Skrypets T, Novosad O, Pastushenko Y, Gorbach O, Kriachok I
Klin Onkol. 2019 Fall;32(6):436-444. doi: 10.14735/amko2019436.
Peripheral T-cell lymphomas (PTCLs) is a diverse group of lymphomas (10-15% of all non-Hodgkins lymphomas) with aggressive behavior. Despite the standard of 1st line anthracycline-containing regimens, clinical outcomes are poor compared to B-cell lymphomas. In addition, there are still debates about specific prognostic factors (PF) in PTCLs.
Primary endpoints - event-free survival (EFS) and overall survival (OS). To evaluate the prognostic significance of five PTCLs scores (International Prognostic Index - IPI, International Peripheral T-cell lymphoma Project Score - IPTCL, Prognostic Index for T-cell lymphoma - PIT, modified Prognostic Index for T-cell lymphoma - mPIT and T-cell score).
From 67 enrolled patients, only 50 were included: PTCL not otherwise specified (22, 44%), anaplastic large cell lymphoma ALK+ (anaplastic lymphoma kinase-positive) (10, 20%) and ALK (anaplastic lymphoma kinase-negative) (18, 36%). Patients received CHOP-like regimens (CHOP, CHOEP, EPOCH).
The overall rate response was observed in 66% of cases (complete response 78%). There were 48% of relapses after the 1st line therapy during follow-up (median 11 months; range 1-85 months). Median age 57 (range 22-80) with male predominance 62%. In total, 40% of patients were > 60 years old, 48% had stage III-IV. Majority of patients were assessed by five prognostic scores. IPI (45 patients): the 3-year EFS and OS were higher for IPI 1 vs. IPI > 2 (80 vs. 18% and 87 vs. 27%, respectively; p = 0.0002). Receiver operating characteristic analysis confirmed poor clinical outcome to patients with PF > 1 (Se = 88 %; Sp = 68 %; AUC = 0.7; p = 0.0081). IPTCLP (41 patients): the presence of PF = 1-2 showed EFS and OS reduction. A 3-year EFS rate for 1-2 PF was 25 vs. 70% for PF = 0 (p = 0.003). Thus, 3-year OS in patients with PF = 0 vs. PF = 1-2 was 100 vs. 20% (p = 0.0001). PIT (42 patients): better 3-year EFS and OS in patients with PF = 0 vs. PF = 1-3 (88 vs. 28% and 100 vs. 34%, respectively, p = 0.001). Patients with PF = 1-3 have a higher rate of relapses vs. PF = 0 (p = 0.0005 by Cox-test). mPIT (21 patients): no significant difference between PF and clinical outcomes. T-cell score (18 patients): higher survival rates with PF 2. More than 2 PF have an impact on EFS (p = 0.005). The 3-years OS in patients with PF 2 was 77 vs. 25% in cases with PF 3 (p = 0.001).
IPI, PIT, IPTCLP are still very useful in defining risk stratification. As to mPIT and T-cell score, more patients to evaluate their prognostication possibility are needed.
外周T细胞淋巴瘤（PTCLs）是一组异质性淋巴瘤（占所有非霍奇金淋巴瘤的10 - 15%），具有侵袭性。尽管一线含蒽环类药物方案是标准治疗，但与B细胞淋巴瘤相比，临床结局较差。此外，关于PTCLs的特定预后因素（PF）仍存在争议。
主要终点——无事件生存期（EFS）和总生存期（OS）。评估五个PTCLs评分（国际预后指数 - IPI、国际外周T细胞淋巴瘤项目评分 - IPTCL、T细胞淋巴瘤预后指数 - PIT、改良T细胞淋巴瘤预后指数 - mPIT和T细胞评分）的预后意义。
67名入组患者中，仅50名被纳入：未另行指定的PTCL（22例，44%）；间变性大细胞淋巴瘤ALK +（间变性淋巴瘤激酶阳性）（10例，20%）和ALK（间变性淋巴瘤激酶阴性）（18例，36%）。患者接受类似CHOP的方案（CHOP、CHOEP、EPOCH）。
66%的病例观察到总体缓解率（完全缓解率78%）。随访期间一线治疗后有48%的复发（中位时间11个月；范围1 - 85个月）。中位年龄57岁（范围22 - 80岁），男性占62%。总共有40%的患者年龄>60岁，48%为III - IV期。大多数患者通过五个预后评分进行评估。IPI（45例患者）：IPI 1组的3年EFS和OS高于IPI>2组（分别为80%对18%和87%对27%；p = 0.0002）。受试者工作特征分析证实PF>1的患者临床结局较差（Se = 88%；Sp = 68%；AUC = 0.7；p = 0.0081）。IPTCLP（41例患者）：PF = 1 - 2的患者EFS和OS降低。PF = 1 - 2的患者3年EFS率为25%，而PF = 0的患者为70%（p = 0.003）。因此，PF = 0与PF = 1 - 2的患者3年OS分别为100%对20%（p = 0.0001）。PIT（42例患者）：PF = 0的患者3年EFS和OS优于PF = 1 - 3的患者（分别为88%对28%和100%对34%，p = 0.001）。PF = 1 - 3的患者复发率高于PF = 0的患者（Cox检验p = 0.0005）。mPIT（21例患者）：PF与临床结局之间无显著差异。T细胞评分（18例患者）：PF≤2的患者生存率较高。PF>2对EFS有影响（p = 0.005）。PF≤2的患者3年OS为
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