontline treatments are necessary, anthracyclines remain an important component of initial therapy for curative intent. Cancer 2017;123:1174-1183. © 2016 American Cancer Society.
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Affiliation(s)
- Kenneth R Carson
- Research Service, St Louis Veterans Affairs Medical Center, St. Louis, Missouri.,Department of Medical Oncology, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Steven M Horwitz
- Department of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | | | - Steven T Rosen
- Provost and Chief Scientific Officer, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Barbara Pro
- Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Eric D Hsi
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Massimo Federico
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | - Mark A Acosta
- Research and Development, Spectrum Pharmaceuticals Inc, Irvine, California
| | - Andrei R Shustov
- Department of Medicine, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ranjana H Advani
- Department of Medicine, Stanford University Medical Center, Stanford, California
| | - Tatyana A Feldman
- Department of Hematology/Oncology, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey
| | - Mary Jo Lechowicz
- Department of Hematology and Oncology, Emory University, Atlanta, Georgia
| | - Sonali M Smith
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Frederick Lansigan
- Department of Medicine, Dartmouth Hitchcock Medical Center, Hanover, New Hampshire
| | - Anil Tulpule
- Department of Medicine, University of Southern California, Los Angeles, California
| | - Michael D Craig
- Department of Medicine, West Virginia University, Morgantown, West Virginia
| | - John P Greer
- Department of Hematology, Vanderbilt University, Nashville, Tennessee
| | - Brad S Kahl
- Department of Medical Oncology, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Joseph W Leach
- Minnesota Oncology, Virginia Piper Cancer Institute, Minneapolis, Minnesota
| | | | - Carla Casulo
- Department of Medicine, University of Rochester, Rochester, New York
| | - Steven I Park
- Department of Internal Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Francine M Foss
- Department of Medical Oncology, Yale University, New Haven, Connecticut
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Gemcitabine, dexamethasone, and cisplatin (GDP) as salvage chemotherapy for patients with relapsed or refractory peripheral T cell lymphoma-not otherwise specified. Ann Hematol 2016; 96:245-251. [PMID: 27858107 DOI: 10.1007/s00277-016-2877-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 11/08/2016] [Indexed: 12/23/2022]
Abstract
Standard therapeutic options for patients with relapsed or refractory peripheral T cell lymphoma-not otherwise specified (PTCL-NOS) remain unclear. There are few large cohort studies specifically focused on gemcitabine-based chemotherapy for PTCL-NOS. We retrospectively reviewed patients with relapsed or refractory PTCL-NOS who received salvage GDP (gemcitabine, dexamethasone, and cisplatin) chemotherapy at the Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China, from May 2008 to August 2014. Twenty-five patients were enrolled and analyzed. The median number of cycles of GDP chemotherapy per patient was four (range, 2-8 cycles). Overall response rate was 64.0% (16/25) with five achieved complete remission or complete remission unconfirmed. After a median follow-up of 9 months, median overall survival (OS) and progression-free survival after relapse or progression (second-PFS) were 9.3 and 5.4 months. One-year PFS rate and 1-year OS rate were 27.4% and 43.9%, respectively. Median second-PFS was significantly longer in patients sensitive to GDP than the ones resistant to the treatment (10.3 vs. 2.8 months, p < .01). In addition, the low International Prognostic Index, low Prognostic Index for T cell lymphoma, or normal level of LDH in serum was associated with favorable prognosis. Grade 3/4 adverse effect was observed in 10 of 25 patients treated with GDP including neutropenia (8/25), thrombocytopenia (5/25), and anemia (4/25). Taken together, our study suggests that GDP is an effective and optional salvage regimen for relapsed or refractory PTCL-NOS.
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Affiliation(s)
- Antony S. Moore
- Veterinary Oncology Consultants; Wauchope New South Wales 2446 Australia
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Jia B, Hu S, Yang J, Zhou S, Liu P, Qin Y, Gui L, Yang S, Lin H, Zhang C, Xing P, Wang L, Dong M, Zhou L, Sun Y, He X, Shi Y. Comparison of gemcitabin, cisplatin, and dexamethasone (GDP), CHOP, and CHOPE in the first-line treatment of peripheral T-cell lymphomas. ACTA ACUST UNITED AC 2016; 21:536-41. [PMID: 27077778 DOI: 10.1080/10245332.2016.1152084] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Optimal chemotherapy regimen for peripheral T-cell lymphomas (PTCL) has not been fully defined. This study aimed to evaluate the optimal chemotherapy regimen in the first-line treatment for PTCL patients. METHODS Between 2003 and 2014, 93 consecutive patients with PTCL were enrolled in this study. Of 93 patients, 42 patients received CHOPE, 40 patients with CHOP, and 11 patients with GDP regimen. RESULTS Response could be evaluated in 88 of 93 patients at the end of primary treatment. The CR rate for patients received CHOP (n = 38), CHOPE (n = 39), and GDP (n = 11) were 28.9, 51.3, and 45.5%, respectively, (P = 0.132) with an ORR of 65.8, 76.9, and 90.9%, respectively, (P = 0.210). The median follow-up time was 17.1 (1.4-108.3) months. Median progression-free survival (PFS) in CHOP (n = 40), CHOPE (n = 42), and GDP (n = 11) groups were 6.0, 15.3, and 9.7 months (P = 0.094) with 1-year PFS of 35.0, 54.8, and 45.5%, respectively, (P = 0.078). One-year OS for patients received CHOP (n = 40), CHOPE (n = 42), and GDP (n = 11) were 65.0, 83.3, and 100%, respectively, (P = 0.013) (CHOP vs CHOPE, P = 0.030; CHOP vs GDP, P = 0.024; CHOPE vs GDP, P = 0.174). CONCLUSION CHOPE has a trend to improve CR rate, 1-year PFS and OS compared with CHOP alone. GDP shows promising efficacy which worth further exploration in large cohort studies. Clinical experience presented in this study may serve as reference for future large cohort studies.
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Affiliation(s)
- Bo Jia
- a Department of Medical Oncology, Cancer Hospital , Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs , No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021 , China
| | - Shaoxuan Hu
- a Department of Medical Oncology, Cancer Hospital , Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs , No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021 , China
| | - Jianliang Yang
- a Department of Medical Oncology, Cancer Hospital , Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs , No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021 , China
| | - Shengyu Zhou
- a Department of Medical Oncology, Cancer Hospital , Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs , No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021 , China
| | - Peng Liu
- a Department of Medical Oncology, Cancer Hospital , Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs , No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021 , China
| | - Yan Qin
- a Department of Medical Oncology, Cancer Hospital , Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs , No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021 , China
| | - Lin Gui
- a Department of Medical Oncology, Cancer Hospital , Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs , No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021 , China
| | - Sheng Yang
- a Department of Medical Oncology, Cancer Hospital , Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs , No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021 , China
| | - Hua Lin
- b Department of Medical Record Library, Cancer Hospital , Chinese Academy of Medical Sciences & Peking Union Medical College , No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021 , China
| | - Changgong Zhang
- a Department of Medical Oncology, Cancer Hospital , Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs , No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021 , China
| | - Puyuan Xing
- a Department of Medical Oncology, Cancer Hospital , Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs , No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021 , China
| | - Lin Wang
- a Department of Medical Oncology, Cancer Hospital , Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs , No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021 , China
| | - Mei Dong
- a Department of Medical Oncology, Cancer Hospital , Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs , No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021 , China
| | - Liqiang Zhou
- a Department of Medical Oncology, Cancer Hospital , Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs , No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021 , China
| | - Yan Sun
- a Department of Medical Oncology, Cancer Hospital , Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs , No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021 , China
| | - Xiaohui He
- a Department of Medical Oncology, Cancer Hospital , Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs , No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021 , China
| | - Yuankai Shi
- a Department of Medical Oncology, Cancer Hospital , Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs , No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021 , China
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Ansell S. How to select the frontline treatment for a patient with peripheral T-cell lymphoma. Leuk Lymphoma 2016; 57:783-8. [DOI: 10.3109/10428194.2016.1140760] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wang JJ, Dong M, He XH, Li YX, Wang WH, Liu P, Yang JL, Gui L, Zhang CG, Yang S, Zhou SY, Shi YK. GDP (Gemcitabine, Dexamethasone, and Cisplatin) Is Highly Effective and Well-Tolerated for Newly Diagnosed Stage IV and Relapsed/Refractory Extranodal Natural Killer/T-Cell Lymphoma, Nasal Type. Medicine (Baltimore) 2016; 95:e2787. [PMID: 26871836 PMCID: PMC4753932 DOI: 10.1097/md.0000000000002787] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
This study was conducted to evaluate the effectiveness and tolerance of GDP (gemcitabine, dexamethasone, and cisplatin) regimen in patients with newly diagnosed stage IV and relapsed/refractory extranodal natural killer/T-cell lymphoma, nasal type (ENKTL).The study enrolled 41 ENKTL patients who received GDP regimen at the Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between January 2008 and January 2015.The disease status was newly diagnosed stage IV in 15 patients and relapsed/refractory in 26 patients. The median number of cycles of chemotherapy per patient was 6 (range, 2-8 cycles). The overall response rate and complete-remission rate were 83.0% (34/41) and 41.5% (17/41), respectively. After a median follow-up of 16.2 months, 1-year progression-free survival rate and 1-year overall survival rate for the whole cohort were 54.5% and 72.7%. Grade 3 to 4 adverse events included neutropenia (34.1%), thrombocytopenia (19.5%), and anemia (14.6%).Our study has suggested high efficacy and low toxicity profile of GDP regimen in patients with newly diagnosed stage IV and relapsed/refractory ENKTL.
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Affiliation(s)
- Jing-Jing Wang
- From the Department of Medical Oncology (J-JW, MD, X-HH, PL, J-LY, LG, C-GZ, SY, S-YZ, Y-kS); and Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Chaoyang, Beijing, China (Y-XL, W-HW)
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46
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Advani RH, Ansell SM, Lechowicz MJ, Beaven AW, Loberiza F, Carson KR, Evens AM, Foss F, Horwitz S, Pro B, Pinter-Brown LC, Smith SM, Shustov AR, Savage KJ, Vose JM. A phase II study of cyclophosphamide, etoposide, vincristine and prednisone (CEOP) Alternating with Pralatrexate (P) as front line therapy for patients with peripheral T-cell lymphoma (PTCL): final results from the T- cell consortium trial. Br J Haematol 2015; 172:535-44. [PMID: 26627450 DOI: 10.1111/bjh.13855] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/06/2015] [Indexed: 12/18/2022]
Abstract
Peripheral T-cell lymphomas (PTCL) have suboptimal outcomes using conventional CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy. The anti-folate pralatrexate, the first drug approved for patients with relapsed/refractory PTCL, provided a rationale to incorporate it into the front-line setting. This phase 2 study evaluated a novel front-line combination whereby cyclophosphamide, etoposide, vincristine and prednisone (CEOP) alternated with pralatrexate (CEOP-P) in PTCL. Patients achieving a complete or partial remission (CR/PR) were eligible for consolidative stem cell transplantation (SCT) after 4 cycles. Thirty-three stage II-IV PTCL patients were treated: 21 PTCL-not otherwise specified (64%), 8 angioimmunoblastic T cell lymphoma (24%) and 4 anaplastic large cell lymphoma (12%). The majority (61%) had stage IV disease and 46% were International Prognostic Index high/intermediate or high risk. Grade 3-4 toxicities included anaemia (27%), thrombocytopenia (12%), febrile neutropenia (18%), mucositis (18%), sepsis (15%), increased creatinine (12%) and liver transaminases (12%). Seventeen patients (52%) achieved a CR. The 2-year progression-free survival and overall survival, were 39% (95% confidence interval 21-57) and 60% (95% confidence interval 39-76), respectively. Fifteen patients (45%) (12 CR) received SCT and all remained in CR at a median follow-up of 21·5 months. CEOP-P did not improve outcomes compared to historical data using CHOP. Defining optimal front line therapy in PTCL continues to be a challenge and an unmet need.
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Affiliation(s)
| | | | - Mary J Lechowicz
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Anne W Beaven
- Medicine-Oncology, Duke University Medical Center, Durham, NC, USA
| | - Fausto Loberiza
- Division of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kenneth R Carson
- Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrew M Evens
- Division of Hematology/Oncology, Tufts Medical Center, Boston, MA, USA
| | | | - Steven Horwitz
- Hematology/Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Barbara Pro
- Medical Oncology, Jefferson University Hospital, Philadelphia, PA, USA
| | | | - Sonali M Smith
- Center for Advanced Medicine, University of Chicago, Chicago, IL, USA
| | - Andrei R Shustov
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Kerry J Savage
- Centre for Lymphoid Cancer and Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Julie M Vose
- Division of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE, USA
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47
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d'Amore F, Gaulard P, Trümper L, Corradini P, Kim WS, Specht L, Bjerregaard Pedersen M, Ladetto M. Peripheral T-cell lymphomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015; 26 Suppl 5:v108-15. [PMID: 26314772 DOI: 10.1093/annonc/mdv201] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- F d'Amore
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - P Gaulard
- Department of Pathology, Hôpital Henri Mondor, Créteil, France
| | - L Trümper
- Department of Hematology and Oncology, Georg August University, Göttingen, Germany
| | - P Corradini
- Department of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milan, Milan, Italy
| | - W-S Kim
- Department of Medicine, Division of Hematology-Oncology, Samsung Medical Center, Seoul, Korea
| | - L Specht
- Department of Oncology and Hematology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - M Ladetto
- Divisione di Ematologia, Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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48
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Gallop-Evans E. The role of alisertib in treatment of peripheral T-cell lymphomas. Future Oncol 2015; 11:2515-24. [DOI: 10.2217/fon.15.154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Peripheral T-cell lymphomas are aggressive lymphomas with poor outcomes for which novel treatments are urgently needed. Alisertib (MLN8237) is a second-generation oral Aurora A kinase inhibitor. Treatment with alisertib results in an accumulation of cells with abnormal mitotic spindles, leading to decreased proliferation and apoptosis in a range of human tumor cell lines. Alisertib has shown single-agent antitumor activity in animal xenograft models and promising antitumor activity alone or in combination with other agents in patients with solid and hematologic cancers, and T-cell lymphomas in particular. It is currently being tested in randomized controlled Phase III trials in relapsed/refractory peripheral T-cell lymphoma.
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Affiliation(s)
- Eve Gallop-Evans
- Department of Clinical Oncology, Velindre Cancer Centre, Cardiff, CF14 2TL, Wales, UK
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49
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Park BB, Kim WS, Suh C, Shin DY, Kim JA, Kim HG, Lee WS. Salvage chemotherapy of gemcitabine, dexamethasone, and cisplatin (GDP) for patients with relapsed or refractory peripheral T-cell lymphomas: a consortium for improving survival of lymphoma (CISL) trial. Ann Hematol 2015; 94:1845-51. [PMID: 26251158 DOI: 10.1007/s00277-015-2468-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 07/20/2015] [Indexed: 11/24/2022]
Abstract
There is no standard salvage chemotherapy for relapsed or refractory peripheral T-cell lymphomas (PTCLs). Gemcitabine combined with cisplatin has been known as an effective regimen for lymphoma treatment in the salvage setting. We investigated the efficacy and toxicity of gemcitabine, dexamethasone, and cisplatin (GDP) for relapsed or refractory PTCLs in search of a more effective and less toxic therapy. Patients with relapsed or refractory PTCLs with more than one previous regimen were eligible. Treatment consisted of gemcitabine 1000 mg/m(2) intravenously (i.v.) on days 1 and 8, dexamethasone 40 mg orally on days 1-4, and cisplatin 70 mg/m(2) i.v. on day 1, and then every 21 days. Patients could proceed to autologous stem cell transplantation (ASCT) after four cycles of GDP or receive up to six treatment cycles. Twenty-five eligible patients were evaluated for toxicity and response. The diagnoses of participants included 14 cases of PTCL-not otherwise specified (NOS) (56 %) and four cases of angioimmunoblastic T-cell lymphoma (16 %) among others. The median age of the patients was 59 years (range 20-75 years). After treatments with GDP, which delivered a median of four GDP cycles, there were 12 patients with complete responses (CR; 48 %) and six with partial responses (PR; 24 %). The overall response rate (RR) was 72 %. Four patients preceded to ASCT, and three patients finally achieved CR. The median progression free survival was 9.3 months (95 % confidence interval (CI); 4.1-14.6) with a median follow-up duration of 27.1 months. In a total of 86 cycles of GDP, grade 3 or 4 neutropenia and thrombocytopenia occurred in 16.3 and 12.8 % of cycles, respectively. Three patients (3.3 %) experienced febrile neutropenia. GDP is a highly effective and optimal salvage regimen for relapsed or refractory PTCLs and can be administered with acceptable toxicity.
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Affiliation(s)
- Byeong-Bae Park
- Division of Hematology/Oncology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Won Seog Kim
- Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 50 Ilwon-dong, Kangnam-gu, Seoul, 135-710, Republic of Korea.
| | - Cheolwon Suh
- Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Dong-Yeop Shin
- Division of Hematology/Oncology, Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical sciences, Seoul, Korea
| | - Jeong-A Kim
- Division of Hematology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, Catholic University of Korea, Suwon, Korea
| | - Hoon-Gu Kim
- Division of Hematology-Oncology, Department of Internal Medicine, School of Medicine, Gyeongsang National University, Jinju, Korea
| | - Won Sik Lee
- Division of Hematology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
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50
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O'Connor OA, Bhagat G, Ganapathi K, Pedersen MB, D'Amore F, Radeski D, Bates SE. Changing the paradigms of treatment in peripheral T-cell lymphoma: from biology to clinical practice. Clin Cancer Res 2015; 20:5240-54. [PMID: 25320373 DOI: 10.1158/1078-0432.ccr-14-2020] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite enormous advances in our understanding of aggressive lymphomas, it is clear that progress in the peripheral T-cell lymphomas (PTCL) has lagged well behind other B-cell malignancies. Although there are many reasons for this, the one commonly cited notes that the paradigms for diffuse large B-cell lymphoma (DLBCL) were merely applied to all patients with PTCL, the classic "one-size-fits-all" approach. Despite these challenges, progress is being made. Recently, the FDA has approved four drugs for patients with relapsed/refractory PTCL over the past 5 years, and if one counts the recent Japanese approval of the anti-CCR4 monoclonal antibody for patients with adult T-cell leukemia/lymphoma, five drugs have been approved worldwide. These efforts have led to the initiation of no fewer than four randomized clinical studies exploring the integration of these new agents into standard CHOP (cyclophosphamide-Adriamycin-vincristine-prednisone)-based chemotherapy regimens for patients with newly diagnosed PTCL. In addition, a new wave of studies are exploring the merits of novel drug combinations in the disease, an effort to build on the obvious single-agent successes. What has emerged most recently is the recognition that the PTCL may be a disease-characterized by epigenetic dysregulation, which may help explain its sensitivity to histone deacetylase (HDAC) inhibitors, and open the door for even more creative combination approaches. Nonetheless, advances made over a relatively short period of time are changing how we now view these diseases and, hopefully, have poised us to finally improve its prognosis. See all articles in this CCR Focus section, "Paradigm Shifts in Lymphoma."
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Affiliation(s)
- Owen A O'Connor
- Center for Lymphoid Malignancies, Department of Medicine, Columbia University Medical Center, The New York Presbyterian Hospital, New York, New York.
| | - Govind Bhagat
- Division of Hematopathology, Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York
| | - Karthik Ganapathi
- Division of Hematopathology, Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York
| | | | - Francesco D'Amore
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Dejan Radeski
- Center for Lymphoid Malignancies, Department of Medicine, Columbia University Medical Center, The New York Presbyterian Hospital, New York, New York
| | - Susan E Bates
- Developmental Therapeutics Branch, National Cancer Institute, Bethesda, Maryland
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