Feldman Tatyana, Farber Charles M, Choi Kelly, Faria Claudio, Goy Andre, Connors Jacqueline, Paramanathan Dhakshila, Kaur Sukhi, Schultz Eric, McGuire Michael, Goldberg Stuart L
John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ.
Summit Medical Group, Morristown, NJ.
Clin Lymphoma Myeloma Leuk. 2017 Jun;17(6):354-361. doi: 10.1016/j.clml.2017.05.001. Epub 2017 May 10.
Peripheral T-cell lymphomas (PTCLs) represent a rare and heterogeneous group of malignancies that do not have consensus treatment recommendations. Strategies extrapolated from B-cell lymphoma have met with limited efficacy, although T-cell-specific salvage therapies have been recently developed.
To determine treatment patterns and associated outcomes in PTCL not otherwise specified (PTCL-NOS), anaplastic large T-cell lymphoma (ALCL), and angioimmunoblastic T-cell lymphoma (AITL), a retrospective analysis was undertaken at a large US community oncology network among patients treated between January 2010 and April 2015.
Among 93 patients (44 PTCL-NOS, 30 ALCL, 19 AITL), 23 unique treatments were used in 66 first-line patients and 12 unique second-line treatments were used in 24 relapsed/refractory patients. First-line CHOP and CHOP-like regimens were used in 74% of patients, providing 4-year overall survival (OS) outcomes of 34% (95% confidence interval [CI], 14%-83%) in patients without transplant consolidation (82% in ALCL, 37% in PTCL-NOS, and 0% in AITL). Upfront stem cell transplantation trended toward improved 4-year progression-free survival 77% (95% CI, 54%-100%) versus 34% (95% CI, 14%-80%); (P = .08; hazard ratio [HR] 0.29) with 4-year OS 77% (95% CI, 54%-100%) versus 34% (P = .22; HR 0.41). Brentuximab was the most common second-line therapy, with multiple additional regimens used in sequence (up to 5 salvage regimens) in many.
The significant variability in treatments used for PTCL emphasizes the lack of consensus therapy in this rarer lymphoma and calls for additional organized prospective and registry studies to evaluate comparative effectiveness.
外周T细胞淋巴瘤（PTCLs）是一类罕见且异质性的恶性肿瘤，目前尚无共识性的治疗推荐。尽管最近已开发出针对T细胞的挽救性疗法，但从B细胞淋巴瘤推断出的策略疗效有限。
为了确定未另行指定的PTCL（PTCL-NOS）、间变性大T细胞淋巴瘤（ALCL）和血管免疫母细胞性T细胞淋巴瘤（AITL）的治疗模式及相关结局，在美国一个大型社区肿瘤学网络中对2010年1月至2015年4月期间接受治疗的患者进行了回顾性分析。
在93例患者（44例PTCL-NOS、30例ALCL、19例AITL）中，66例一线患者使用了23种独特的治疗方法，24例复发/难治性患者使用了12种独特的二线治疗方法。74%的患者使用了一线CHOP及类似CHOP的方案，在未进行移植巩固的患者中，4年总生存率（OS）为34%（95%置信区间[CI]，14%-83%）（ALCL中为82%，PTCL-NOS中为37%，AITL中为0%）。 upfront干细胞移植在4年无进展生存率方面有改善趋势，分别为77%（95%CI，54%-100%）和34%（95%CI，14%-80%）；（P = 0.08；风险比[HR] 0.29），4年OS分别为77%（95%CI，54%-100%）和34%（P = 0.22；HR 0.41）。Brentuximab是最常见的二线治疗药物，许多患者还依次使用了多种其他方案（多达5种挽救方案）。
PTCL治疗方法的显著变异性强调了这种较罕见淋巴瘤缺乏共识性治疗方案，并呼吁开展更多有组织的前瞻性和登记研究以评估比较疗效。
