Abramson J S, Feldman T, Kroll-Desrosiers A R, Muffly L S, Winer E, Flowers C R, Lansigan F, Nabhan C, Nastoupil L J, Nath R, Goy A, Castillo J J, Jagadeesh D, Woda B, Rosen S T, Smith S M, Evens A M
Center for Lymphoma, Massachusetts General Hospital Cancer Center, Boston.
John Theurer Cancer Center, Hackensack University Medical Center, Hackensack.
Ann Oncol. 2014 Nov;25(11):2211-2217. doi: 10.1093/annonc/mdu443. Epub 2014 Sep 5.
Optimal frontline therapy for peripheral T-cell lymphoma (PTCL) in the modern era remains unclear.
We examined patient characteristics, treatment, and outcomes among 341 newly diagnosed PTCL patients from 2000 to 2011. Outcome was compared with a matched cohort of diffuse large B-cell lymphoma (DLBCL) patients, and prognostic factors were assessed using univariate and multivariate analyses.
PTCL subtypes included PTCL, not otherwise specified (PTCL-NOS) (31%), anaplastic large T-cell lymphoma (ALCL) (26%), angioimmunoblastic T-cell lymphoma (23%), NK/T-cell lymphoma (7%), acute T-cell leukemia/lymphoma (6%), and other (7%). Median age was 62 years (range 18-95 years), and 74% had stage III-IV disease. Twenty-three (7%) patients received only palliative care whereas 318 received chemotherapy: CHOP-like regimens (70%), hyperCVAD/MA (6%), or other (18%). Thirty-three patients (10%) underwent stem-cell transplantation (SCT) in first remission. The overall response rate was 73% (61% complete); 24% had primary refractory disease. With 39-month median follow-up, 3-year progression-free survival (PFS) and overall survival (OS) were 32% and 52%. PFS and OS for PTCL patients were significantly inferior to matched patients with DLBCL. On multivariate analysis, stage I-II disease was the only significant pretreatment prognostic factor [PFS: hazard ratio (HR) 0.54, 95% confidence interval (CI) 0.34-0.85, P = 0.007; OS: HR 0.42, 95% CI 0.22-0.78, P = 0.006]. ALK positivity in ALCL was prognostic on univariate analysis, but lost significance on multivariate analysis. The most dominant prognostic factor was response to initial therapy (complete response versus other), including adjustment for stage and SCT [PFS: HR 0.19, 95% CI 0.14-0.28, P < 0.0001; OS: HR 0.26, 95% CI 0.17-0.40, P < 0.0001]. No overall survival difference was observed based on choice of upfront regimen or SCT in first remission.
This analysis identifies early-stage disease and initial treatment response as dominant prognostic factors in PTCL. No clear benefit was observed for patients undergoing consolidative SCT. Novel therapeutic approaches for PTCL are critically needed.
现代外周T细胞淋巴瘤（PTCL）的最佳一线治疗方案仍不明确。
我们研究了2000年至2011年期间341例新诊断的PTCL患者的特征、治疗及预后。将预后与匹配的弥漫性大B细胞淋巴瘤（DLBCL）患者队列进行比较，并采用单因素和多因素分析评估预后因素。
PTCL亚型包括未另行特指的PTCL（PTCL-NOS）（31%）、间变性大T细胞淋巴瘤（ALCL）（26%）、血管免疫母细胞性T细胞淋巴瘤（23%）、NK/T细胞淋巴瘤（7%）、急性T细胞白血病/淋巴瘤（6%）及其他（7%）。中位年龄为62岁（范围18 - 95岁），74%的患者为Ⅲ - Ⅳ期疾病。23例（7%）患者仅接受姑息治疗，而318例接受化疗：CHOP样方案（70%）、hyperCVAD/MA（6%）或其他方案（18%）。33例（10%）患者在首次缓解期接受了干细胞移植（SCT）。总体缓解率为73%（61%为完全缓解）；24%的患者为原发性难治性疾病。中位随访39个月，3年无进展生存期（PFS）和总生存期（OS）分别为32%和52%。PTCL患者的PFS和OS显著低于匹配的DLBCL患者。多因素分析显示，Ⅰ - Ⅱ期疾病是唯一显著的治疗前预后因素[PFS：风险比（HR）0.54，95%置信区间（CI）0.34 - 0.85，P = 0.007；OS：HR 0.42，95% CI 0.22 - 0.78，P = 0.006]。ALCL中的ALK阳性在单因素分析中具有预后意义，但在多因素分析中失去显著性。最主要的预后因素是对初始治疗的反应（完全缓解与其他情况），包括对分期和SCT进行调整[PFS：HR 0.19，95% CI 0.14 - 0.28，P < 0.0001；OS：HR 0.26，95% CI 0.17 - 0.40，P < 0.0001]。基于初始方案的选择或首次缓解期的SCT，未观察到总生存期的差异。
该分析确定早期疾病和初始治疗反应是PTCL的主要预后因素。未观察到接受巩固性SCT的患者有明显获益。PTCL急需新的治疗方法。
