Cancer treatment source reading

Therapy involves doxorubicin-based combination chemotherapy such as cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or CHO(E)P (cyclophosphamide, doxorubicin, vincristine, etoposide, and prednisone). Doses are the same as those used for DLBCL.[7] For CD30-positive cases, brentuximab vedotin combined with cyclophosphamide, doxorubicin, and prednisone is the proposed standard of care.[8][Level of evidence C3] Patients with PTCL-NOS were included in the clinical trial involving mostly patients with anaplastic large cell lymphoma. A benefit for this smaller PTCL-NOS subgroup cannot be established.[8,9][Level of evidence C3] For more information, see the Treatment of Anaplastic Large Cell Lymphoma section.

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For patients with early-stage disease, anecdotal retrospective series disagree on the value of consolidative radiation therapy after combination chemotherapy.[10][Level of evidence C3] Consolidation therapy using high-dose chemotherapy with autologous or allogeneic hematopoietic stem cell transplant (SCT) has been given to patients with advanced-stage PTCL after induction therapy in multiple phase II or retrospective trials. Evidence for this approach is anecdotal.[11-18][Level of evidence C3]

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Evidence (CHOP, CHO[E]P, or other options for relapsing disease):

A randomized prospective trial included 104 patients younger than 61 years with stage II, III, or IV PTCL (excluding ALK-positive anaplastic large cell lymphoma). Patients received either autologous SCT or allogeneic SCT as consolidation therapy after induction with CHO(E)P followed by DHAP (dexamethasone, cytarabine, and cisplatin).[19][Level of evidence C3]

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A randomized prospective trial included 104 patients younger than 61 years with stage II, III, or IV PTCL (excluding ALK-positive anaplastic large cell lymphoma). Patients received either autologous SCT or allogeneic SCT as consolidation therapy after induction with CHO(E)P followed by DHAP (dexamethasone, cytarabine, and cisplatin).[19][Level of evidence C3]

With a median follow-up of 42 months, the 3-year EFS rate was 43% for patients who received allogeneic SCT and 38% for patients who received autologous SCT.

A randomized prospective trial included 104 patients younger than 61 years with stage II, III, or IV PTCL (excluding ALK-positive anaplastic large cell lymphoma). Patients received either autologous SCT or allogeneic SCT as consolidation therapy after induction with CHO(E)P followed by DHAP (dexamethasone, cytarabine, and cisplatin).[19][Level of evidence C3]

The 3-year OS rate was 57% for patients who received allogeneic SCT and 70% for patients who received autologous SCT (P = nonsignificant).

A randomized prospective trial included 104 patients younger than 61 years with stage II, III, or IV PTCL (excluding ALK-positive anaplastic large cell lymphoma). Patients received either autologous SCT or allogeneic SCT as consolidation therapy after induction with CHO(E)P followed by DHAP (dexamethasone, cytarabine, and cisplatin).[19][Level of evidence C3]

None of the 21 responding patients who proceeded to allogeneic SCT relapsed, and 36% of patients who proceeded to autologous SCT relapsed.

A randomized prospective trial included 104 patients younger than 61 years with stage II, III, or IV PTCL (excluding ALK-positive anaplastic large cell lymphoma). Patients received either autologous SCT or allogeneic SCT as consolidation therapy after induction with CHO(E)P followed by DHAP (dexamethasone, cytarabine, and cisplatin).[19][Level of evidence C3]

Eight of 26 patients (31%) who received allogeneic SCT died of graft-versus-host disease, and none of the 41 patients who received autologous SCT died of toxicity.

A randomized prospective trial included 104 patients younger than 61 years with stage II, III, or IV PTCL (excluding ALK-positive anaplastic large cell lymphoma). Patients received either autologous SCT or allogeneic SCT as consolidation therapy after induction with CHO(E)P followed by DHAP (dexamethasone, cytarabine, and cisplatin).[19][Level of evidence C3]

The benefit of graft-versus-lymphoma effect was negated by increased transplant-related mortality.

In a prospective trial of 109 evaluable patients with relapsing disease, treatment with pralatrexate resulted in a 30% response rate and a median 10-month duration of response.[20,21][Level of evidence C3]

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Similar response rates were seen in 130 evaluable patients with relapsing disease who received romidepsin in a prospective trial.[21][Level of evidence C3]

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Anecdotal responses have been seen with a combination of pralatrexate and romidepsin,[22] single-agent bendamustine,[23] belinostat,[24] and brentuximab vedotin (even if there is little or no CD30 expression on the lymphoma).[25][Level of evidence C3]Incorporation of these new agents with CHOP chemotherapy is under clinical evaluation.[3,8]

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Treatment Options for Peripheral T-Cell Lymphoma, Not Otherwise Specified

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