Management of advanced-stage peripheral T-cell lymphomas.
Peripheral T-cell lymphomas (PTCLs), several entities with great clinical, histologic, and biologic heterogeneity, represent 8% to 15% of all malignant lymphomas. With current treatment regimens, 5-year survival is only about 30% to 35%. Outcome is poorer with PTCL than with aggressive B-cell lymphoma because of more frequent adverse clinical features at diagnosis, a lower response rate to chemotherapy, and a higher incidence of relapses, but it is also known that the T-cell phenotype itself is associated with a poor prognosis independent of other prognostic factors. Initial treatment of patients with advanced-stage PTCL mostly consists of six to eight courses of anthracycline-based chemotherapy such as CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone). In fit elderly patients, standard therapy is still six cycles of CHOP-14, but up-front consolidation with intensive chemotherapy and autologous stem cell transplantation are often used in younger patients. The humanized CD52 monoclonal antibody alemtuzumab has shown activity in some T-cell malignancies; with appropriate antibiotic and virostatic prophylaxis, its use seems feasible for PTCL, both as a single agent and in conjunction with chemotherapy. New drugs such as denileukin diftitox, histone deacetylase inhibitors, and pralatrexate have shown promising activity in PTCL.
Kimby
Eva
E
Karolinska University Hospital, 141 86, Stockholm, Sweden. eva@kimby.se
D000074323:Alemtuzumab; D000818:Animals; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000627:therapeutic use; D015703:Antigens, CD / Q000276:immunology; D000951:Antigens, Neoplasm / Q000276:immunology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000074301:CD52 Antigen; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D015507:Drugs, Investigational / Q000627:therapeutic use; D005493:Folic Acid Antagonists / Q000627:therapeutic use; D006023:Glycoproteins / Q000276:immunology; D056572:Histone Deacetylase Inhibitors / Q000627:therapeutic use; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007167:Immunotherapy; D016411:Lymphoma, T-Cell, Peripheral / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D051379:Mice; D008819:Mice, Nude; D015337:Multicenter Studies as Topic; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D023041:Xenograft Model Antitumor Assays
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D015703:Antigens, CD; D000951:Antigens, Neoplasm; D000074301:CD52 Antigen; C000613862:CD52 protein, human; D015507:Drugs, Investigational; D005493:Folic Acid Antagonists; D006023:Glycoproteins; D056572:Histone Deacetylase Inhibitors; D007155:Immunologic Factors; D000074323:Alemtuzumab