Elevated CRP Is Associated with Longer Survival of PTCL-NOS in Peripheral T-Cell Lymphomas: A Single Institution Research
Authors: Gunji Tadahiro , Terui Yasuhito , Takahashi Anna , Inoue Norihito , Kusano Yoshiharu , Nitta Hideaki , Ueda Kyoko , Nishimura Noriko , Mishima Yuko , Yokoyama Masahiro , Hatake Kiyohiko 
Published: October 2019

Abstract
Backgrounds
Peripheral T-cell lymphomas (PTCLs) are heterogeneous diseases on clinical, pathological, cytogenetic, and regional differences among their subtypes. When compared to B cell lymphomas, PTCLs generally have more dismal outcome with the exception of ALK-positive anaplastic large cell lymphoma (ALK+ALCL), mainly due to lower response rates and shorter duration of response with front line chemotherapy. Although some reports indicated that IPI and PIT were available as prognostic factors, we couldn't use them well to introduce more intensive therapy into poor prognostic groups in clinical practice. The aim of the present work was to show characteristics and response with front-line therapy and to reveal that prognostic factors (IPI/PIT) were available to identify poor outcome groups.
Material and Methods
We retrospectively collected from the computerized database of the patients diagnosed with PTCLs from December 2000 to December 2014 in our institution. We extracted 82 newly diagnosed patients with ALCL(N=15, 18%), Angioimmunoblastic T-cell lymphoma (AITL N=26, 32 %), Peripheral T-cell lymphoma, not otherwise specified(PTCL-NOS N=41, 50 %) and analyzed each patient's characteristic, prognostic index, extranodal disease, the response of front-line therapy, duration of response (DOR), progression free survival (PFS), and overall survival (OS). We also evaluated PFS and OS in ALCL and PTCL-NOS stratified by ALK-positive or -negative and PTCL-NOS stratified by IPI and PIT.
Results
We analyzed 78 PTCLs patients. Median age was 63 years (range 20-81).49 patients were male (63 %) and 29 were female (37 %).Follow-up period was from December 2014 to July 2015 and median follow-up time was 31 months (range 0-163). 16 (21 %) had an ECOG performance status > 0, 4 (5 %) had Bulky disease, 32 (41 %) had B symptoms, 57 (73 %) had Ann Arbor stage >II, and 57 (73 %) had IPI score >1. Splenomegaly and extranodal disease(more than one) were recognized with 28 patients (36 %), respectively. Bone marrow and skin were majority part of extranodal disease site.
Almost all patients were treated with CHOP or CHOP like chemotherapy. High dose chemotherapy with autologous stem cell transplantation (HDT/ASCT) was performed for 10 patients (PTCL-NOS N=4, ALCL N=5, AITL N=1) and 6 cases were up-front ASCT among them. Allogenic stem cell transplantation (allo-SCT) was undertaken for 3 cases. In analysis of each subtype, overall response rate (ORR) and complete remission (CR) rate were 74 % / 50 % in PTCL-NOS, 80 % / 60 % in ALCL (ALK positive 86 % / 72 %, ALK negative 75 % / 50 %) and 80 % / 68 % in AITL, respectively. The 5 years PFS and OS were 32 % / 51 % in PTCL-NOS, 47 % / 80 % in ALCL and 22 % / 34 % in AITL, respectively. ALK-positive ALCL was superior in DOR/PFS to ALK-negative as in the past. IPI tended to be able to predict survival of each group rather than PIT. The clinical parameter related to OS of PTCL-NOS in multivariate analysis was only elevated CRP (P=0.04: relative risk 3.12; 95% CI 1.003-9.706)
Conclusion
As is the published data, about half of PTCLs patients undertaken CHOP or CHOP like therapy achieved CR and AITL and PTCL-NOS in survival tended to be inferior to ALCL, but with no significant differences in this research(PFS:P=0.599 OS:P=0.21). We didn't demonstrated that PIT was useful as prognostic factors. Our data suggested that elevated CRP was associated with survival of PTCL-NOS in this study, thus further and large number study was needed to confirm that.

Disclosures
Nishimura: Chugai Pharmaceutical CO., LTD.: Consultancy. Mishima:Chugai Pharmaceutical CO., LTD.: Consultancy. Yokoyama:Chugai Pharmaceutical CO., LTD.: Consultancy. Hatake:Chugai Pharmaceutical CO., LTD.: Other: lecture speaking.