Benefits of CHOP-14 Followed by Transplantation in Patients with Peripheral T-Cell Lymphoma.

Background: Compared to B-cell lymphomas, peripheral T-cell non-Hodgkin lymphomas (PTCL) represent a subtype that more frequently involve extranodal sites and worse relapse free survival (RFS) and overall survival (OS) with and without risk stratification by the international prognostic index (IPI). Moreover, while traditional anthracycline containing regimens can induce complete remission (CR), they have not significantly improved long-term outcomes for patients (pts) with PTCL and resulted in 5-year OS and failure-free survival of 26% and 20%, respectively. We examined the pathologic features and clinical presentation of pts with PTCL from Emory University Hospital to determine the outcome of PTCL patients treated with anthracycline based regimens and to investigate predictors for RFS. Methods: The Winship Cancer Institute Lymphoma database was screened to retrospectively identify all patients diagnosed with PTCL by the World Health Organization classification system. Patients were excluded if they had cutaneous T- cell lymphoma, anaplastic large cell lymphoma or if the pertinent prognostic and treatment information was incomplete. Review of historical pathology slides occurred when required to classify all cases into a WHO diagnosis category. Results: In total, 32 evaluable pts with PTCL diagnosed between 1994 and 2005 were identified. Median age at diagnosis was 46 years (range 18–74 years). 70%were male. PTCL subtypes were distributed as follows: 20 pts with peripheral T-cell lymphoma unspecified (PTCL-US) (61%), 7 with angioimmunoblastic T-NHL (21%), 4 with extranodal or nasal NK/T-cell lymphoma (12%), and one of each enteropathic and hepatosplenic T- NHL. Ten pts had confirmed gamma/delta T-cell gene rearrangement (30%). Most pts had advanced stage disease (79% stage IV, 9% stage III); 65% had IPI > 2. Fifteen pts had bone marrow involvement at diagnosis (45%) and 4 had biopsy proven skin involvement (12%). Twenty patients were treated with CHOP chemotherapy initially, 4 of whom received CHOP every 14 days with growth factor support (CHOP14), 8 patients received hyperCVAD/Mtx-Ara-C (HCVAD) and 5 received other regimens. Complete remission (CR) was achieved in 50% of pts who received CHOP, in 63% of pts with HCVAD and 17% of pts receiving other therapies. Three of the four pts who received CHOP-14 achieved CR. 50% of pt receiving CHOP21 and 75% of pts receiving HCVAD underwent stem cell transplantation at relapse (n=10) or in CR1 (n=3). All pts who received CHOP14 proceeded to planned SCT. Median RFS and OS were 7months (range 0.9–65) and 24 months (9–59) among patients who received any CHOP regimen, and were 8 months (1–50) and 20 months (5–54) among those who received HCVAD, respectively. Pts who received CHOP14 followed by planned transplantation had the longest RFS of any subgroup: 16 months (0.9–24). Kaplan-Maier OS curves for pts who received CHOP14, CHOP21, HCVAD, and other regimens are shown below. Conclusions: CHOP14 followed by planned stem cell transplantation may provide a platform for achieving CR and sustaining RFS in pts with PTCL. This treatment strategy is a promising one for study in prospective clinical trials of PTCL.