First-line therapy for T cell lymphomas: a retrospective population-based analysis of 906 T cell lymphoma patients.
Peripheral T cell lymphomas (PTLs) have a globally poor prognosis. The CHOP regimen shows insufficient efficacy; first-line consolidation with autologous stem cell transplantation (auto-SCT) is a promising strategy but has never been confirmed by randomized data. We analyzed retrospectively 906 patients diagnosed with PTL between 1999 and 2015. Chemotherapy was given to 862 patients, and 412 of them were < 60 years. In this subset, we compared induction with CHOP (n = 113) vs. CHOEP (n = 68) and tested auto-SCT (n = 79) vs. no SCT (n = 73) in the intent-to-treat analysis. The median age of the whole cohort at diagnosis was 60 years (range; 18-91); the median follow-up was 4.3 years (range; 0.1-17.8). A shorter overall survival (OS) was associated with the male gender, age ≥ 60 years, stage III/IV, performance status ≥ 2, bulky tumor ≥ 10 cm, and elevated LDH. CHOEP induction showed a better 5-year PFS (25.0% vs. 32.9%; p.001), and 5-year OS (65.6% vs. 47.6%; p.008) than CHOP. Auto-SCT compared to no SCT brought a 5-year OS of 49.2% vs. 59.5% (p.187). Auto-SCT did not influence the OS in low-risk or low-intermediate risk PTLs. The high-intermediate and high-risk IPIs displayed a worse 5-year OS in auto-SCT arm (17.7% vs.46.2%; p.049); however, 73.9% of the patients never received planned auto-SCT. Our population-based analysis showed the superiority of CHOEP over CHOP in first-line treatment. We confirm the 5-year OS of around 50% in PTLs undergoing auto-SCT. However, the intended auto-SCT could not be given in 73.9% of the high-risk PTLs.
['Janikova|Andrea|A|http://orcid.org/0000-0002-2647-7769', 'Chloupkova|Renata|R|', 'Campr|Vit|V|', 'Klener|Pavel|P|', 'Hamouzova|Jitka|J|', 'Belada|David|D|', 'Prochazka|Vit|V|', 'Pytlik|Robert|R|', 'Pirnos|Jan|J|', 'Duras|Juraj|J|', 'Mocikova|Heidi|H|', 'Bortlicek|Zbynek|Z|', 'Kopalova|Natasa|N|', 'Mayer|Jiri|J|', 'Trneny|Marek|M|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D000971:Antineoplastic Combined Chemotherapy Protocols D003520:Cyclophosphamide D018450:Disease Progression D004317:Doxorubicin D005047:Etoposide D005260:Female D018380:Hematopoietic Stem Cell Transplantation D006801:Humans D016411:Lymphoma, T-Cell, Peripheral D008297:Male D008875:Middle Aged D009367:Neoplasm Staging D011239:Prednisolone D011241:Prednisone D011379:Prognosis D012189:Retrospective Studies D012307:Risk Factors D016019:Survival Analysis D014182:Transplantation, Autologous D014750:Vincristine
T cell lymphoma Prognosis Auto-SCT Etoposide