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First-line therapy for T cell lymphomas: a retrospective population-based analysis of 906 T cell lymphoma patients

A. Janikova, R. Chloupkova, V. Campr, P. Klener, J. Hamouzova, D. Belada, V. Prochazka, R. Pytlik, J. Pirnos, J. Duras, H. Mocikova, Z. Bortlicek, N. Kopalova, J. Mayer, M. Trneny,

. 2019 ; 98 (8) : 1961-1972. [pub] 20190508

Language English Country Germany

Document type Journal Article

Persistent link   https://www.medvik.cz/link/bmc19034584

Grant support
AZV CR 16-31092A Ministry of Education and Youth of the Czech Republic
NV16-31092A MZ0 CEP Register

Peripheral T cell lymphomas (PTLs) have a globally poor prognosis. The CHOP regimen shows insufficient efficacy; first-line consolidation with autologous stem cell transplantation (auto-SCT) is a promising strategy but has never been confirmed by randomized data. We analyzed retrospectively 906 patients diagnosed with PTL between 1999 and 2015. Chemotherapy was given to 862 patients, and 412 of them were < 60 years. In this subset, we compared induction with CHOP (n = 113) vs. CHOEP (n = 68) and tested auto-SCT (n = 79) vs. no SCT (n = 73) in the intent-to-treat analysis. The median age of the whole cohort at diagnosis was 60 years (range; 18-91); the median follow-up was 4.3 years (range; 0.1-17.8). A shorter overall survival (OS) was associated with the male gender, age ≥ 60 years, stage III/IV, performance status ≥ 2, bulky tumor ≥ 10 cm, and elevated LDH. CHOEP induction showed a better 5-year PFS (25.0% vs. 32.9%; p.001), and 5-year OS (65.6% vs. 47.6%; p.008) than CHOP. Auto-SCT compared to no SCT brought a 5-year OS of 49.2% vs. 59.5% (p.187). Auto-SCT did not influence the OS in low-risk or low-intermediate risk PTLs. The high-intermediate and high-risk IPIs displayed a worse 5-year OS in auto-SCT arm (17.7% vs.46.2%; p.049); however, 73.9% of the patients never received planned auto-SCT. Our population-based analysis showed the superiority of CHOEP over CHOP in first-line treatment. We confirm the 5-year OS of around 50% in PTLs undergoing auto-SCT. However, the intended auto-SCT could not be given in 73.9% of the high-risk PTLs.

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$a Peripheral T cell lymphomas (PTLs) have a globally poor prognosis. The CHOP regimen shows insufficient efficacy; first-line consolidation with autologous stem cell transplantation (auto-SCT) is a promising strategy but has never been confirmed by randomized data. We analyzed retrospectively 906 patients diagnosed with PTL between 1999 and 2015. Chemotherapy was given to 862 patients, and 412 of them were < 60 years. In this subset, we compared induction with CHOP (n = 113) vs. CHOEP (n = 68) and tested auto-SCT (n = 79) vs. no SCT (n = 73) in the intent-to-treat analysis. The median age of the whole cohort at diagnosis was 60 years (range; 18-91); the median follow-up was 4.3 years (range; 0.1-17.8). A shorter overall survival (OS) was associated with the male gender, age ≥ 60 years, stage III/IV, performance status ≥ 2, bulky tumor ≥ 10 cm, and elevated LDH. CHOEP induction showed a better 5-year PFS (25.0% vs. 32.9%; p.001), and 5-year OS (65.6% vs. 47.6%; p.008) than CHOP. Auto-SCT compared to no SCT brought a 5-year OS of 49.2% vs. 59.5% (p.187). Auto-SCT did not influence the OS in low-risk or low-intermediate risk PTLs. The high-intermediate and high-risk IPIs displayed a worse 5-year OS in auto-SCT arm (17.7% vs.46.2%; p.049); however, 73.9% of the patients never received planned auto-SCT. Our population-based analysis showed the superiority of CHOEP over CHOP in first-line treatment. We confirm the 5-year OS of around 50% in PTLs undergoing auto-SCT. However, the intended auto-SCT could not be given in 73.9% of the high-risk PTLs.
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$a Chloupkova, Renata $u Institute of Biostatistics and Analyses, Faculty of Medicine Masaryk University, Brno, Czech Republic.
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$a Campr, Vit $u Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Faculty Hospital in Motol, Prague, Czech Republic.
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$a Klener, Pavel $u 1st Department of Medicine, First Medical Faculty, Charles University and General University Hospital, Prague, Czech Republic.
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$a Hamouzova, Jitka $u 1st Department of Medicine, First Medical Faculty, Charles University and General University Hospital, Prague, Czech Republic.
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$a Belada, David $u 4th Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic.
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$a Prochazka, Vit $u Department of Hematology, University Hospital Olomouc, Olomouc, Czech Republic.
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$a Pytlik, Robert $u 1st Department of Medicine, First Medical Faculty, Charles University and General University Hospital, Prague, Czech Republic.
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$a Pirnos, Jan $u Department of Oncology, Hospital Ceske Budejovice, Ceske Budejovice, Czech Republic.
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$a Duras, Juraj $u Department of Clinical Hematology, Teaching Hospital Ostrava, Ostrava, Czech Republic.
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$a Mocikova, Heidi $u Internal Clinic of Haematology, University Hospital Kralovske Vinohrady, Prague, Czech Republic. 3rd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
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$a Bortlicek, Zbynek $u Institute of Biostatistics and Analyses, Faculty of Medicine Masaryk University, Brno, Czech Republic.
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$a Mayer, Jiri $u Department of Internal Medicine-Hematology and Oncology, Masaryk University and University Hospital Brno, Jihlavska 20, 62500, Brno, Czech Republic.
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