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Chen J, Zhao Y. Pre-treatment [ 18F]FDG PET/CT for assessing bone marrow involvement and prognosis in patients with newly diagnosed peripheral T-cell lymphoma. Hematology 2024; 29:2325317. [PMID: 38465661 DOI: 10.1080/16078454.2024.2325317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 02/26/2024] [Indexed: 03/12/2024] Open
Abstract
PURPOSE To explore the value of [18F]fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) in assessing bone marrow involvement (BMI) and prognosis in newly diagnosed peripheral T-cell lymphomas (PTCLs) before treatment. METHODS This retrospective study included 201 eligible PTCLs who received pre-bone marrow biopsy (BMB) and PET/CT. The status of bone marrow (BM) by PET was assessed using a visual examination and a quantitative index (the maximal standardized uptake value [SUVmax] of BM divided by the SUVmax of the liver [M/L]). RESULTS Totally 148 patients had no evidence of BMI by PET or BMB; BMI was detected by both methods in 16 patients. The sensitivity and specificity of PET/CT for patients with confirmed BMI by BMB were 43.2% and 90.2%, respectively (κ = 0.353). In addition, 25 patients assessed by PET/CT staging (having stage I to II disease) had no evidence of BMI detected by both PET/CT and BMB. Image-guided biopsy was also recommended when PET/CT showed a focal FDG uptake outside the iliac crest. Survival analysis revealed that BMB was significant for overall survival (OS) (P = 0.020) while M/L for both progression free survival (P = 0.002) and OS (P < 0.001). In multivariate analysis, M/L (HR 1.825, 95% CI 1.071-3.110, P = 0.027) was an independent prognostic factor for OS. There were no statistical differences at the genetic level about BMI confirmed by PET or BMB. CONCLUSION PET/CT has a complementary role in assessing BMI and an ability to predict prognosis in PTCL patients.
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Affiliation(s)
- Jing Chen
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Yi Zhao
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
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2
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Meeuwes FO, Brink M, Plattel W, Van der Poel MWM, Kersten MJ, Wondergem M, Böhmer L, Woei-A-Jin FJSH, Visser O, Oostvogels R, Jansen PM, Neelis KJ, Crijns APG, Daniëls LA, Snijders TJF, Vermaat JSP, Huls GA, Nijland M. Outcome of combined modality treatment in first-line for stage I(E) peripheral T-cell lymphoma; a nationwide population-based cohort study from the Netherlands. Haematologica 2024; 109:1163-1170. [PMID: 37794805 PMCID: PMC10985449 DOI: 10.3324/haematol.2023.283174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Indexed: 10/06/2023] Open
Abstract
Peripheral T-cell lymphomas (PTCL) comprise a heterogeneous group of mature T-cell neoplasms with an unfavorable prognosis; presentation with stage I(E) disease is uncommon. In clinical practice, an abbreviated chemotherapy treatment regimen combined with radiotherapy (combined modality treatment [CMT]) is commonly used, although evidence from clinical trials is lacking. The aim of this nationwide population-based cohort study is to describe first-line treatment and outcome of patients with stage I(E) PTCL. All newly diagnosed patients ≥18 years with stage I(E) anaplastic large cell lymphoma (ALCL), angioimmunoblastic T-cell lymphoma (AITL) and peripheral T-cell lymphoma NOS (PTCL not otherise specified [NOS]) in 1989-2020 were identified in the Netherlands Cancer Registry. Patients were categorized according to treatment regimen, i.e., chemotherapy (CT), radiotherapy (RT), CMT, other therapy and no treatment. The primary endpoint was overall survival (OS). Patients with stage I(E) ALCL, AITL and PTCL NOS (n=576) were most commonly treated with CMT (28%) or CT (29%), 2% underwent SCT. RT only was given in 18%, and 8% received other therapy and 16% no treatment. Overall, the 5-year OS was 59%. According to subtype, 5-year OS was superior for ALCL as compared to PTCL NOS and AITL (68% vs. 55% and 52%, respectively; P=0.03). For patients treated with CMT, 5-year OS was significantly higher (72%) as compared to patients treated with either CT or RT alone (55% and 55%, respectively; P<0.01). In multivariable analysis, age per year increment (hazard ratio [HR] =1.06, 95% confidence interval [CI]: 1.05-1.07), male sex (HR=1.53, 95% CI: 1.23-1.90), and CT, or no treatment (HR=1.64, 95% CI: 1.21-2.21, and HR=1.55, 95% CI: 1.10-2.17, respectively) were associated with a higher risk of mortality. For stage I(E) ALCL, AITL and PTCL NOS, 5-year OS is 59%, comparing favorably to historical outcome in advanced-stage disease. Superior outcome estimates were observed in patients treated with CMT.
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Affiliation(s)
- Frederik O Meeuwes
- Department of Hematology, Treant Hospital, Emmen, The Netherlands; Department of Hematology, University Medical Center Groningen, Groningen
| | - Mirian Brink
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht
| | - Wouter Plattel
- Department of Hematology, University Medical Center Groningen, Groningen
| | - Marjolein W M Van der Poel
- Department of Hematology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht
| | - Marie José Kersten
- Department of Hematology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam
| | - Mariëlle Wondergem
- Department of Hematology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam
| | - Lara Böhmer
- Department of Hematology, Haga Hospital, The Hague
| | | | - Otto Visser
- Department of Hematology, Isala Hospital, Zwolle
| | - Rimke Oostvogels
- Department of Hematology, University Medical Center Utrecht, Utrecht
| | - Patty M Jansen
- Department of Pathology, Leiden University Medical Center, Leiden
| | - Karen J Neelis
- Department of Radiotherapy, Leiden University Medical Center, Leiden
| | - Anne P G Crijns
- Department of Radiotherapy, University Medical Center Groningen, Groningen
| | - Laurien A Daniëls
- Department of Radiotherapy, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam
| | | | | | - Gerwin A Huls
- Department of Hematology, University Medical Center Groningen, Groningen
| | - Marcel Nijland
- Department of Hematology, University Medical Center Groningen, Groningen.
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Ong SY, Zain JM. Aggressive T-cell lymphomas: 2024: Updates on diagnosis, risk stratification, and management. Am J Hematol 2024; 99:439-456. [PMID: 38304959 DOI: 10.1002/ajh.27165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/18/2023] [Accepted: 11/05/2023] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Aggressive T-cell lymphomas continue to have a poor prognosis. There are over 30 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 and other molecular techniques have enabled deeper understanding of differences in various subtypes as reflected in the latest 5th WHO classification of PTCL. It is becoming increasingly clear that therapeutic approaches that target specific cellular pathways are needed to improve the clinical outcomes of PTCL. 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. This includes the CD30 directed antibody drug conjugate brentuximab vedotin. Other notable targets are phosphatidylinositol 3-kinase inhibitors, histone deacetylase inhibitors, CD25, and chemokine receptor 4. Anaplastic lymphoma kinase (ALK) inhibitors are promising for ALK expressing tumors. IMMUNOTHERAPIES Allogeneic stem cell transplant continues to be the curative therapy for most aggressive subtypes of PTCL. The use of checkpoint inhibitors in the treatment of PTCL is still controversial, with best results seen in cases of extranodal natural killer cell/T-cell lymphoma. Bispecific antibody-based treatments and chimeric antigen receptor cell-based therapies are in clinical trials.
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Affiliation(s)
- Shin Yeu Ong
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, California, USA
- Department of Haematology, Singapore General Hospital, Singapore, Singapore
| | - Jasmine M Zain
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, California, USA
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Cao Z, Wang X, Xue X, Feng X. Clinical significance and predictive risk factors for event-free survival at 24 months in patients with PTCL, NOS. Ann Hematol 2024; 103:869-883. [PMID: 38040859 DOI: 10.1007/s00277-023-05559-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/18/2023] [Indexed: 12/03/2023]
Abstract
Peripheral T cell lymphoma, not otherwise specified (PTCL, NOS), is a heterogeneous and aggressive type of non-Hodgkin's lymphoma with a bleak prognosis. This study was designed to assess the value of EFS24 as an alternative clinical endpoint and identify prognosis-related factors in PTCL, NOS. Patients diagnosed with PTCL, NOS were retrospectively collected and slides were reviewed by two hematopathologists. EFS was defined as the time from diagnosis to the occurrence of disease progression after initial treatment, retreatment, or death. Subsequent overall survival (OS) was defined from EFS24 or time of progression, if it occurred within 24 months, to the last follow-up or death. 97 cases with complete follow-up were selected. Approximately 66 patients (68.04%) failed to achieve ES24, with the median OS of 12.17 months, and 5-year OS rate of 15.17%. While patients who reached EFS24 had a median OS of 60.57 months and a 5-year OS rate of 68.77%. Multivariate Cox analysis indicated that bone marrow involvement and elevated β2 Microglobulin (β2-MG) were associated with a poor prognosis. B symptoms, extranodal involvement more than one site, and a high Ki67 index were significant factors in predicting the failure of EFS24. EFS24 can help stratify the subsequent outcomes of PTCL, NOS. Patients who achieve EFS24 have a favorable prognosis, although it does not reach that of the general population. On the other hand, patients who do not achieve EFS24 have an extremely poor prognosis. Therefore, EFS24 can be used for patient risk stratification, patient counseling, and study design.
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Affiliation(s)
- Zheng Cao
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaojun Wang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuemin Xue
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoli Feng
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Cordoba R, Sánchez-García J, Domingo-Domenech E, López Jiménez J, Martínez Pozo A, Carpio C, Bendaña Á, González AJ, González de Villambrosia S, Gómez Codina J, Navarro B, Rodríguez G, Naves A, Baeza L, Martín García-Sancho A. 18F-FDG-PET/CT response after first-line treatment as a prognostic factor for survival in peripheral T-cell lymphoma: a Spanish retrospective study. Expert Rev Hematol 2024; 17:95-100. [PMID: 38299464 DOI: 10.1080/17474086.2024.2313457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 01/25/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND An accurate assessment of tumor viability after first-line treatment is critical for predicting treatment failure in peripheral T-cell lymphomas (PTCLs). 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) has been adopted as the preferred assessment method in clinical trials, but its impact in clinical practice should be examined. This study aims to determine the prognostic significance of18F-FDG-PET/CT for survival following first-line treatment in PTCL patients. RESEARCH DESIGN AND METHODS Retrospective observational study including 175 patients diagnosed with PTCL between 2008 and 2013 in 13 Spanish sites. RESULTS Fifty patients were evaluated with18F-FDG-PET/CT following first-line therapy: 58% were18F-FDG-PET/CT-negative and 42% were18F-FDG-PET/CT-positive. Disease progression occurred in 37.9% of18F-FDG-PET/CT-negative patients and in 80.9% of18F-FDG-PET/CT-positive patients (p = 0.0037). Median progression-free survival and overall survival were 67 and 74 months for18F-FDG-PET/CT-negative patients, and 5 (p < 0.0001) and 10 months (p < 0.0001), respectively, in18F-FDG-PET/CT-positive patients. After multivariate analysis, only B symptoms emerged as a negative predictive factor of complete response (RR 7.08; 95% CI 1.60-31.31; p = 0.001). CONCLUSIONS 18F-FDG-PET/CT identifies high-risk PTCL patients who will have poor prognosis and survival following first-line treatment. However, more research is needed to confirm the best treatment options for PTCL patients.
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Affiliation(s)
- Raul Cordoba
- Lymphoma Unit, Department of Haematology, Health Research Institute IIS-FJD, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Joaquín Sánchez-García
- Hematology Department Department, IMIBIC Hospital Universitario Reina Sofía, UCO, Cordoba, Andalucía, Spain
| | - Eva Domingo-Domenech
- Hematology Department, Institut Català D'oncologia, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Antonio Martínez Pozo
- Pathology Department, Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), CIBERONC, Universitat de Barcelona, Barcelona, Spain
| | - Cecilia Carpio
- Department of Haematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital (HUVH), Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ángeles Bendaña
- Hematology Department, Complexo Hospitalario Universitario de Santiago de Compostela, La Coruña, Spain
| | - Ana Julia González
- Hematology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - José Gómez Codina
- Medical Oncology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Belén Navarro
- Hematology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Guillermo Rodríguez
- Hematology Department, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/Universidad de Sevilla, Seville, Spain
| | - Andrea Naves
- Medical Department, Takeda Farmacéutica España S.A, Madrid, Spain
| | - Lourdes Baeza
- Medical Department, Takeda Farmacéutica España S.A, Madrid, Spain
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Zhang Q, Yin L, Lai Q, Zhao Y, Peng H. Advances in the pathogenesis and therapeutic strategies of angioimmunoblastic T-cell lymphoma. Clin Exp Med 2023; 23:4219-4235. [PMID: 37759042 DOI: 10.1007/s10238-023-01197-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) is an aggressive subtype of peripheral T-cell lymphomas with its cell origin determined to be follicular helper T-cells. AITL is characterized by a prominent tumor microenvironment involving dysregulation of immune cells, signaling pathways, and extracellular matrix. Significant progress has been made in the molecular pathophysiology of AITL, including genetic mutations, immune metabolism, hematopoietic-derived microenvironment, and non-hematopoietic microenvironment cells. Early diagnosis, detection of severe complications, and timely effective treatment are crucial for managing AITL. Treatment typically involves various combination chemotherapies, but the prognosis is often poor, and relapsed and refractory AITL remains challenging, necessitating improved treatment strategies. Therefore, this article provides an overview of the pathogenesis and latest advances in the treatment of AITL, with a focus on potential therapeutic targets, novel treatment strategies, and emerging immunotherapeutic approaches.
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Affiliation(s)
- Qingyang Zhang
- Department of Hematology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Le Yin
- Department of Hematology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Qinqiao Lai
- Department of Hematology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Yan Zhao
- Department of Hematology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Hongling Peng
- Department of Hematology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, Changsha, 410011, Hunan, China.
- Hunan Engineering Research Center of Cell Immunotherapy for Hematopoietic Malignancies, Changsha, 410011, Hunan, China.
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7
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Cao LQ, Huang XJ, Mo XD. [Current status and prospects of hematopoietic stem cell transplantation in peripheral T-cell lymphoma]. Zhonghua Nei Ke Za Zhi 2023; 62:1489-1493. [PMID: 38044079 DOI: 10.3760/cma.j.cn112138-20230417-00200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Affiliation(s)
- L Q Cao
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
| | - X J Huang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
| | - X D Mo
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China
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Jeon Y, Kim TY, Min GJ, Park SS, Park S, Yoon JH, Lee SE, Cho BS, Eom KS, Kim YJ, Kim HJ, Lee S, Min CK, Lee JW, Cho SG. Efficacy of ex vivo purging with CD34+ selection to maximize the effects of autologous stem cell transplantation in peripheral T-cell lymphoma patients. Cytotherapy 2023; 25:1307-1316. [PMID: 37542512 DOI: 10.1016/j.jcyt.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/07/2023] [Accepted: 07/14/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND AIMS Peripheral T-cell lymphomas (PTCLs) are rare and aggressive tumors with uncertain optimal treatment. This study investigated the clinical outcomes of high-dose chemotherapy (HDT) followed by autologous stem cell transplantation (ASCT) after CD34+ selective purging in PTCL patients. METHODS Retrospective analysis included 67 PTCL patients who achieved remission and underwent HDT/ASCT. CD34+ selective purging was performed using CliniMACS® (Miltenyi Biotec, Bergisch Gladbach, Germany). Survival outcomes, engraftment, lymphocyte subsets and viral infections were evaluated. RESULTS CD34+ selective purged autografts were associated with significantly improved overall survival (OS) and disease-free survival (DFS) compared with unpurged autografts (5-year OS, 73.3% versus 37.8%, 5-year DFS, 73.8% versus 33.4%). The cumulative incidence of relapse was also lower in the purged group (31.5% versus 73.3%). Subgroup analysis revealed significant survival benefits in the high-risk group receiving purged autografts. Lymphocyte subset analysis showed increased natural killer (NK) cell counts in the purged group after ASCT. Higher post-ASCT lymphocyte-to-monocyte ratio (LMR) was associated with improved OS and DFS. CONCLUSIONS CD34+ selective purging in PTCL patients undergoing HDT/ASCT improved survival outcomes and reduced relapse risk. The procedure increased NK cell counts and post-ASCT LMR. CD34+ selective purging may minimize autograft tumor cell contamination and enhance efficacy in T-cell lymphomas.
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Affiliation(s)
- Youngwoo Jeon
- Lymphoma and Cell Therapy-Research Center, Yeouido St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea; Catholic University Lymphoma Group, Seoul St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Tong-Yoon Kim
- Lymphoma and Cell Therapy-Research Center, Yeouido St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea; Catholic University Lymphoma Group, Seoul St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea; Catholic Hematology Hospital, Seoul St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Gi June Min
- Catholic University Lymphoma Group, Seoul St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea; Catholic Hematology Hospital, Seoul St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Soo Park
- Catholic Hematology Hospital, Seoul St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Silvia Park
- Catholic Hematology Hospital, Seoul St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Jae-Ho Yoon
- Catholic Hematology Hospital, Seoul St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Eun Lee
- Catholic Hematology Hospital, Seoul St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Byung-Sik Cho
- Catholic Hematology Hospital, Seoul St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Ki-Seong Eom
- Catholic Hematology Hospital, Seoul St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Yoo-Jin Kim
- Catholic Hematology Hospital, Seoul St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Hee-Je Kim
- Catholic Hematology Hospital, Seoul St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Seok Lee
- Catholic Hematology Hospital, Seoul St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Chang-Ki Min
- Catholic Hematology Hospital, Seoul St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Jong-Wook Lee
- Catholic Hematology Hospital, Seoul St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Seok-Goo Cho
- Lymphoma and Cell Therapy-Research Center, Yeouido St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea; Catholic University Lymphoma Group, Seoul St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea; Catholic Hematology Hospital, Seoul St Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea.
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Savage KJ, De Leval L. Introduction to the peripheral T-cell lymphoma review series: advances in molecular characterization, classification refinement and treatment optimization. Haematologica 2023; 108:3204-3210. [PMID: 38037798 PMCID: PMC10690918 DOI: 10.3324/haematol.2023.282719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 08/29/2023] [Indexed: 12/02/2023] Open
Affiliation(s)
- Kerry J Savage
- Center for Lymphoid Cancer, Division of Medical Oncology, BC Cancer and the University of British Columbia, British Columbia.
| | - Laurence De Leval
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and Lausanne University, Lausanne
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10
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Stuver R, Epstein-Peterson ZD, Horwitz SM. Few and far between: clinical management of rare extranodal subtypes of mature T-cell and NK-cell lymphomas. Haematologica 2023; 108:3244-3260. [PMID: 38037801 PMCID: PMC10690914 DOI: 10.3324/haematol.2023.282717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 07/03/2023] [Indexed: 12/02/2023] Open
Abstract
While all peripheral T-cell lymphomas are uncommon, certain subtypes are truly rare, with less than a few hundred cases per year in the USA. There are often no dedicated clinical trials in these rare subtypes, and data are generally limited to case reports and retrospective case series. Therefore, clinical management is often based on this limited literature and extrapolation of data from the more common, nodal T-cell lymphomas in conjunction with personal experience. Nevertheless, thanks to tremendous pre-clinical efforts to understand these rare diseases, an increasing appreciation of the biological changes that underlie these entities is forming. In this review, we attempt to summarize the relevant literature regarding the initial management of certain rare subtypes, specifically subcutaneous panniculitis-like T-cell lymphoma, hepatosplenic T-cell lymphoma, intestinal T-cell lymphomas, and extranodal NK/T-cell lymphoma. While unequivocally established approaches in these diseases do not exist, we make cautious efforts to provide our approaches to clinical management when possible.
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Affiliation(s)
- Robert Stuver
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center.
| | - Zachary D Epstein-Peterson
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center; Department of Medicine, Weill Cornell Medical College
| | - Steven M Horwitz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center; Department of Medicine, Weill Cornell Medical College; Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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Galligan D, Williamson S, Myers J, Chen AI, Hayes-Lattin B, Okada C, Spurgeon S, Maziarz R, Schachter L. Long-term Outcomes After Hematopoietic Cell Transplant in Peripheral T-Cell Lymphoma - The Oregon Health and Science University Experience. Clin Lymphoma Myeloma Leuk 2023; 23:874-881. [PMID: 37741763 DOI: 10.1016/j.clml.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/04/2023] [Accepted: 08/11/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Peripheral T-cell lymphomas (PTCL) are a group of aggressive malignancies with inferior outcomes compared to B-cell non-Hodgkin lymphoma (NHL). Both allogeneic and autologous hematopoietic cell transplantation (HCT) are commonly employed for consolidation and salvage. MATERIALS AND METHODS We conducted a single-center review of all adult PTCL patients at OHSU who received HCT from 1991 to 2020 with responses assed by CIBMTR criteria. RESULTS 88 patients (autoHCT = 52, alloHCT = 36) were identified from the internal registry of ∼3800 autoHCT & alloHCT recipients in that time period. Median OS after autoHCT and alloHCT were 7.0 and 2.6 years. Median PFS after autoHCT and alloHCT was 3.9 vs 1.1 years. Post-HCT median OS for ALCL, AITL, and PTCL NOS were 14.9, 3.9, and 3.4 years, respectively. Median PFS after autoHCT performed while in CR vs. not in CR was 3.4 vs 4.2 years (P = 0.86); for alloHCT in CR vs. not CR 2.4 vs 0.7 years (P = 0.28). 1-year non-relapse mortality (NRM) for autoHCT and alloHCT were 6.1% and 22.2% (P = 0.2). 10/88 patients developed secondary malignancies including 4 skin cancers, 3 new lymphomas, and 2 MDS. CONCLUSION Our experience with HCT for PTCL shows that HCT has acceptable toxicities and relatively long disease remissions. AutoHCT was most frequently utilized as planned remission consolidation while alloHCT was most often used late during salvage. Differences in response between autoHCT and alloHCT likely reflect differences in clinical setting and underlying disease natural history and biology.
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Affiliation(s)
| | | | - Jessie Myers
- Oregon Health and Science University, Portland, OR
| | - Andy I Chen
- Oregon Health and Science University, Portland, OR
| | | | - Craig Okada
- Oregon Health and Science University, Portland, OR
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12
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Delehaye F, Deparis M, Buchbinder N, Bodet D, Minard V, Jean-Jacques B, Marie-Laure Q, Gaulard P, Sako N, Robe C, Bardet H, Damaj G, Rouger J. Successful allogeneic hematopoietic stem cell transplantation in a child with angioimmunoblastic T-cell lymphoma: A case report. Pediatr Blood Cancer 2023; 70:e30497. [PMID: 37335263 DOI: 10.1002/pbc.30497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023]
Affiliation(s)
- Fanny Delehaye
- Department of Pediatric Oncology and Hematology, University Hospital of Caen, Normandy, Caen, France
- University of Caen, Normandy, Caen, France
| | - Marianna Deparis
- Department of Pediatric Oncology and Hematology, University Hospital of Caen, Normandy, Caen, France
| | - Nimrod Buchbinder
- Department of Pediatric Oncology and Hematology, University Hospital of Rouen, Normandy, Rouen, France
| | - Damien Bodet
- Department of Pediatric Oncology and Hematology, University Hospital of Caen, Normandy, Caen, France
| | - Véronique Minard
- Department of Pediatric Oncology, Gustave Roussy Institute, VilleJuif, France
| | | | | | - Philippe Gaulard
- Department of Pathology, Hôpital Henri Mondor APHP, Créteil, France
| | - Nouhoum Sako
- Department of Pathology, Hôpital Henri Mondor APHP, Créteil, France
| | - Cyrielle Robe
- Department of Pathology, Hôpital Henri Mondor APHP, Créteil, France
| | - Hippolyte Bardet
- Department of Hematology, University Hospital of Caen, Caen, France
| | - Gandhi Damaj
- Department of Hematology, University Hospital of Caen, Caen, France
| | - Jérémie Rouger
- Department of Pediatric Oncology and Hematology, University Hospital of Caen, Normandy, Caen, France
- University of Caen, Normandy, Caen, France
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13
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Chen H, Tao Y, Zhou Y, Liu P, Yang J, He X, Zhou S, Qin Y, Song Y, Gui L, Zhang C, Yang S, Shi Y. The clinical features, treatment, and prognostic factors for peripheral T-cell lymphomas: A single-institution analysis of 240 Chinese patients. Asia Pac J Clin Oncol 2023; 19:e202-e214. [PMID: 35821612 DOI: 10.1111/ajco.13831] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 06/22/2022] [Accepted: 06/27/2022] [Indexed: 12/22/2022]
Abstract
AIM This study aimed to analyze the clinical features, treatment, survival, and prognostic factors of Chinese patients with peripheral T-cell lymphoma (PTCL) excluding natural killer/T-cell lymphoma (NKTCL). METHODS Data on patients with newly diagnosed PTCLs between January 1, 2006 and December 31, 2017 at our hospital were retrospectively reviewed. Patients with NKTCL were excluded. RESULTS A total of 240 patients were included. PTCL, not otherwise specified (PTCL-NOS), was the most frequent subtype (42.5%), followed by angioimmunoblastic T-cell lymphoma (AITL) (21.3%), anaplastic lymphoma kinase (ALK)-negative anaplastic large-cell lymphoma (ALK-ALCL) (16.7%), ALK-positive ALCL (ALK+ALCL) (10.8%) and others (8.8%). With a median follow-up of 81.1 months, the 5-year progression-free survival (PFS) and overall survival (OS) rates for all patients were 30.4% (95% CI 25.0%-37.0%) and 48.8% (95% CI 42.6%-55.7%), respectively. On multivariate analysis, no consolidative autologous stem cell transplantation (ASCT) and not achieving complete response after first-line chemotherapy retained independently prognostic value for inferior PFS and OS. Besides, bone marrow involvement and serum albumin level were independent factors for PFS, and Eastern Cooperative Oncology Group performance status ≥2 was significantly predictive of inferior OS. Compared with PTCL-NOS, significantly superior PFS and OS were observed for ALK+ALCL and ALK-ALCL. CONCLUSION The survival outcomes with current treatment for most PTCL subtypes are still unsatisfactory. Prospective randomized studies are needed to establish the value of consolidative ASCT in PTCL, and novel therapeutic approaches should be explored.
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Affiliation(s)
- Haizhu Chen
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Yunxia Tao
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Yu Zhou
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Peng Liu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Jianliang Yang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Xiaohui He
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Shengyu Zhou
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Yan Qin
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Yongwen Song
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Gui
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Changgong Zhang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Sheng Yang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Yuankai Shi
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
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14
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Hapgood G, Civallero M, Stepanishyna Y, Vose J, Cabrera ME, Advani RH, Pileri SA, Manni M, Horwitz SM, Foss FM, Hitz F, Radford J, Dlouhy I, Chiattone C, Kim WS, Skrypets T, Nagler A, Trotman J, Luminari S, Federico M. The SALENTO prognostic model for limited-stage peripheral T-cell lymphoma from the International T-Cell Project Network. Blood Adv 2023; 7:5047-5054. [PMID: 37163360 PMCID: PMC10471929 DOI: 10.1182/bloodadvances.2023010037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/12/2023] Open
Abstract
The natural history of limited-stage peripheral T-cell lymphomas (PTCLs) remains poorly defined. We investigated outcomes and prognostic variables in patients registered in the T-Cell Project (TCP) (#NCT01142674) to develop a model to predict overall survival (OS) for the common nodal PTCL subtypes (PTCL-NOS, AITL, ALCL). The model was validated in an independent data set from Australian and Brazilian registries. 211 patients registered in the TCP between 2006-2018 were studied. The median age was 59 years (range 18-88) and median follow-up was 49 months. One hundred twenty-seven patients (78%) received anthracycline-based regimens, 5 patients (3%) radiotherapy alone (RT), 24 patients (15%) chemotherapy+RT. 5-year OS and PFS were 47% and 37%, respectively. Age >60 years, elevated LDH and low serum albumin were independent prognostic factors. The model identified 3 groups with low- (26%, score 0), intermediate- (41%, score 1), and high-risk (33%, score 2-3) with 5-year OS of 78% (95% confidence interval [95% CI], 29-127), 46% (95% CI, 24-68), and 25% (95% CI, 20-30), respectively (P < 0.001) and 5-year PFS of 66% (95% CI, 33-99), 37% (95% CI, 9-65), and 17% (95% CI, 9-25), respectively (P < 0.001). The model demonstrated greater discriminatory power than established prognostic indices and an analogous distribution and outcomes in the 3 groups in the validation cohort of 103 patients. The SALENTO Model (Limited Stage Peripheral T-Cell Lymphoma Prognostic Model) is an objective, simple and robust prognostic tool. The high-risk group has poor outcomes, comparable to advanced stage disease, and should be considered for innovative first-line approaches.
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Affiliation(s)
- Greg Hapgood
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Monica Civallero
- CHIMOMO Department, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Julie Vose
- University of Nebraska Medical Center, Omaha, NE
| | - Monica Elena Cabrera
- Hematology Section, Hospital del Salvador, University of Chile, Santiago de Chile, Chile
| | - Ranjana H. Advani
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA
| | - Stefano A. Pileri
- Division of Diagnostic Haematopathology, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Martina Manni
- CHIMOMO Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Steven M. Horwitz
- Department Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Felicitas Hitz
- The Swiss Group for Clinical Cancer Research, Department of Oncology/Haematology, Cantonal Hospital, St. Gallen, Switzerland
| | - John Radford
- Medical Oncology, University of Manchester, Manchester, England
| | - Ivan Dlouhy
- Clinic Barcelona, Hospital Universitari, Barcelona, Spain
| | - Carlos Chiattone
- Santa Casa Medical School of Sao Paulo and Samaritan Hospital, Sao Paulo, Brazil
| | - Won Seog Kim
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
| | - Tetiana Skrypets
- Hematology, IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
| | - Arnon Nagler
- Hematology Division BMT and Cord Blood Bank Chaim Sheba Medical Center Tel-Hashomer, Ramat-Gan, Israel
| | - Judith Trotman
- Department of Haematology, Concord Hospital, University of Sydney, Sydney, Australia
| | - Stefano Luminari
- CHIMOMO Department, University of Modena and Reggio Emilia, Modena, Italy
- Hematology, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Federico
- CHIMOMO Department, University of Modena and Reggio Emilia, Modena, Italy
| | - International T-Cell Project
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- CHIMOMO Department, University of Modena and Reggio Emilia, Modena, Italy
- Kiev National Cancer Institute, Kiev, Ukraine
- University of Nebraska Medical Center, Omaha, NE
- Hematology Section, Hospital del Salvador, University of Chile, Santiago de Chile, Chile
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA
- Division of Diagnostic Haematopathology, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Yale University School of Medicine, New Haven, CT
- The Swiss Group for Clinical Cancer Research, Department of Oncology/Haematology, Cantonal Hospital, St. Gallen, Switzerland
- Medical Oncology, University of Manchester, Manchester, England
- Clinic Barcelona, Hospital Universitari, Barcelona, Spain
- Santa Casa Medical School of Sao Paulo and Samaritan Hospital, Sao Paulo, Brazil
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
- Hematology, IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
- Hematology Division BMT and Cord Blood Bank Chaim Sheba Medical Center Tel-Hashomer, Ramat-Gan, Israel
- Department of Haematology, Concord Hospital, University of Sydney, Sydney, Australia
- Hematology, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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15
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Bhansali RS, Barta SK. SOHO State of the Art Updates and Next Questions | Challenging Cases in Rare T-Cell Lymphomas. Clin Lymphoma Myeloma Leuk 2023; 23:642-650. [PMID: 37302955 PMCID: PMC10524462 DOI: 10.1016/j.clml.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 05/19/2023] [Indexed: 06/13/2023]
Abstract
Mature T- and NK-cell neoplasms (MTNKN) collectively represent a rare disorder, representing less than 15% of all non-Hodgkin lymphoma (NHL) cases and qualifying for orphan disease designation by the U.S. Food and Drug Administration (FDA). These consist of 9 families in the fifth revised WHO classification of lymphoid neoplasms, which are made up of over 30 disease subtypes, underscoring the heterogeneity of clinical features, molecular biology, and genetics across this disease group. Moreover, the 5 most common subtypes (peripheral T-cell lymphoma, not otherwise specified; nodal TFH cell lymphoma, angioimmunoblastic type; extranodal NK-cell/T-cell lymphoma; adult T-cell leukemia/lymphoma; and ALK-positive or -negative anaplastic large cell lymphoma) comprise over 75% of MTNKN cases, so other subtypes are exceedingly rare in the context of all NHL diagnoses and consequently often lack consensus on best practices in diagnosis and management. In this review, we discuss the following entities-enteropathy-associated T-cell lymphoma (EATL), monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL), hepatosplenic T-cell lymphoma (HSTCL), subcutaneous panniculitis-like T-cell lymphoma (SPTCL), and primary cutaneous ɣδ T-cell lymphoma (PCGD-TCL) - with an emphasis on clinical and diagnostic features and options for management.
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Affiliation(s)
- Rahul S Bhansali
- Department of Medicine, Division of Hematology and Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Stefan K Barta
- Department of Medicine, Division of Hematology and Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA.
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16
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Macapagal SC, Bennani NN. Nodal peripheral T-cell lymphoma: Chemotherapy-free management, are we there yet? Blood Rev 2023; 60:101071. [PMID: 36898933 DOI: 10.1016/j.blre.2023.101071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023]
Abstract
Peripheral T-cell lymphomas (PTCLs) are a diverse and uncommon type of lymphoid malignancies with a dismal prognosis. Recent advances in genomic studies have shown recurring mutations that are changing our knowledge of the disease's molecular genetics and pathogenesis. As such, new targeted therapies and treatments to improve disease outcomes are currently being explored. In this review, we discussed the current understanding of the nodal PTCL biology with potential therapeutic implications and gave our insights on the promising novel therapies that are currently under study such as immunotherapy, chimeric antigen receptor T-cell therapy, and oncolytic virotherapy.
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Affiliation(s)
| | - N Nora Bennani
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
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17
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Castro D, Valcarcel B, Runciman T, Huerta-Collado Y, Paredes S, Beltran BE, Castillo JJ, Malpica L. The prognostic role of red cell distribution width on all-cause and cause-specific outcomes in peripheral T-cell lymphoma: a retrospective cohort study. Leuk Lymphoma 2023; 64:1225-1233. [PMID: 37132428 DOI: 10.1080/10428194.2023.2205975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/10/2023] [Accepted: 04/13/2023] [Indexed: 05/04/2023]
Abstract
Readily accessible biomarkers for risk stratification in settings with limited resources are lacking. We evaluated the effect of high red distribution width-coefficient of variation (RDW-CV) values (>14%) on all-cause and lymphoma-specific mortality outcomes among 118 patients with peripheral T-cell lymphoma (PTCL) who received systemic treatment at two tertiary centers between 2010 and 2019. With a median follow-up of 45 months, patients with a high RDW-CV had a lower 4-year overall survival rate (34% vs. 45%, p = 0.015) and higher cumulative incidence of lymphoma mortality (54% vs. 34%, p = 0.007). RDW-CV >14% was associated with all-cause (adjusted Hazard Ratio [aHR] 1.98, 95% confidence interval [CI] 1.10-3.56) and lymphoma-specific mortality (aHR 2.64, 95% CI 1.32-5.29). In our study, RDW-CV emerges as an easily accessible and complementary prognostic biomarker for risk stratification among treated patients with de novo PTCL. Further research should validate the predictive role of RDW-CV in prospective cohorts.
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Affiliation(s)
- Denisse Castro
- Departamento de Oncología y Radioterapia, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
- Centro de Investigación de Medicina de Precisión, Universidad de San Martin de Porres, Lima, Peru
| | - Bryan Valcarcel
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Thanya Runciman
- Departamento de Oncología y Radioterapia, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru
| | - Yesenia Huerta-Collado
- Departamento de Oncología y Radioterapia, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Sally Paredes
- Departamento de Oncología y Radioterapia, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
- Centro de Investigación de Medicina de Precisión, Universidad de San Martin de Porres, Lima, Peru
| | - Brady E Beltran
- Departamento de Oncología y Radioterapia, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
- Centro de Investigación de Medicina de Precisión, Universidad de San Martin de Porres, Lima, Peru
| | - Jorge J Castillo
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Luis Malpica
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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18
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Abstract
PURPOSE OF REVIEW Here, we review the management of peripheral T-cell lymphoma, particularly focusing on the role of autologous and allogeneic stem cell transplant. RECENT FINDINGS Peripheral T-cell lymphomas are a rare subset of non-Hodgkin's lymphomas that are treated with curative intent. While therapy has been based on other aggressive lymphoid malignancies, outcomes are generally poorer than B-cell lymphomas with 5-year overall and progression-free survival of 30-40% and 20-30%, respectively. In effort to improve outcomes, transplant has been used in both the frontline and salvage settings. Although not studied in randomized studies, consolidation with autologous stem cell transplant in first remission has been associated with an approximate 5-year overall survival of 50-60% and 5-year progression-free survival of 40-45%. Unfortunately, most patients relapse, and, in this setting, allogeneic transplant remains the only curative option for those who are transplant-eligible. Multiple series have now shown that 3-year overall survival with allogeneic transplant is approximately 60%. However, outcomes with transplant are associated with disease control at the time of transplant. In contrast to B-cell malignancies, treatment decisions for peripheral T-cell lymphomas are supported mostly by phase II studies, retrospective series, and expert opinion. For patients with peripheral T-cell lymphoma able to achieve sufficient disease control, autologous stem cell transplantation in first remission and allogeneic stem cell transplantation in relapsed disease offer modest benefit over chemotherapy alone.
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Affiliation(s)
- Nicole C Foley
- Department of Medicine, Division of Oncology, 660 S. Euclid Ave., Box 8056-59, Saint Louis, MO, 63110, USA
| | - Neha Mehta-Shah
- Department of Medicine, Division of Oncology, 660 S. Euclid Ave., Box 8056-59, Saint Louis, MO, 63110, USA.
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19
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Ravichandran N, Uppuluri R, Vellaichamy Swaminathan V, Melarcode Ramanan K, Meena S, Varla H, Chandar R, Jayakumar I, Raj R. Management of Peripheral T-Cell Lymphoma in Children and Adolescents Including STAT 3 Mutation Hyper-IgE Syndrome: One Size Does Not Fit All. J Pediatr Hematol Oncol 2022; 44:e849-e854. [PMID: 34862350 DOI: 10.1097/mph.0000000000002364] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 10/13/2021] [Indexed: 11/26/2022]
Abstract
Peripheral T-cell lymphoma (PTCL) is a rare form of lymphoma in children with limited published data on treatment and lack of a uniformly accepted treatment algorithm. We retrospectively analyzed the data in children up to 18 years of age diagnosed to have PTCL from January 2016 to June 2020. The study included six children with a median age of 10 years, the youngest being a 7-month-old girl. According to the WHO-PTCL classification, three had PTCL-not otherwise specified (NOS), 2 had hepatosplenic TCL, and 1 had subcutaneous panniculitis-like TCL. All children had presented with advanced disease, 4 in St. Jude stage IV, 2 in St. Jude stage III. Three children received CHOEP chemotherapy including cyclophosphamide, doxorubicin, vincristine, prednisone, etoposide, while 1 child received CHOP. Two children received induction as per acute lymphoblastic leukemia followed by Bendamustine. Two patients succumbed to progressive disease, the infant with PTCL-NOS and 1 child with hepatosplenic TCL. Three children were in remission (median follow up of 44 mo). One child with PTCL-NOS Stage IV had an underlying STAT3 mutated hyperimmunoglobulin E syndrome and was in remission 12 months post a matched unrelated donor hematopoietic stem cell transplantation. He had grade 4 skin graft versus host disease and required extracorporeal photopheresis and ibrutinib, to which he had responded. CHOEP chemotherapy is well-tolerated and subcutaneous panniculitis-like TCL has the best prognosis thus far.
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Affiliation(s)
- Nikila Ravichandran
- Departments of Pediatric Hematology, Oncology, Blood and Marrow Transplantation
| | - Ramya Uppuluri
- Departments of Pediatric Hematology, Oncology, Blood and Marrow Transplantation
| | | | | | - Satishkumar Meena
- Departments of Pediatric Hematology, Oncology, Blood and Marrow Transplantation
| | - Harika Varla
- Departments of Pediatric Hematology, Oncology, Blood and Marrow Transplantation
| | - Rumesh Chandar
- Departments of Pediatric Hematology, Oncology, Blood and Marrow Transplantation
| | - Indira Jayakumar
- Pediatric Critical Care, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Revathi Raj
- Departments of Pediatric Hematology, Oncology, Blood and Marrow Transplantation
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20
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Wedekind MF, Saraf A, Willen F, Audino AN. Durable Response in Relapsed Adolescent Peripheral T-cell Lymphoma: A Case Report and Review of the Literature. J Pediatr Hematol Oncol 2022; 44:e278-e281. [PMID: 33769385 DOI: 10.1097/mph.0000000000002147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/12/2021] [Indexed: 11/27/2022]
Abstract
Peripheral T-cell lymphoma (PTCL) is an aggressive tumor, rarely seen in pediatrics or adolescent and young adults (AYAs) so there is no upfront or relapsed standard of care. The authors describe a 16-year-old with PTCL, treated with chemotherapy and autologous stem cell transplant. Upon relapse, he received ifosfamide, carboplatin, etoposide, and radiation with durable remission of 4 years. Data in pediatric/AYA PCTL continue to lack an understanding of the biology and microenvironment, the differences to adult patients, and a lack of adequate therapy. Targeted therapy may improve outcomes for children and AYAs with refractory or relapsed PTCL.
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Affiliation(s)
- Mary Frances Wedekind
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Amanda Saraf
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Indiana University, Riley Hospital for Children, Indianapolis, IN
| | - Faye Willen
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, The Ohio State University, Nationwide Children's Hospital, Columbus, OH
| | - Anthony N Audino
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, The Ohio State University, Nationwide Children's Hospital, Columbus, OH
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21
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Mohammed Saleh MF, Kotb A, Abdallah GEM, Muhsen IN, El Fakih R, Aljurf M. Recent Advances in Diagnosis and Therapy of Angioimmunoblastic T Cell Lymphoma. Curr Oncol 2021; 28:5480-5498. [PMID: 34940095 PMCID: PMC8699908 DOI: 10.3390/curroncol28060456] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/09/2021] [Accepted: 12/17/2021] [Indexed: 12/28/2022] Open
Abstract
Angioimmunoblastic T cell lymphoma (AITL) is a common subtype of mature peripheral T cell lymphoma (PTCL). As per the 2016 World Health Organization classification, AITL is now considered as a subtype of nodal T cell lymphoma with follicular helper T cells. The diagnosis is challenging and requires a constellation of clinical, laboratory and histopathological findings. Significant progress in the molecular pathophysiology of AITL has been achieved in the past two decades. Characteristic genomic features have been recognized that could provide a potential platform for better diagnosis and future prognostic models. Frontline therapy for AITL was mainly depending on chemotherapy and the management of relapsed or refractory AITL is still unsatisfactory with a very poor prognosis. Upfront transplantation offers better survival. Novel agents have been introduced recently with promising outcomes. Several clinical trials of combinations using novel agents are underway. Herein, we briefly review recent advances in AITL diagnosis and the evolving treatment landscape.
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Affiliation(s)
- Mostafa F. Mohammed Saleh
- Adult Hematology, Transplantation and Cellular Therapy Section, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia; (A.K.); (R.E.F.); (M.A.)
- Clinical Hematology Unit, Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut 71515, Egypt;
| | - Ahmed Kotb
- Adult Hematology, Transplantation and Cellular Therapy Section, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia; (A.K.); (R.E.F.); (M.A.)
- Clinical Hematology Unit, Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Ghada E. M. Abdallah
- Clinical Hematology Unit, Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut 71515, Egypt;
| | - Ibrahim N. Muhsen
- Department of Medicine, Houston Methodist Hospital, Houston, TX 77030, USA;
| | - Riad El Fakih
- Adult Hematology, Transplantation and Cellular Therapy Section, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia; (A.K.); (R.E.F.); (M.A.)
| | - Mahmoud Aljurf
- Adult Hematology, Transplantation and Cellular Therapy Section, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia; (A.K.); (R.E.F.); (M.A.)
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22
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Abstract
Natural killer/T-cell lymphoma (NKTL) is a sub-type of Epstein-Barr virus (EBV)-related non-Hodgkin lymphomas common in Asia and Latin America but rare elsewhere. Its pathogenesis is complex and incompletely understood. Lymphoma cells are transformed from NK- or T-cells, sometimes both. EBV-infection and subsequent genetic alterations in infected cells are central to NKTL development. Hemophagocytic syndrome is a common complication. Accurate staging is important to predict outcomes but there is controversy which system is best. More than two-thirds of NKTL lympohmas are localized at diagnosis, are frequently treated with radiation therapy only and have 5-year survival of about 70 percent. Persons with advanced NKTLs receive radiation therapy synchronously or metachronously with diverse multi-drug chemotherapy typically including L-asparginase with 5-year survival of about 40 percent. Some persons with widespread NKTL receive chemotherapy only. There are few data on safety and efficacy of high-dose therapy and a haematopoietic cell autotransplant. Immune therapies, histone deacetylase (HDAC)-inhibitors and other drugs are in early clinical trials. There are few randomized controlled clinical trials in NKTLs and no therapy strategy is clearly best; more effective therapy(ies) are needed. Some consensus recommendations are not convincingly evidence-based. Mechanisms of multi-drug resistance are considered. We discuss these issues including recent advances in our understanding of and therapy of NKTLs.
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Affiliation(s)
- Hua Wang
- Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Bi-Bo Fu
- Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China
| | - Robert Peter Gale
- Haematology Research Centre, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Yang Liang
- Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, PR China.
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23
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Advani RH, Skrypets T, Civallero M, Spinner MA, Manni M, Kim WS, Shustov AR, Horwitz SM, Hitz F, Cabrera ME, Dlouhy I, Vassallo J, Pileri SA, Inghirami G, Montoto S, Vitolo U, Radford J, Vose JM, Federico M. Outcomes and prognostic factors in angioimmunoblastic T-cell lymphoma: final report from the international T-cell Project. Blood 2021; 138:213-220. [PMID: 34292324 PMCID: PMC8493974 DOI: 10.1182/blood.2020010387] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/12/2021] [Indexed: 11/20/2022] Open
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) is a unique subtype of peripheral T-cell lymphoma (PTCL) with distinct clinicopathologic features and poor prognosis. We performed a subset analysis of 282 patients with AITL enrolled between 2006 and 2018 in the international prospective T-cell Project (NCT01142674). The primary and secondary end points were 5-year overall survival (OS) and progression-free survival (PFS), respectively. We analyzed the prognostic impact of clinical covariates and progression of disease within 24 months (POD24) and developed a novel prognostic score. The median age was 64 years, and 90% of patients had advanced-stage disease. Eighty-one percent received anthracycline-based regimens, and 13% underwent consolidative autologous stem cell transplant (ASCT) in first complete remission (CR1). Five-year OS and PFS estimates were 44% and 32%, respectively, with improved outcomes for patients who underwent ASCT in CR1. In multivariate analysis, age ≥60 years, Eastern Cooperative Oncology Group performance status >2, elevated C-reactive protein, and elevated β2 microglobulin were associated with inferior outcomes. A novel prognostic score (AITL score) combining these factors defined low-, intermediate-, and high-risk subgroups with 5-year OS estimates of 63%, 54%, and 21%, respectively, with greater discriminant power than established prognostic indices. Finally, POD24 was a powerful prognostic factor with 5-year OS of 63% for patients without POD24 compared with only 6% for patients with POD24 (P < .0001). These data will require validation in a prospective cohort of homogeneously treated patients. Optimal treatment of AITL continues to be an unmet need, and novel therapeutic approaches are required.
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Affiliation(s)
- Ranjana H Advani
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA
| | - Tetiana Skrypets
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance (CHIMOMO), University of Modena and Reggio Emilia, Modena, Italy
| | - Monica Civallero
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance (CHIMOMO), University of Modena and Reggio Emilia, Modena, Italy
| | - Michael A Spinner
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA
| | - Martina Manni
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance (CHIMOMO), University of Modena and Reggio Emilia, Modena, Italy
| | - Won Seog Kim
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
| | - Andrei R Shustov
- Division of Hematology, Fred Hutchinson Cancer Research Center, University of Washington Medical Center, Seattle, WA
| | - Steven M Horwitz
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Felicitas Hitz
- The Swiss Group for Clinical Cancer Research, Department of Oncology/Haematology, Cantonal Hospital, St Gallen, Switzerland
| | - Maria Elena Cabrera
- Sección Hematología, Hospital del Salvador, Universidad de Chile, Santiago, Chile
| | - Ivan Dlouhy
- Hematology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - José Vassallo
- A.C. Camargo Cancer Center, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil
| | - Stefano A Pileri
- Division of Haematopathology, Istituto Europeo di Oncologia Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milano, Italy
| | - Giorgio Inghirami
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY
| | - Silvia Montoto
- Department of Haemato-oncology, Barts Health NHS Trust, London, United Kingdom
| | - Umberto Vitolo
- Hematology, Città della Salute e della Scienza Hospital and University, Turin, Italy
| | - John Radford
- Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; and
| | - Julie M Vose
- University of Nebraska Medical Center, Omaha, NE
| | - Massimo Federico
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance (CHIMOMO), University of Modena and Reggio Emilia, Modena, Italy
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24
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Du J, Yu D, Han X, Zhu L, Huang Z. Comparison of Allogeneic Stem Cell Transplant and Autologous Stem Cell Transplant in Refractory or Relapsed Peripheral T-Cell Lymphoma: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e219807. [PMID: 34042995 PMCID: PMC8160596 DOI: 10.1001/jamanetworkopen.2021.9807] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Hematopoietic stem cell transplant (HSCT) is an advisable option for refractory or relapsed peripheral T-cell lymphoma (R/R-PTCL), but whether allogeneic HSCT or autologous HSCT is more beneficial is unknown. OBJECTIVE To compare the effectiveness and safety of allogeneic HSCT vs autologous HSCT in patients with R/R-PTCL. DATA SOURCES A systematic search of the PubMed, Embase, the Cochrane Central Register of Controlled Trials, Wanfang, and China National Knowledge Infrastructure databases with the search items refractory or relapsed peripheral T-cell lymphoma, ASCT/autologous stem-cell transplantation, allo-HSCT/allogeneic stem-cell transplantation, therapeutic effect, and treatment was conducted for articles published from January 12, 2001, to October 1, 2020. STUDY SELECTION After duplicate and irrelevant publications were discarded, 329 were ineligible according to the inclusion (clinical trials or retrospective studies with >10 samples) and exclusion criteria (articles without overall survival [OS], progression-free survival [PFS], and transplantation-related mortality [TRM]). Thirty trials were included in the meta-analysis. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. DATA EXTRACTION AND SYNTHESIS Data on study design, individual characteristics, and outcomes were extracted. All statistics were pooled by applying a random-effects model. MAIN OUTCOMES AND MEASURES The prespecified main outcomes were OS, PFS, and TRM. RESULTS Of 6548 articles, data extracted from the 30 studies (including 880 patients who underwent allogeneic HSCT and 885 who underwent autologous HSCT) were included in this meta-analysis. In the allogeneic HSCT group, a 3-year OS of 50% (95% CI, 41%-60%) and PFS of 42% (95% CI, 35%-51%), a 5-year OS of 54% (95% CI, 47%-62%) and PFS of 48% (95% CI, 40%-56%), and a 3-year TRM of 32% (95% CI, 27%-37%) were observed. In the autologous HSCT group, a 3-year OS of 55% (95% CI, 48%-64%) and PFS of 41% (95% CI, 33%-51%), a 5-year OS of 53% (95% CI, 44%-64%) and PFS of 40% (95% CI, 24%-58%), and a 3-year TRM of 7% (95% CI, 2%-23%) were observed. CONCLUSIONS AND RELEVANCE In this systematic review and meta-analysis, OS and PFS were similar in the allogeneic HSCT and autologous HSCT groups; however, allogeneic HSCT was associated with specific survival benefits among patients with R/R-PTCL.
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Affiliation(s)
- Jun Du
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, People's Republic of China
| | - Dandan Yu
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, People's Republic of China
| | - Xinle Han
- Shenzhen PKU-HKUST Medical Center, Shenzhen, People's Republic of China
| | - Lijun Zhu
- Binjiang College of Nanjing University of Information Science & Technology, Jiangsu, People's Republic of China
| | - Zoufang Huang
- Department of Hematology, The First Affiliated Hospital of Gannan Medical University, Jiangxi, People's Republic of China
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25
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Boo YL, Koh LP. Hematopoietic Stem Cell Transplantation in T Cell and Natural Killer Cell Lymphomas: Update on Recent Advances. Transplant Cell Ther 2021; 27:571-588. [PMID: 33857661 DOI: 10.1016/j.jtct.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 11/19/2022]
Abstract
Mature T and natural killer (NK) cell non-Hodgkin lymphoma (T-NHL) has a poor prognosis. Data from existing retrospective and prospective studies have suggested that high-dose chemotherapy followed by autologous hematopoietic cell transplantation (auto-HCT) may improve the survival in patients with chemosensitive disease, either in the upfront or salvage setting. Auto-HCT is currently recommended to be used as frontline consolidation in peripheral T cell lymphoma not otherwise specified, angioimmunoblastic T cell lymphoma, anaplastic large cell lymphoma-anaplastic lymphoma kinase negative, NK/T cell (disseminated), and enteropathy-associated T cell lymphoma. However, about one-third of patients never reach transplantation because of early relapse or refractory disease. Allogeneic hematopoietic cell transplantation (allo-HCT), via its immunologic graft-versus-lymphoma effect, has been used to salvage patients with relapsed or refractory disease, resulting in long-term disease-free survival in a fraction of patients. However, the higher risk of transplant-related mortality due to regimen-related toxicities, graft-versus-host disease, and post-transplant infectious complications continues to limit the mainstream adoption of allo-HCT for this disease. Despite that, allo-HCT has been incorporated as part of the frontline treatment for aggressive subtypes of T-NHL, such as γδ T cell lymphoma and aggressive NK cell leukemia. Recent attempts to incorporate novel targeted T cell directed therapies into the treatment pathway of T-NHL may enhance treatment response and enable more patients to reach transplant, offering an alternative means of treating this disease.
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Affiliation(s)
- Yang Liang Boo
- Department of Hematology-Oncology, National University Cancer Institute, Singapore; Department of Hematology, Hospital Sultanah Aminah, Johor Bahru, Malaysia
| | - Liang Piu Koh
- Department of Hematology-Oncology, National University Cancer Institute, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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26
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Zhang Q, Liu C, Liu Z, Liu M, Xie C, Zheng J, Han C, Zhang D, Zhang J, Fu S, Liu J. Esophageal peripheral T-cell lymphoma treated with radiotherapy: A case report. Medicine (Baltimore) 2021; 100:e24455. [PMID: 33530254 PMCID: PMC7850710 DOI: 10.1097/md.0000000000024455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/06/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE The clinical prognosis of peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) patients is poor. Therefore, effective treatment is still a challenge at present. Moreover, little is known about the value of radiotherapy in the treatment of PTCL-NOS. PATIENT CONCERNS A 55-year-old male patient with eating difficulties and progressive exacerbation for 3 months was diagnosed as non-Hodgkin's lymphoma. Airway compression occurred after 2 cycles of first line treatment with cyclophosphamide-Adriamycin-vincristine-prednisone regimen, radiotherapy (48Gy/24f) was given as the second line therapy. DIAGNOSIS After radiotherapy, the patient complained that mild intermittent dysphagia still existed. Endoscopic biopsy of the upper digestive tract confirmed necrotic material and superficial squamous epithelial mucosa, suggesting esophageal stricture after radiotherapy, which was indistinguishable from tumor residue. INTERVENTIONS The patient received anti-inflammatory treatment outside the hospital and did not receive any other special treatment. OUTCOMES The symptoms of dysphagia disappeared and the focus showed complete response (CR). As of October 1, 2020, the patient has been diagnosed with PTCL-NOS for more than 57 months and the overall survival (OS) have not been achieved. LESSONS Radiotherapy has obvious and rapid anti-tumor effect on cyclophosphamide-Adriamycin-vincristine-prednisone refractory PTCL-NOS. At the same time, hollow organs after radiotherapy can lead to lumen stenosis and the symptoms of suspected recurrence which is difficult to distinguish only from the imaging findings.
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Affiliation(s)
- Qiujing Zhang
- Department of Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences
| | | | - Zining Liu
- Department of Oncology, The Third Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
| | - Menghan Liu
- Basic Medicine College, Shandong First Medical University, Taian
| | - Chao Xie
- Department of Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences
| | | | - Congcong Han
- Department of Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences
| | - Dexian Zhang
- Department of Pathology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Jianjun Zhang
- Department of Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences
| | - Shuai Fu
- Department of Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences
| | - Jie Liu
- Department of Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences
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27
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Abstract
The aggressive peripheral T-cell lymphomas (PTCLs) are a heterogenous group of uncommon lymphomas of mature T lymphocytes dominated by 3 subtypes: systemic anaplastic large-cell lymphoma, both anaplastic lymphoma kinase positive and negative; nodal PTCL with T-follicular helper phenotype; and PTCL, not otherwise specified. Although the accurate diagnosis of T-cell lymphoma and the subtyping of these lymphomas may be challenging, there is growing evidence that knowledge of the subtype of disease can aid in prognostication and in the selection of optimal treatments, in both the front-line and the relapsed or refractory setting. This report focuses on the 3 most common subtypes of aggressive PTCL, to learn how current knowledge may dictate choices of therapy and consultative referrals and inform rational targets and correlative studies in the development of future clinical trials. Finally, I note that clinical-pathologic correlation, especially in cases of T-cell lymphomas that may present with an extranodal component, is essential in the accurate diagnosis and subsequent treatment of our patients.
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28
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Ma WL, Yeh KH, Yao M, Tang JL, Lin CW, Wang YT, Yeh YC, Wang HP, Cheng AL, Kuo SH. Comparison of clinicopathological features and treatment outcomes in aggressive primary intestinal B- and T/NK-cell lymphomas. J Formos Med Assoc 2020; 120:293-302. [PMID: 33289640 DOI: 10.1016/j.jfma.2020.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/26/2020] [Accepted: 10/05/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Primary intestinal lymphomas (PILs) are rare, and this study compared the clinical outcomes of aggressive primary intestinal B-cell lymphomas (aB-PILs) and T/natural killer-cell lymphomas (T/NK-PILs). METHODS The clinical information of patients diagnosed with aggressive PILs at our institution between 1995 and 2015 were retrospectively investigated. Pathological subtypes were confirmed according to the 2016 revision of the World Health Organization classification. The correlation between clinicopathological features and overall survival (OS) was determined using univariate and multivariate analyses. RESULTS Cases of T/NK-PILs had higher initial bowel perforation incidence (67% vs. 7%, P < 0.001) and lower complete response rate to first-line chemotherapy regimens (22% vs. 69%, P = 0.009) than aB-PILs. Patients with aB-PILs had a better 5-year event-free survival rate (55.8% vs. 13.9%, P = 0.026) and a 5-year OS rate (74.3% vs. 29.6%, P = 0.036) than those with T/NK-cell lymphomas. Multivariate analysis identified that female gender and stage III/IV were unfavorable prognostic factors. Among the 54 patients with diffuse large B-cell lymphoma (DLBCL), those with International Prognostic Index (IPI) scores of 0-2 had a better 5-year OS rate than those with scores of 3-5 (84.2% vs. 46.8%, P = 0.002). IPI scores of 3-5 (P = 0.026) and tumors located in the large intestine (P = 0.015) were poor prognostic factors based on the multivariate analysis. CONCLUSION The prognosis of T/NK-PILs was less favorable than that of aB-PILs. Female gender, stage III/IV disease, DLBCL with IPI scores of 3-5, or tumors in the large intestine were poor prognostic factors.
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MESH Headings
- Adult
- Aged
- Female
- Humans
- Immunophenotyping
- Intestinal Perforation/epidemiology
- Intestinal Perforation/etiology
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, T-Cell, Peripheral/mortality
- Lymphoma, T-Cell, Peripheral/pathology
- Lymphoma, T-Cell, Peripheral/therapy
- Male
- Middle Aged
- Retrospective Studies
- Survival Rate
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Wei-Li Ma
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan; Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Kun-Huei Yeh
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan; Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Oncology, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Ming Yao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Jih-Luh Tang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Hematological Oncology, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Chung-Wu Lin
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan.
| | - Yu-Ting Wang
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.
| | - Yi-Chun Yeh
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Ann-Lii Cheng
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan; Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Oncology, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Sung-Hsin Kuo
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan; Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Oncology, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Radiation Oncology, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei, Taiwan.
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29
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Foss FM, Horwitz SM, Civallero M, Bellei M, Marcheselli L, Kim WS, Cabrera ME, Dlouhy I, Nagler A, Advani RH, Pesce EA, Ko YH, Montoto S, Chiattone C, Moskowitz A, Spina M, Cesaretti M, Biasoli I, Federico M. Incidence and outcomes of rare T cell lymphomas from the T Cell Project: hepatosplenic, enteropathy associated and peripheral gamma delta T cell lymphomas. Am J Hematol 2020; 95:151-155. [PMID: 31709579 DOI: 10.1002/ajh.25674] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/18/2019] [Accepted: 11/01/2019] [Indexed: 12/20/2022]
Abstract
The T Cell Project was the largest prospective trial to explore the incidence, treatment patterns, and outcomes for T cell lymphomas. The rare subtypes of T cell lymphomas, including hepatosplenic T cell lymphoma (HSTCL), enteropathy associated T cell lymphoma (EATL), and peripheral gamma delta T cell lymphomas (PGDTCLs) are poorly represented in most studies and there is little data regarding treatment patterns. We report results from 115 patients with hepatosplenic (n = 31), enteropathy associated (n = 65), and PGDTCLs (n = 19). While anthracycline regimens were most commonly used as first line therapy, response rates ranged from 20%-40% and were suboptimal for all groups. Autologous stem cell transplantation was performed as a consolidation in first remission in a small number of patients (33% of HSTCL, 7% of EATL, and 12% of PGDTCL), and four patients with HSTCL underwent allogeneic stem cell transplantation in first remission. The progression free survival at 3 years ranged from 28%-40% for these rare subtypes, and the overall survival at 3 years was most favorable for PGDTCL (70%). These data highlight the need for novel treatment approaches for rare subtypes of T cell lymphomas and for their inclusion in clinical trials.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Disease-Free Survival
- Enteropathy-Associated T-Cell Lymphoma/blood
- Enteropathy-Associated T-Cell Lymphoma/mortality
- Enteropathy-Associated T-Cell Lymphoma/therapy
- Female
- Hematopoietic Stem Cell Transplantation
- Humans
- Incidence
- Lymphoma, T-Cell, Peripheral/blood
- Lymphoma, T-Cell, Peripheral/mortality
- Lymphoma, T-Cell, Peripheral/therapy
- Male
- Middle Aged
- Neoplasm Proteins/blood
- Receptors, Antigen, T-Cell, gamma-delta/blood
- Survival Rate
- Transplantation, Autologous
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Affiliation(s)
| | - Steven M Horwitz
- Department Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Monica Civallero
- CHIMOMO Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Monica Bellei
- Fondazione Italiana Linfomi (FIL) onlus, University of Modena and Reggio Emilia, Modena, Italy
| | - Luigi Marcheselli
- Fondazione Italiana Linfomi (FIL) onlus, University of Modena and Reggio Emilia, Modena, Italy
| | - Won Seog Kim
- Division of Hematology-Oncology, Samsung Medical Center, Seoul, South Korea
| | - Maria E Cabrera
- Sección Hematología, Hospital del Salvador, Universidad de Chile, Santiago, Chile
| | - Ivan Dlouhy
- Hematology Department, Hematologia, Hospital Clinic, Villarroel, Spain
| | - Arnon Nagler
- Department of Bone Marrow Transplantation, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Emanuela A Pesce
- Fondazione Italiana Linfomi (FIL) onlus, University of Modena and Reggio Emilia, Modena, Italy
| | - Young-Hyeh Ko
- Department of Pathology, Sungkyunkwan University, Seoul, Korea
| | - Silvia Montoto
- Department of Haematology, Barts Health NHS Trust, London, UK
| | - Carlos Chiattone
- Departamento de Clínica Médica, FCM da Santa Casa de São Paulo, and Centro de Linfomas Núcleo de Oncologia Hospital Samaritano, São Paulo, Brazil
| | - Alison Moskowitz
- Department Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Michele Spina
- Medical Oncology A, Aviano National Cancer Institute, Aviano, Italy
| | - Marina Cesaretti
- Fondazione Italiana Linfomi (FIL) onlus, University of Modena and Reggio Emilia, Modena, Italy
| | - Irene Biasoli
- Department of Medicine, University Hospital and School of Medicine, Universida de Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Massimo Federico
- CHIMOMO Department University of Modena and Reggio Emilia, Modena, Italy
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Abstract
Peripheral T-cell lymphomas (PTCLs) are a heterogenous group of aggressive non-Hodgkin lymphomas that are less chemosensitive than their B-cell counterparts. Until recently, standard therapy did not distinguish between subtypes, and deeper understanding of the biology of these diseases was lacking. The availability of targeted therapy and more sophisticated subtype classification has translated into the development of novel treatment options for these rare diseases. This includes the development of a brentuximab vedotin-based upfront chemotherapy regimen that confers an overall survival benefit for a subset of patients. Clinical trials of targeted agents, as well as development of better preclinical models of PTCL, are leading to therapeutic advances in the field, including the development of phosphoinositide-3-kinase inhibitors, histone deacetylase inhibitor-based strategies, CD30-directed strategies, Janus kinase inhibitors, and spleen-associated tyrosine kinase inhibitors. Better understanding of the biology of these diseases based on gene expression profiling, minimal residual disease evaluation, and modeling in patient-derived xenografts should help define mechanisms of response and resistance to therapy. Given the complex biology of these heterogeneous lymphomas, well-tolerated combination strategies targeted toward specific subtypes of PTCL can lead to advances in the field. Similar to the story of brentuximab vedotin, development of effective therapies in the salvage setting will likely lead to improved upfront strategies in PTCLs, and ultimately a more personalized approach.
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31
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Hopfinger G, Staber P. [Current standard in diagnostic and therapy of peripheral T-cell lymphoma]. Dtsch Med Wochenschr 2019; 144:1400-1404. [PMID: 31594013 DOI: 10.1055/a-0597-7606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
NEW WHO CLASSIFICATION 2016 FOR LYMPHOMA AND MOLECULAR MARKER: The new WHO 2016 Classification for Lymphomas included more detailed definitions of individual entities, such as: the Anaplastic Large Cell Lymphoma, ALK; the terminus of enteropathy-associated T-cell lymphoma (EATCL, type 1) now is restricted to celiac-associated form. The integration of next Generation sequencing (NGS) enables better differential diagnostics, e. g. angioimmunoblastic lymphoma (AITL) can be characterized by the presence of TET2, RHOA, IDH2 or DNMT3A mutations. Furthermore, certain mutations also have prognostic impact. In ALCL/ALK-, evidence of a DUSP22 / IRF4 re-arrangement is associated with a better and detection of TP63 is associated with a worse prognosis. CLINICAL COURSE AND PROGNOSIS In addition to B symptoms and nodal manifestation, extranodal manifestations such as skin infiltrates can be observed in up to 20 %. In AITL, polyclonal hypergammaglobulinemia, Coombs-positive hemolytic anemia and immunodeficiency can occur, as a sign of a dysregulated immune system. ADVANCES IN THERAPY By combining the immunoconjugate brentuximab-vedotin with chemotherapy, improvement in disease-free and overall survival in CD30+-PTCL (especially in ALCL) was observed. FUTURE PERSPECTIVE At present demethylating agent 5-azacytidine is explored in AITL and PTCL with a T-follicle helper type (TFH).
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Affiliation(s)
- Georg Hopfinger
- Univ.-Klinik für Innere Medizin 1, Medizinische Universität Wien
| | - Philipp Staber
- Univ.-Klinik für Innere Medizin 1, Medizinische Universität Wien
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Roerden M, Walz JS, Müller MR, Sökler M, Federmann B, Kanz L, Bethge W, Vogel W. The role of autologous stem cell transplantation in peripheral T cell lymphoma: a long-term follow-up single-center experience. J Cancer Res Clin Oncol 2019; 145:2595-2604. [PMID: 31410605 DOI: 10.1007/s00432-019-02999-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/06/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Peripheral T cell lymphomas (PTCL) are a rare and heterogeneous group of aggressive non-Hodgkin lymphomas, showing a generally poor prognosis. In this retrospective analysis, we aimed to investigate the impact of autologous stem cell transplantation (autoSCT) in PTCL. METHODS A retrospective analysis of 58 consecutive unselected PTCL patients aged 21-71 years undergoing autoSCT as first-line consolidation as well as in the relapse setting was performed. RESULTS The median follow-up time was 67 months. A 5-year overall survival (OS) of 53% and a 5-year progression-free survival (PFS) after autoSCT of 44% was achieved. The overall relapse rate after autoSCT was 50%. On multivariate analysis, standard baseline characteristics such as age, disease stage and international prognostic index (IPI) score failed to predict outcome in our cohort. First-line treatment with autoSCT was not associated with a benefit in OS when compared to patients receiving autoSCT at relapse. Notably, autoSCT seemed to be a suitable approach even for older transplant-eligible patients (aged ≥ 60 years), with a similar 5-year OS of 49% when compared to younger patients. CONCLUSIONS Our study suggests that autoSCT can achieve long-term survival in PTCL patients even after relapse and should also be considered for eligible older patients.
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Affiliation(s)
- Malte Roerden
- Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany
| | - Juliane S Walz
- Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany.
| | - Martin R Müller
- Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany
| | - Martin Sökler
- Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany
| | - Birgit Federmann
- Department of Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Lothar Kanz
- Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany
| | - Wolfgang Bethge
- Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany
| | - Wichard Vogel
- Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany
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Okuni M, Yakushijin K, Uehara K, Ichikawa H, Suto H, Hashimoto A, Tanaka Y, Shinzato I, Sakai R, Mizutani Y, Nagao S, Kurata K, Kakiuchi S, Miyata Y, Inui Y, Saito Y, Kawamoto S, Yamamoto K, Ito M, Matsuoka H, Minami H. Successful Bridging Chemotherapy with Gemcitabine, Carboplatin, and Dexamethasone before Unrelated Stem Cell Transplantation for Hepatosplenic T-cell Lymphoma. Intern Med 2019; 58:707-712. [PMID: 30449784 PMCID: PMC6443557 DOI: 10.2169/internalmedicine.1266-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
A 45-year-old woman was diagnosed with hepatosplenic T-cell lymphoma (HSTCL), a rare subtype of peripheral T-cell lymphoma. She received different types of chemotherapy, but disease progression was observed. To reduce the tumor burden before an unrelated bone marrow transplantation, combination chemotherapy consisting of the gemcitabine, carboplatin, and dexamethasone (GCD) was administered as bridging therapy, resulting in a reduction in the number of lymphoma cells. We were then able to perform bone marrow transplantation. Although she experienced some adverse events, she successfully achieved long-term remission. We herein report a successful case of HSTCL treated with unrelated stem cell transplantation following the GCD regimen as bridging chemotherapy.
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Affiliation(s)
- Marika Okuni
- The Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital, Japan
| | - Kimikazu Yakushijin
- The Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital, Japan
| | - Keiichiro Uehara
- Department of Diagnostic Pathology, Kobe University Hospital, Japan
| | - Hiroya Ichikawa
- The Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital, Japan
| | - Hirotaka Suto
- The Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital, Japan
| | - Akiko Hashimoto
- Department of Hematology and Clinical Immunology, Kobe City Nishi-Kobe Medical Center, Japan
| | - Yasuhiro Tanaka
- Department of Hematology and Clinical Immunology, Kobe City Nishi-Kobe Medical Center, Japan
| | - Isaku Shinzato
- Department of Hematology and Clinical Immunology, Kobe City Nishi-Kobe Medical Center, Japan
| | - Rina Sakai
- The Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital, Japan
| | - Yu Mizutani
- The Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital, Japan
| | - Shigeki Nagao
- The Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital, Japan
| | - Keiji Kurata
- The Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital, Japan
| | - Seiji Kakiuchi
- The Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital, Japan
| | - Yoshiharu Miyata
- The Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital, Japan
| | - Yumiko Inui
- The Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital, Japan
| | - Yasuyuki Saito
- Division of Molecular and Cellular Signaling, Department of Biochemistry and Molecular Biology, Kobe University Graduate School of Medicine, Japan
| | - Shinichiro Kawamoto
- The Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital, Japan
| | - Katsuya Yamamoto
- The Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital, Japan
| | - Mitsuhiro Ito
- Laboratory of Hematology, Division of Medical Biophysics, Kobe University Graduate School of Health Sciences, Japan
| | - Hiroshi Matsuoka
- The Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital, Japan
| | - Hironobu Minami
- The Division of Medical Oncology and Hematology, Department of Medicine, Kobe University Hospital, Japan
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34
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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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35
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Yang W, Jiang S, Lin J, Li Y. CT findings predict survival of patients with peripheral T cell lymphoma: a preliminary study. Radiol Oncol 2019; 53:31-38. [PMID: 30681975 PMCID: PMC6411030 DOI: 10.2478/raon-2019-0005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 12/19/2018] [Indexed: 02/05/2023] Open
Abstract
Background Peripheral T-cell lymphoma (PTCL) is an uncommon disease with poor clinical outcomes. Radiological reports on the survival of patients with PTCL are scarce. The purpose of this study is to investigate the prognostic value of CT findings to predict clinical outcomes in fifty-one patients with histologically proven PTCL. Patients and methods The clinical data and CT images of all patients were retrospectively reviewed. CT features including number of involvement sites, lesion size, shape, margin, density, peritumoral invasion, intratumoral necrosis, lymph node involvement, and degree of contrast enhancement were evaluated. Univariate and multiple logistic regression analysis were used to determine the association between the clinical outcome and radiologic factors. Results Multiple site involvement, an ill-defined margin with peritumoral invasion, inhomogeneous density, and intratumoral necrosis were found to be associated with poor outcomes in univariate analysis (P < 0.05). An ill-defined margin with peritumoral invasion, was identified as an independent risk sign by further multivariate logistic regression analysis (P < 0.05). The area under the ROC curve of this CT feature was 0.745 (P < 0.05). Conclusions An ill-defined margin with peritumoral invasion was a valuable prognostic factor to predict the worse clinical outcomes in patients with PTCL.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Anaplastic Lymphoma Kinase/analysis
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Area Under Curve
- Child
- Cyclophosphamide/administration & dosage
- Doxorubicin/administration & dosage
- Duodenal Neoplasms/diagnostic imaging
- Female
- Humans
- Logistic Models
- Lymphoma, T-Cell, Peripheral/diagnostic imaging
- Lymphoma, T-Cell, Peripheral/mortality
- Lymphoma, T-Cell, Peripheral/pathology
- Lymphoma, T-Cell, Peripheral/therapy
- Male
- Mediastinal Neoplasms/diagnostic imaging
- Middle Aged
- Multidetector Computed Tomography
- Necrosis
- Neoplasm Invasiveness
- Paranasal Sinus Neoplasms/diagnostic imaging
- Prednisone/administration & dosage
- Prognosis
- ROC Curve
- Retrospective Studies
- Tomography, Spiral Computed
- Treatment Outcome
- Vincristine/administration & dosage
- Young Adult
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Affiliation(s)
- Wenbin Yang
- Department of Radiology, Cancer Hospital, Shantou University Medical College, Guangdong, China
| | - Sen Jiang
- Department of Radiology, Cancer Hospital, Shantou University Medical College, Guangdong, China
| | - Jianbang Lin
- Department of Radiology, Cancer Hospital, Shantou University Medical College, Guangdong, China
| | - Yangkang Li
- Department of Radiology, Cancer Hospital, Shantou University Medical College, Guangdong, China
- Yangkang Li, Department of Radiology, Cancer Hospital, Shantou University Medical College, No7, Raoping Rd, Shantou, Guangdong Province 515041, P. R. China. Phone: +86 0754 8855 5844; Fax: +86 0754 8856 0352
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36
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Abstract
Mature T-cell non-Hodgkin lymphomas (T-cell NHL) are a heterogeneous group of lymphoid malignancies including NK/T-cell lymphomas. Hematopoietic cell transplantation (HCT) is an important component of the management of T-cell NHL; however, the optimal timing and type of transplant for each different subtype is an ongoing debate. For the purpose of this chapter, PTCL will be classified as (1) systemic PTCL that includes nodal as well as non-nodal histologies in PTCL (2) CTCL-or cutaneous T-cell lymphomas that arise primarily in the skin and (3) NK/T-cell lymphomas both nasal and extranasal types. It is difficult to do any large trials in PTCL as they are rare diseases with variable clinical and biological characteristics and most patients are not transplant eligible due to various reasons including poor disease control. There are no randomized trials in transplant for PTCL but there is an experience based on retrospective as well as some well-designed prospective trials that have helped outline the role of HSCT in the treatment paradigm of PTCL. High-dose therapy and autologous HCT is recommended in first complete remission for most systemic (non-cutaneous) nodal subtypes, or peripheral T-cell lymphomas (PTCL). Autologous HCT can provide long-term remission for relapsed PTCL but is ineffective for refractory/chemoresistant disease. Allogeneic stem cell transplantation harnesses the graft-versus-lymphoma effect, providing long-term remission for relapsed PTCL. AlloHCT is also being used successfully to provide long-term disease control for advanced cutaneous T-cell lymphoma (CTCL). The use of transplant in NK/T-cell lymphoma is increasingly being recommended in the relapsed setting only as there are more effective treatments available for the upfront setting in limited stage disease.
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Affiliation(s)
- Jasmine Zain
- City of Hope National Medical Center, Duarte, CA, USA.
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37
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Abstract
PURPOSE OF THE REVIEW T-cells and natural killer (NK) cells share the same ontogeny, and lymphomas derived from them are clinically diverse, occurring in nodal and extranodal sites. In addition to inherent properties of these lymphomas, their microenvironment also impacts on pathogenesis and response to therapy. An understanding of the milieu of T-cell and NK cell lymphomas has important implications on treatment. RECENT FINDINGS Components of the microenvironment include tumour-associated macrophages (TAM), non-neoplastic T-cells and B-cells, eosinophils, dendritic cells, endothelial cells and blood vessels. TAM typically undergoes M2 polarization, promoting angiogenesis and inhibiting anti-tumour cellular immunity. In lymphomas of follicular helper T-cell derivation, increased B-cell proliferation occurs, which may in turn enhance neoplastic T-cell growth. The expression of immune checkpoint ligands on TAM, dendritic cells or lymphoma cells induces an immunosuppressive environment conducive to neoplastic proliferation. Strategies against this complex cellular and immunologic microenvironment have shown promises. These include the use of signal transduction inhibitors, monoclonal antibodies against chemokines or non-neoplastic microenvironmental cells, immunomodulatory drugs and immune checkpoint blockade. As T-cell and NK cell lymphomas are highly heterogeneous, clinical trials to demonstrate efficacy of a given therapeutic approach requires careful design aiming at enriching patient populations who will best respond. Targeting of the immunologic milieu in T-cell and NK-cell lymphomas offers exciting challenges and opportunities.
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MESH Headings
- B-Lymphocytes/immunology
- B-Lymphocytes/pathology
- Cell Proliferation
- Dendritic Cells/immunology
- Dendritic Cells/pathology
- Humans
- Lymphoma, Extranodal NK-T-Cell/immunology
- Lymphoma, Extranodal NK-T-Cell/pathology
- Lymphoma, Extranodal NK-T-Cell/therapy
- Lymphoma, T-Cell, Peripheral/immunology
- Lymphoma, T-Cell, Peripheral/pathology
- Lymphoma, T-Cell, Peripheral/therapy
- T-Lymphocytes, Helper-Inducer/immunology
- T-Lymphocytes, Helper-Inducer/pathology
- Tumor Microenvironment/immunology
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Affiliation(s)
- Eric Tse
- Department of Medicine, Professorial Block, Queen Mary Hospital, Pokfulam Road, Hong Kong, China
| | - Yok-Lam Kwong
- Department of Medicine, Professorial Block, Queen Mary Hospital, Pokfulam Road, Hong Kong, China.
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38
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Gu Z, Wang L, Wang Q, Li H, Bo J, Wang S, Zhao Y, Li F, Gao C, Liu D, Huang W. Outcomes of myeloablative peripheral blood stem cell transplantation for non-complete remission patients with relapsed/refractory peripheral T cell lymphomas. Ann Hematol 2018; 98:1237-1247. [PMID: 30539277 DOI: 10.1007/s00277-018-3559-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 11/15/2018] [Indexed: 11/25/2022]
Abstract
There was limited information about the efficacy of myeloablative allogeneic peripheral blood stem cell transplantation (allo-PBSCT) in non-complete remission (non-CR) patients with relapsed/refractory peripheral T cell lymphomas (PTCLs). We conducted a retrospective study of 21 consecutive non-CR patients with relapsed/refractory PTCLs who received myeloablative allo-PBSCT between January 2008 and June 2016. The median follow-up of survivors was 46.5 months (range, 14-105 months). The estimated 3-year relapse rate was 24% (95% CI, 9 to 43%). The 3-year non-relapsed mortality rate was 24% (95% CI, 9 to 44%). Overall, the estimated 3-year overall survival was 47% (95% CI, 25 to 66%). And the estimated 3-year progression-free survival was 46% (95% CI, 24 to 66%). Specifically, eight patients failed to achieve a CR at the first evaluation 3 months after allo-PBSCT and received withdraw of immunosuppression. Five patients also received donor lymphocytes infusions. Five (5/8, 62.5%) patients responded subsequently to these interventions (complete = 4, partial = 1). Overall, ten patients were alive at our last follow-ups, and durable CR were achieved in nine patients without further therapy. Five (50%) of these ten alive patients experienced chronic graft-versus-host disease (GVHD). Our favorable clinical outcomes suggested myeloablative allo-PBSCT was a valid therapeutic option for non-CR patients with relapsed/refractory PTCLs. The sustained CR after immunotherapeutic intervention and high prevalence of chronic GVHD in alive patients provided evidence of graft versus T cell lymphoma effects.
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Affiliation(s)
- Zhenyang Gu
- Department of Hematology, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China
| | - Lu Wang
- Department of Hematology, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China
- Department of Hematology, Hainan Branch of General Hospital of PLA, Sanya, 572013, Hainan, China
| | - Quanshun Wang
- Department of Hematology, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China
| | - Honghua Li
- Department of Hematology, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China
| | - Jian Bo
- Department of Hematology, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China
| | - Shuhong Wang
- Department of Hematology, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China
| | - Yu Zhao
- Department of Hematology, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China
| | - Fei Li
- Department of Hematology, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China
| | - Chunji Gao
- Department of Hematology, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China.
- Department of Hematology, Hainan Branch of General Hospital of PLA, Sanya, 572013, Hainan, China.
| | - Daihong Liu
- Department of Hematology, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China.
| | - Wenrong Huang
- Department of Hematology, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China.
- Department of Hematology, Hainan Branch of General Hospital of PLA, Sanya, 572013, Hainan, China.
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39
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Abstract
Treatment outcomes for patients with peripheral T-cell lymphomas (PTCLs) and advanced-stage cutaneous T-cell lymphomas (CTCLs) remain poor. The past few years have witnessed an explosion in our understanding of the genetics of these diverse malignancies. Many subtypes harbor highly recurrent mutations, including single-nucleotide variants, insertions/deletions, and chromosomal rearrangements, that affect T-cell receptor signaling, costimulatory molecules, JAK/STAT and phosphatidylinositol 3-kinase pathways, transcription factors, and epigenetic modifiers. An important subset of these mutations is included within commercially available, multigene panels and, in rare circumstances, indicate therapeutic targets. However, current preclinical and clinical evidence suggests that only a minority of mutations identified in TCLs indicate biologic dependence. With a few exceptions that we highlight, mutations identified in TCLs should not be routinely used to select targeted therapies outside of a clinical trial. Participation in trials and publication of both positive and negative results remain the most important mechanisms for improving patient outcomes.
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MESH Headings
- Genomics/methods
- Humans
- Lymphoma, T-Cell, Peripheral/genetics
- Lymphoma, T-Cell, Peripheral/metabolism
- Lymphoma, T-Cell, Peripheral/pathology
- Lymphoma, T-Cell, Peripheral/therapy
- Mutation
- Neoplasm Proteins/genetics
- Neoplasm Proteins/metabolism
- Receptors, Antigen, T-Cell/genetics
- Receptors, Antigen, T-Cell/metabolism
- Signal Transduction/genetics
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Affiliation(s)
- Eric D. Jacobsen
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; and
| | - David M. Weinstock
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; and
- Broad Institute of MIT and Harvard, Cambridge, MA
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40
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Yhim HY, Park Y, Han YH, Kim S, Kang SR, Moon JH, Jeong JH, Shin HJ, Kim K, Choi YS, Kim K, Kim MK, Kong E, Kim DS, Eo JS, Lee JH, Kang DY, Lee WS, Lee SM, Do YR, Ham JS, Kim SJ, Kim WS, Choi JY, Yang DH, Kwak JY. A risk stratification model for nodal peripheral T-cell lymphomas based on the NCCN-IPI and posttreatment Deauville score. Eur J Nucl Med Mol Imaging 2018; 45:2274-2284. [PMID: 30056546 DOI: 10.1007/s00259-018-4093-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 07/11/2018] [Indexed: 02/01/2023]
Abstract
PURPOSE The aim of this study was to establish a risk-stratification model integrating posttreatment metabolic response using the Deauville score and the pretreatment National Comprehensive Cancer Network-International Prognostic Index (NCCN-IPI) in nodal PTCLs. METHODS We retrospectively analysed 326 patients with newly diagnosed nodal PTCLs between January 2005 and June 2016 and both baseline and posttreatment PET/CT data. The final model was validated using an independent prospective cohort of 79 patients. RESULTS Posttreatment Deauville score (1/2, 3, and 4/5) and the NCCN-IPI (low, low-intermediate, high-intermediate, and high) were independently associated with progression-free survival: for the Deauville score, the hazard ratios (HRs) were 1.00 vs. 2.16 (95% CI 1.47-3.18) vs. 7.86 (5.66-10.92), P < 0.001; and for the NCCN-IPI, the HRs were 1.00 vs. 2.31 (95% CI 1.20-4.41) vs. 4.42 (2.36-8.26) vs. 7.09 (3.57-14.06), P < 0.001. Based on these results, we developed a simplified three-group risk model comprising a low-risk group (low or low-intermediate NCCN-IPI with a posttreatment Deauville score of 1 or 2, or low NCCN-IPI with a Deauville score of 3), a high-risk group (high or high-intermediate NCCN-IPI with a Deauville score of 1/2 or 3, or low-intermediate NCCN-IPI with a Deauville score of 3), and a treatment failure group (Deauville score 4 or 5). This model was significantly associated with progression-free survival (5-year, 70.3%, 31.4%, and 4.7%; P < 0.001) and overall survival (5-year, 82.1%, 45.5%, and 14.7%; P < 0.001). Similar associations were also observed in the independent validation cohort. CONCLUSION The risk-stratification model integrating posttreatment Deauville score and pretreatment NCCN-IPI is a powerful tool for predicting treatment failure in patients with nodal PTCLs.
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Affiliation(s)
- Ho-Young Yhim
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, South Korea
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, South Korea
| | - Yong Park
- Department of Internal Medicine, Korea University Anam Hospital College of Medicine, Seoul, South Korea
| | - Yeon-Hee Han
- Department of Nuclear Medicine, Chonbuk National University Hospital, Jeonju, South Korea
| | - Sungeun Kim
- Department of Nuclear Medicine, Korea University Anam Hospital, Seoul, South Korea
| | - Sae-Ryung Kang
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Jeollanam-do, South Korea
| | - Joon-Ho Moon
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - Ju Hye Jeong
- Department of Nuclear Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - Ho-Jin Shin
- Department of Internal Medicine, Pusan National University Hospital, Busan, South Korea
| | - Keunyoung Kim
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Yoon Seok Choi
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Kunho Kim
- Department of Nuclear Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Min Kyoung Kim
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, South Korea
| | - Eunjung Kong
- Department of Nuclear Medicine, Yeungnam University College of Medicine, Daegu, South Korea
| | - Dae Sik Kim
- Department of Internal Medicine, Korea University Guro Hospital College of Medicine, Seoul, South Korea
| | - Jae Seon Eo
- Department of Nuclear Medicine, Korea University Guro Hospital College of Medicine, Seoul, South Korea
| | - Ji Hyun Lee
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, South Korea
| | - Do-Young Kang
- Department of Nuclear Medicine, Dong-A University College of Medicine, Busan, South Korea
| | - Won Sik Lee
- Department of Internal Medicine, Inje University College of Medicine, Inje University Busan Paik Hospital, Busan, South Korea
| | - Seok Mo Lee
- Department of Nuclear Medicine, Inje University College of Medicine, Inje University Busan Paik Hospital, Busan, South Korea
| | - Young Rok Do
- Department of Internal Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea
| | - Jun Soo Ham
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seok Jin Kim
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Won Seog Kim
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Deok-Hwan Yang
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun, Jeollanam-do, 519-763, Republic of Korea.
| | - Jae-Yong Kwak
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, South Korea
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, South Korea
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Wu M, Wang X, Xie Y, Liu W, Zhang C, Ping L, Ying Z, Deng L, Zheng W, Lin N, Tu M, Song Y, Zhu J. Outcome and Prospective Factor Analysis of High-dose Therapy Combined with Autologous Peripheral Blood Stem Cell Transplantation in Patients with Peripheral T-cell Lymphomas. Int J Med Sci 2018; 15:867-874. [PMID: 30008598 PMCID: PMC6036090 DOI: 10.7150/ijms.23067] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 04/12/2018] [Indexed: 01/01/2023] Open
Abstract
Background: For peripheral T-cell lymphomas (PTCLs) patients, high-dose therapy combined with autologous peripheral blood stem cell transplantation (HDT/ASCT) has been an alternative treatment option, due to the lack of efficacy from conventional chemotherapy. While not all PTCLs could have benefit in survival from HDT/ASCT. The aim of this study was to evaluate the value of high-dose therapy combined with autologous peripheral blood stem cell transplantation (HDT/ASCT) in Chinese patients with Peripheral T-cell Lymphomas (PTCLs), in order to determine the cohort most suitable to receive HDT/ASCT. Methods: A total of 79 patients with PTCLs who received HDT/ASCT in Peking University Cancer Hospital & Institute from January 2001 to august 2016 were retrospectively analyzed. Results: At a median follow-up time of 23.6 months, the 2-year progression-free survival (PFS) and 2-year overall survival (OS) of the entire cohort were 75.2% and 83.6% respectively. Patients with first complete remission (CR1) (2-year PFS 85.8%, 2-year OS 94.2%) were superior to others in survival. Patients with second complete remission (CR2) had no advantage in survival compared with those with first partial remission (PR1) (2-year PFS: 43.8% vs. 76.2%, p=0.128; 2-year OS: 72.9% vs. 77.1%, p=0.842). In multivariate analysis, response before HDT/ASCT (p=0.001) and LDH before HDT/ASCT (p=0.047) were highly predictive for PFS, while no factors could independently predict OS. Subgroup analysis revealed that HDT/ASCT could improve the survival of patients with angioimmunoblastic T-cell lymphoma (AITL), especially in patients with chemosensitivity. Patients with natural killer / T-cell lymphoma (NKTCL) who received HDT/ASCT with CR1 also had benefit in survival from HDT/ASCT, while nearly 90% of non-CR1 patients appeared bone marrow involvement after HDT/ASCT. Conclusion: Patients who achieved complete remission after first-line therapy, especially with AITL and NKTCL, should strongly be recommended to receive HDT/ASCT. The future prospective trial is warranted.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Jun Zhu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Muta T, Yoshihiro T, Jinnouchi F, Aoki K, Kochi Y, Shima T, Takenaka K, Ogawa R, Akashi K, Oshima K. Expansion of NKG2C-expressing Natural Killer Cells after Umbilical Cord Blood Transplantation in a Patient with Peripheral T-cell Lymphoma with Cytotoxic Molecules. Intern Med 2018; 57:861-866. [PMID: 29269653 PMCID: PMC5891528 DOI: 10.2169/internalmedicine.9437-17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
A 64-year-old woman presented with generalized lymphadenopathy and systemic manifestations. The examination of a biopsy specimen revealed peripheral T-cell lymphoma not otherwise specified (PTCL-NOS) expressing cytotoxic molecules. Umbilical cord blood transplantation was successful during a partial remission state after the administration of salvage chemotherapy. The donor-derived large granular lymphocytes started to increase as a result of cytomegalovirus reactivation. The fraction of natural killer (NK) cells expressing the NKG2C molecule accounted for one-third of the total lymphocytes for almost two years. We implicitly indicate the association between the persistence of donor-derived NKG2C+ NK cell-expansion and maintaining a complete remission in similar cases of aggressive PTCL-NOS.
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Affiliation(s)
- Tsuyoshi Muta
- Department of Hematology/Oncology, Japan Community Health Care Organization (JCHO) Kyushu Hospital, Japan
| | | | - Fumiaki Jinnouchi
- Department of Hematology/Oncology, Kyushu University Hospital, Japan
| | - Kenichi Aoki
- Department of Hematology/Oncology, Japan Community Health Care Organization (JCHO) Kyushu Hospital, Japan
| | - Yu Kochi
- Department of Hematology/Oncology, Kyushu University Hospital, Japan
| | - Takahiro Shima
- Department of Hematology/Oncology, Kyushu University Hospital, Japan
| | - Katsuto Takenaka
- Department of Hematology/Oncology, Kyushu University Hospital, Japan
| | - Ryosuke Ogawa
- Department of Hematology/Oncology, Japan Community Health Care Organization (JCHO) Kyushu Hospital, Japan
| | - Koichi Akashi
- Department of Hematology/Oncology, Kyushu University Hospital, Japan
| | - Koichi Oshima
- Department of Pathology, Kurume University School of Medicine, Japan
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Chihara D, Fanale MA, Miranda RN, Noorani M, Westin JR, Nastoupil LJ, Hagemeister FB, Fayad LE, Romaguera JE, Samaniego F, Turturro F, Lee HJ, Neelapu SS, Rodriguez MA, Wang M, Fowler NH, Davis RE, Medeiros LJ, Oki Y. The risk of central nervous system relapses in patients with peripheral T-cell lymphoma. PLoS One 2018. [PMID: 29538376 PMCID: PMC5851529 DOI: 10.1371/journal.pone.0191461] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
We performed a retrospective analysis to identify risk factors and survival outcome for central nervous system (CNS) relapse of peripheral T-cell lymphoma (PTCL) by histologic type. Records of 600 PTCL patients diagnosed between 1999 and 2014 were analyzed including PTCL not otherwise specified (PTCL-NOS, 174 patients), angoimmunoblastic T-cell lymphoma (AITL, 144), ALK+anaplastic large cell lymphoma (ALCL, 74), ALK-ALCL (103), extranodal NK-cell lymphoma (ENKL, 54), or others (51). With a median follow up of 57 months, 13 patients (4 PTCL-NOS, 1 AITL, 4 ALK+ALCL, 2 ALK-ALCL, 2 ENKL) experienced CNS relapse. One-year and 5-year cumulative incidence of CNS relapse were 1.5% (95%CI: 0.7–2.8%) and 2.1% (95%CI: 1.1–3.5%), respectively. The 5-year cumulative incidence of CNS relapse was 1.8% in PTCL-NOS, 0.7% in AITL, 5.4% in ALK+ALCL, 2.1% in ALK-ALCL and 3.7% in ENKL. Extranodal involvement >1 site was the only significant factor associated with higher chance of CNS relapse (HR: 4.9, 95%CI: 1.6–15.0, p = 0.005). Patients with ALK+ALCL who had extranodal involvement >1 (N = 19) had very high risk of CNS relapse with one year cumulative incidence of 17% (95%CI: 4%-37%), all occurring within six months after diagnosis. All patients with CNS relapse eventually died (median, 1.5 months; range, 0.1–10.1 months). CNS relapse in patients with PTCL is rare event but the risk varies by subtype. ALK+ALCL patients with extranodal involvement >1 site have a very high risk of early CNS relapse, and thus evaluation of CNS involvement at the time of diagnosis and possible CNS-directed prophylaxis may be considered.
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Affiliation(s)
- Dai Chihara
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Michelle A. Fanale
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Roberto N. Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Mansoor Noorani
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Jason R. Westin
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Loretta J. Nastoupil
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Fredrick B. Hagemeister
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Luis E. Fayad
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Jorge E. Romaguera
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Felipe Samaniego
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Francesco Turturro
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Hun J. Lee
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Sattva S. Neelapu
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - M. Alma Rodriguez
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Michael Wang
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Nathan H. Fowler
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Richard E. Davis
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - L. Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Yasuhiro Oki
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
- * E-mail:
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Tanaka J, Su P, Luedke C, Jug R, Yang LH, Deak K, Rapisardo S, Zhang Y, Delos Angeles M, Xie Y, Wang E. Composite lymphoma of follicular B-cell and peripheral T-cell types with distinct zone distribution in a 75-year-old male patient: a case study. Hum Pathol 2017; 76:110-116. [PMID: 29217426 DOI: 10.1016/j.humpath.2017.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 10/28/2017] [Accepted: 11/17/2017] [Indexed: 12/13/2022]
Abstract
Composite lymphoma of T-/B-cell type is rare, and follicular lymphoma composite with peripheral T-cell lymphoma (PTCL) has not previously been reported. We report such a case with both neoplastic components displaying a unique zone of distribution. A 75-year-old male patient presented with generalized lymphadenopathy. Sections of axillary lymph node demonstrated potentially 2 clonal processes, PTCL with aberrant CD20 expression and follicular lymphoma. Interestingly, the 2 neoplastic components were confined to their respective classic distribution zones, with PTCL occupying the interfollicular areas and follicular lymphoma residing in follicles. Both populations were detected by flow cytometry, but their immunophenotypes were insufficient to define clonality. Nonetheless, biclonality was demonstrated by lymphoid receptor gene rearrangement analyses. Molecular cytogenetics showed IGH/BCL2 fusion in the follicular lymphoma and amplification of IGH gene or trisomy/tetrasomy 14 in the PTCL. The current case underscores the complexity of composite lymphoma and advocates a multimodal approach to establishing the diagnosis.
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MESH Headings
- Aged
- Antigens, CD20/analysis
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/genetics
- Composite Lymphoma/genetics
- Composite Lymphoma/immunology
- Composite Lymphoma/pathology
- Composite Lymphoma/therapy
- Gene Amplification
- Gene Fusion
- Genes, Immunoglobulin Heavy Chain
- Humans
- Immunohistochemistry
- In Situ Hybridization, Fluorescence
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/immunology
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/therapy
- Lymphoma, Follicular/genetics
- Lymphoma, Follicular/immunology
- Lymphoma, Follicular/pathology
- Lymphoma, Follicular/therapy
- Lymphoma, T-Cell, Peripheral/genetics
- Lymphoma, T-Cell, Peripheral/immunology
- Lymphoma, T-Cell, Peripheral/pathology
- Lymphoma, T-Cell, Peripheral/therapy
- Male
- Proto-Oncogene Proteins c-bcl-2/genetics
- Tetrasomy
- Trisomy
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Affiliation(s)
- John Tanaka
- Department of Pathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Pu Su
- Department of Pathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Catherine Luedke
- Department of Pathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Rachel Jug
- Department of Pathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Lian-He Yang
- Department of Pathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Kristen Deak
- Department of Pathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Sarah Rapisardo
- Department of Pathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Yang Zhang
- Department of Pathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Marc Delos Angeles
- Department of Pathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Yi Xie
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Endi Wang
- Department of Pathology, Duke University School of Medicine, Durham, NC 27710, USA.
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Kharfan-Dabaja MA, Kumar A, Ayala E, Hamadani M, Reimer P, Gisselbrecht C, d'Amore F, Jantunen E, Ishida T, Bazarbachi A, Foss F, Advani R, Fenske TS, Lazarus HM, Friedberg JW, Aljurf M, Sokol L, Tobinai K, Tse E, Burns LJ, Chavez JC, Reddy NM, Suzuki R, Ahmed S, Nademanee A, Mohty M, Gopal AK, Fanale MA, Pro B, Moskowitz AJ, Sureda A, Perales MA, Carpenter PA, Savani BN. Clinical Practice Recommendations on Indication and Timing of Hematopoietic Cell Transplantation in Mature T Cell and NK/T Cell Lymphomas: An International Collaborative Effort on Behalf of the Guidelines Committee of the American Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplant 2017; 23:1826-1838. [PMID: 28797780 DOI: 10.1016/j.bbmt.2017.07.027] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 07/30/2017] [Indexed: 01/16/2023]
Abstract
Recognizing the significant biological and clinical heterogeneity of mature T cell and natural killer (NK)/T cell lymphomas, the American Society for Blood and Marrow Transplantation invited experts to develop clinical practice recommendations related to the role of autologous hematopoietic cell transplantation (auto-HCT) and allogeneic HCT (allo-HCT) for specific histological subtypes. We used the GRADE methodology to aid in moving from evidence to decision making and ultimately to generating final recommendations. Auto-HCT in front-line consolidation is recommended in peripheral T cell lymphoma not otherwise specified (PTCL-NOS), angioimmunoblastic T cell lymphoma (AITL), anaplastic large cell lymphoma-anaplastic lymphoma kinase (ALCL-ALK)-negative, NK/T cell (disseminated), enteropathy-associated T cell lymphoma (EATL), and hepatosplenic lymphomas. Auto-HCT in relapsed-sensitive disease is recommended for NK/T cell (localized and disseminated), EATL, subcutaneous panniculitis-like T cell, and ALCL-ALK-positive lymphomas. Auto-HCT is also recommended for PTCL-NOS, AITL, and ALCL-ALK-negative lymphomas if not performed as front-line therapy. Auto-HCT in refractory (primary or relapsed) disease is not recommended for any of the histological subtypes discussed. Allo-HCT in front-line consolidation is recommended for NK/T cell (disseminated), adult T cell leukemia/lymphoma (ATLL; acute and lymphoma type), and hepatosplenic lymphomas. Allo-HCT for relapsed-sensitive disease is recommended for PTCL-NOS, AITL, ALCL-ALK-negative, ALCL-ALK-positive, NK/T cell (localized and disseminated), ATLL (acute, lymphoma type, smoldering/chronic), mycosis fungoides/Sezary syndrome (advanced stage IIB-IVB or tumor stage/extracutaneous), EATL, subcutaneous panniculitis-like T cell, and hepatosplenic lymphoma. Allo-HCT in refractory (primary or relapsed refractory) disease is recommended for any aforementioned histological subtypes. Emerging novel therapies will likely be incorporated into the pretransplantation, peritransplantation, and post-transplantation algorithms (auto-HCT or allo-HCT) with the goals of optimizing efficacy and improving outcomes. We acknowledge that there are unique clinical scenarios not covered by these recommendations that may require individualized decisions.
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Affiliation(s)
- Mohamed A Kharfan-Dabaja
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute and Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida.
| | - Ambuj Kumar
- Program for Comparative Effectiveness Research, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Ernesto Ayala
- Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute and Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Mehdi Hamadani
- Department of Internal Medicine, Division of Hematology-Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Peter Reimer
- Department of Hematology, Medical Oncology and Stem Cell Transplantation, Evangelisches Krankenhaus Essen-Werden, Essen, Germany
| | | | | | - Esa Jantunen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Takashi Ishida
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ali Bazarbachi
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Francine Foss
- Yale University School of Medicine, New Haven, Connecticut
| | | | - Timothy S Fenske
- Department of Internal Medicine, Division of Hematology-Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Hillard M Lazarus
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | | | - Mahmoud Aljurf
- Oncology Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Lubomir Sokol
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute and Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida Tampa, Florida
| | - Kensei Tobinai
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Eric Tse
- Department of Medicine, The University of Hong Kong, Hong Kong
| | - Linda J Burns
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota
| | - Julio C Chavez
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute and Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida Tampa, Florida
| | | | - Ritsuro Suzuki
- Department of Oncology/Hematology, Shimane University Hospital, Shimane, Japan
| | - Sairah Ahmed
- University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | | | - Mohamad Mohty
- Saint-Antoine Hospital, Pierre and Marie Curie University, INSERM UMRs U938, Paris, France
| | - Ajay K Gopal
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | | | - Anna Sureda
- Clinical Hematology Department, Institut Català d'Oncologia, Barcelona, Spain
| | | | | | - Bipin N Savani
- Vanderbilt University Medical Center, Nashville, Tennessee
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Rezania D, Cualing HD, Ayala E. The Diagnosis, Management, and Role of Hematopoietic Stem Cell Transplantation in Aggressive Peripheral T-Cell Neoplasms. Cancer Control 2017; 14:151-9. [PMID: 17387300 DOI: 10.1177/107327480701400208] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Peripheral T-cell neoplasms (PTCNs) comprise a group of uncommon and heterogeneous lymphoid malignancies. They are more difficult to diagnose and treat and have a worse prognosis than B-cell lymphomas. Although PTCNs initially show a significant degree of chemosensitivity, the outcome of treatment with conventional dose chemotherapy remains poor. Methods We reviewed the literature on the diagnosis, treatment, and collective transplant reports regarding PTCNs. Results The correct diagnosis of peripheral T-cell lymphoma requires a combination of clinical presentation, morphology, immunophenotype, and molecular study. While no specific treatment other than conventional dose chemotherapy is currently available for aggressive PTCN, histone acetylase inhibitors and monoclonal antibodies such as anti-CD7 and anti-CD52 are being studied in T-cell malignancies. The role of autologous and allogeneic transplantation is being investigated for high-risk, relapsed, and refractory PTCNs with some promising results. Conclusions Access to hematopathology expertise in a tertiary care setting may lead to earlier and more accurate diagnoses of these diseases. PTCNs comprise a heterogeneous group of diseases with no widely accepted standard of care, and accurate determination of their histologic subtypes correlates with prognosis. Patients in first complete remission with poor risk features and patients with relapsed and refractory disease should be considered for bone marrow transplant due to the poor outcomes obtained with conventional chemotherapy.
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Affiliation(s)
- Dorna Rezania
- Blood and Marrow Transplant Program, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA
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Yang YT, Tai CJ, Chen C, Wu HC, Mikhaylichenko N, Chiu HT, Chen YY, Hsu YHE. Highly Diverse Efficacy of Salvage Treatment Regimens for Relapsed or Refractory Peripheral T-Cell Lymphoma: A Systematic Review. PLoS One 2016; 11:e0161811. [PMID: 27711130 PMCID: PMC5053427 DOI: 10.1371/journal.pone.0161811] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 08/12/2016] [Indexed: 12/21/2022] Open
Abstract
Background The goal of this study was to perform a systematic review to examine the efficacy and safety of various salvage therapy regimens on patients with relapsed/refractory PTCL. Method The electronic searches were performed using PubMed, Cochrane Library, EMBASE, and Web of Science from inception through June 2015, with search terms related to relapsed/refractory PTCL, salvage chemotherapy regimens, and clinical trials. An eligible study met the following inclusion criteria: (1) Patients had refractory or relapsed PTCL; (2) drug regimens were used for salvage therapy; (3) the study was a clinical trial; (4) the study reported on a series of at least 10 patients of PTCL. Results Of 35 records identified, a total of 14 studies were eligible for systematic reviews, and 12 different salvage regimens were investigated. A total of 618 relapsed/refractory PTCL patients were identified. The ORRs ranged from 22% for those treated with lenalidomide to 86% for those with brentuximab vedotin. By the three most frequent subtypes, the ORRs ranged from 14.2% to 71.5% for patients with the PTCL-NOS subtype, 8% to 54% for AITL subtypes, and 24% to 86% for the ALCL subtype. The medians of DOR, PFS, and OS ranged from 2.5 to 16.6 months, 2.6 to 13.3 months, and 3.6 to 14.5 months, respectively. The most frequently reported grade 3 or 4 adverse events (AEs) were hematological AEs, such as neutropenia and thrombocytopenia. Conclusion The efficacy of salvage therapy regimens is highly diverse for patients with relapsed/refractory PTCL; this heterogeneity in therapeutic effects might be due to the diversity in mechanisms, PTCL subtype distribution, and/or numbers/profiles of prior therapy. Comparative studies with matched pair analysis are warranted for more evidence of the salvage treatment effect on relapsed or heavily pretreated patients with PTCL.
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Affiliation(s)
- Ya-Ting Yang
- Institute of Health Policy and Management, National Taiwan University, 17 Xu-Zhou Rd., Taipei, 100, Taiwan
- Golden Dream Think Tank and Research Center, 17 Songjiang Rd., Taipei, 104, Taiwan
- School of Health Care Administration, Taipei Medical University, 250 Wuxing Street, Taipei, Taiwan
| | - Cheng-Jeng Tai
- Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University Hospital, 252 Wuxing Street, Taipei, 110, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, 250 Wuxing Street, Taipei, 110, Taiwan
| | - Chiehfeng Chen
- Center for Evidence-Based Medicine, Taipei Medical University, 250 Wuxing Street, Taipei, 110, Taiwan
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, 250 Wuxing Street, Taipei, 110, Taiwan
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, NO.111, Section 3, Hsing-Long Rd, Taipei, 116, Taiwan
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, NO.111, Section 3, Hsing-Long Rd, Taipei, 116, Taiwan
| | - Hong-Cheng Wu
- Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University Hospital, 252 Wuxing Street, Taipei, 110, Taiwan
| | | | - Hsien-Tsai Chiu
- Golden Dream Think Tank and Research Center, 17 Songjiang Rd., Taipei, 104, Taiwan
- Department of Public Health, China Medical University, 91 Hsueh-Shih Road, Taichung, 404, Taiwan
| | - Yun-Yi Chen
- Institute of Health Policy and Management, National Taiwan University, 17 Xu-Zhou Rd., Taipei, 100, Taiwan
- Golden Dream Think Tank and Research Center, 17 Songjiang Rd., Taipei, 104, Taiwan
| | - Yi-Hsin Elsa Hsu
- Golden Dream Think Tank and Research Center, 17 Songjiang Rd., Taipei, 104, Taiwan
- School of Health Care Administration, Taipei Medical University, 250 Wuxing Street, Taipei, Taiwan
- * E-mail:
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49
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Abstract
OBJECTIVES To investigate the clinicopathologic features of extranodal natural killer/T-cell lymphoma (ENKTL) not preceded by another Epstein-Barr virus (EBV)-related disorder in children and adolescents. METHODS A series of 17 cases of ENKTL not preceded by another EBV-related disorder in children and adolescents in one institution from China was retrospectively analyzed. RESULTS The patients had a median age of 13 years (range, 2-17 years), and the male to female ratio was 3.25:1. All the patients were of Chinese origin and without a history of another EBV-related disorder. The upper aerodigestive tract was involved in 14 (82.4%) cases, of which the sinonasal region was involved in 10 (58.8%) cases. Twelve (70.6%) patients had stage I/II disease. Morphologically, coagulative necrosis and angiocentric/angiodestructive growth pattern were observed in 94.1% (16/17) and 88.2% (15/17) of all cases, respectively. Thirteen (76.5%) cases were mainly composed of medium-sized cells. All cases expressed cytoplasmic CD3 and at least one marker for cytotoxic granules. CD56 expression was seen in 16 (94.1%) of 17 cases. Each case harbored EBV. CONCLUSIONS ENKTL not preceded by another EBV-related disorder in children and adolescents is occasionally observed in China. It tends to have a male predominance. The upper aerodigestive tract, especially the sinonasal region, is the most commonly involved site. The morphologic features and immunophenotype in children and adolescents are similar to that occurring in adults.
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Affiliation(s)
- Yuhua Huang
- From the Department of Pathology, Beijing Friendship Hospital, Capital Medical University Beijing, China; Department of Pathology, Shenzhen Second People's Hospital, Shenzhen, China
| | - Jianlan Xie
- From the Department of Pathology, Beijing Friendship Hospital, Capital Medical University Beijing, China
| | - Yi Ding
- From the Department of Pathology, Beijing Friendship Hospital, Capital Medical University Beijing, China; Department of Pathology, the First Affiliated Hospital of Xiamen University, China
| | - Xiaoge Zhou
- From the Department of Pathology, Beijing Friendship Hospital, Capital Medical University Beijing, China;
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50
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Tang T, Chen Z, Praditsuktavorn P, Khoo LP, Ruan J, Lim ST, Tan D, Phipps C, Lee YS, Goh YT, Hwang W, Tao M, Quek R, Farid M, Furman RR, Leonard JP, Martin P. Role of Surveillance Imaging in Patients With Peripheral T-Cell Lymphoma. Clin Lymphoma Myeloma Leuk 2015; 16:117-21. [PMID: 26796979 DOI: 10.1016/j.clml.2015.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 11/27/2015] [Accepted: 12/15/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The role of surveillance imaging (SI) in patients with peripheral T-cell lymphoma (PTCL) in first complete remission (CR1) is unclear. MATERIALS AND METHODS Patients with PTCL were identified through prospectively maintained T-cell lymphoma databases from the National Cancer Centre Singapore/Singapore General Hospital and Weill-Cornell Medical College after institutional review board approval. Patients with leukemia or indolent, composite, and cutaneous lymphomas were excluded. The patients' medical records were retrospectively reviewed to determine the frequency and type of SI used. Of those with relapse, the method of relapse detection and data on symptoms, signs, and elevated lactate dehydrogenase LDH were extracted. RESULTS A total of 338 patients were included in the present study. In the first year after achieving CR1, patients had an average of 1.2 and a median of 1 SI performed (range, 0-4). In the second year after achieving CR1, they had an average of 0.78 and a median of 1 SI performed (range, 0-4). Of the 135 patients who achieved CR1, 61 (45%) developed a relapse. Relapses were detected before SI in 48 (84%), and 9 patients had relapses detected during routine SI. Of the 9 patients whose relapses were detected during planned SI, only 3 did not have any symptoms or signs suggestive of relapsed disease. Of these 3 patients, 2 had angioimmunoblastic T-cell lymphoma and 1 had natural killer/T-cell lymphoma. CONCLUSION Most PTCL relapses were detected before planned SI, and most patients had symptoms with relapse. Only 3 patients (5.2%) were completely asymptomatic at relapse, suggesting a limited utility of routine imaging for detecting PTCL relapses.
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Affiliation(s)
- Tiffany Tang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore; Division of Hematology and Oncology, Weill Cornell Medical College, New York, NY.
| | - Zhengming Chen
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY
| | | | - Lay Poh Khoo
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Jia Ruan
- Division of Hematology and Oncology, Weill Cornell Medical College, New York, NY
| | - Soon Thye Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Daryl Tan
- Department of Hematology, Singapore General Hospital, Singapore, Singapore
| | - Colin Phipps
- Department of Hematology, Singapore General Hospital, Singapore, Singapore
| | - Yuh Shan Lee
- Department of Hematology, Singapore General Hospital, Singapore, Singapore
| | - Yeow Tee Goh
- Department of Hematology, Singapore General Hospital, Singapore, Singapore
| | - William Hwang
- Department of Hematology, Singapore General Hospital, Singapore, Singapore
| | - Miriam Tao
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Richard Quek
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Mohamad Farid
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Richard R Furman
- Division of Hematology and Oncology, Weill Cornell Medical College, New York, NY
| | - John P Leonard
- Division of Hematology and Oncology, Weill Cornell Medical College, New York, NY
| | - Peter Martin
- Division of Hematology and Oncology, Weill Cornell Medical College, New York, NY
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