Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands.
Department of Hematology, University Medical Center Groningen, Groningen, The Netherlands.
Blood Adv. 2024 Jul 23;8(14):3619-3628. doi: 10.1182/bloodadvances.2023012531.
Optimal treatment in patients with refractory or relapsed peripheral T-cell lymphomas (R/R T-NHLs) is unknown. In this population-based study, outcomes in R/R peripheral T-cell lymphoma not otherwise specified (PTCL NOS), angioimmunoblastic T-cell lymphoma (AITL), and anaplastic lymphoma kinase-positive (ALK+) and ALK-negative (ALK-) anaplastic large cell lymphoma (ALCL) were evaluated. Patients with PTCL NOS, AITL, ALK+ ALCL, and ALK- ALCL (≥18 years) diagnosed in 2014 to 2019 were identified using the Netherlands Cancer Registry. End points were overall response rate (ORR), progression-free survival (PFS), and overall survival (OS). The 2-year PFS of 821 patients was 57%. Among 311 patients with a relapse, 243 received second-line treatment: 44% received salvage chemotherapy, 20% received brentuximab vedotin (BV), and 36% received other treatment. In third-line treatment, BV was most commonly used (38%). ORR after second-line treatment was 47%. Two-year PFS and OS after relapse were 25% and 34%, respectively. The risk of second relapse was negatively affected by early relapse (<12 months after diagnosis), whereas BV reduced this risk compared with salvage chemotherapy. Reduced risk of relapse was independent of histological subtype. The best outcomes were observed for patients treated with salvage chemotherapy receiving consolidative autologous and allogeneic stem cell transplantation (SCT) (2-year OS 68%), patients treated with BV achieving a second complete remission (2-year OS 74%) and patients with allogeneic SCT (2-year OS 60%). The risk of second relapse was significantly lower for patients with R/R T-NHL treated with BV compared with patients treated with salvage chemotherapy, and this was irrespective of subtype. Therefore, the use of salvage chemotherapy for patients with R/R T-NHL is challenged.
对于难治性或复发性外周 T 细胞淋巴瘤（R/R T-NHL）患者，最佳治疗方法尚不清楚。在这项基于人群的研究中，评估了未特指的外周 T 细胞淋巴瘤（PTCL NOS）、血管免疫母细胞性 T 细胞淋巴瘤（AITL）、间变性淋巴瘤激酶阳性（ALK+）和 ALK-间变性大细胞淋巴瘤（ALCL）患者的结局。使用荷兰癌症登记处，确定了 2014 年至 2019 年期间诊断为 PTCL NOS、AITL、ALK+ ALCL 和 ALK- ALCL（≥18 岁）的患者。终点是总体缓解率（ORR）、无进展生存期（PFS）和总生存期（OS）。821 例患者的 2 年 PFS 为 57%。在 311 例复发患者中，243 例接受二线治疗：44%接受挽救化疗，20%接受 Brentuximab Vedotin（BV）治疗，36%接受其他治疗。三线治疗中，BV 最常用（38%）。二线治疗后的 ORR 为 47%。复发后的 2 年 PFS 和 OS 分别为 25%和 34%。第二次复发的风险受早期复发（<12 个月后诊断）的负面影响，而 BV 与挽救化疗相比降低了这种风险。复发风险的降低与组织学亚型无关。接受挽救化疗联合巩固性自体和同种异体干细胞移植（SCT）的患者（2 年 OS 为 68%）、接受 BV 治疗达到第二次完全缓解的患者（2 年 OS 为 74%）和接受同种异体 SCT 的患者（2 年 OS 为 60%）的治疗效果最佳。与接受挽救化疗的患者相比，R/R T-NHL 患者接受 BV 治疗的第二次复发风险显著降低，且与亚型无关。因此，挽救化疗的使用受到 R/R T-NHL 患者的挑战。
