title: Peripheral T-cell lymphomas in a large US multicenter cohort: prognostication in the modern era including impact of frontline therapy.
abstract: BACKGROUND
  Optimal frontline therapy for peripheral T-cell lymphoma (PTCL) in the modern era remains unclear.
  
  
  METHODS
  We examined patient characteristics, treatment, and outcomes among 341 newly diagnosed PTCL patients from 2000 to 2011. Outcome was compared with a matched cohort of diffuse large B-cell lymphoma (DLBCL) patients, and prognostic factors were assessed using univariate and multivariate analyses.
  
  
  RESULTS
  PTCL subtypes included PTCL, not otherwise specified (PTCL-NOS) (31%), anaplastic large T-cell lymphoma (ALCL) (26%), angioimmunoblastic T-cell lymphoma (23%), NK/T-cell lymphoma (7%), acute T-cell leukemia/lymphoma (6%), and other (7%). Median age was 62 years (range 18-95 years), and 74% had stage III-IV disease. Twenty-three (7%) patients received only palliative care whereas 318 received chemotherapy: CHOP-like regimens (70%), hyperCVAD/MA (6%), or other (18%). Thirty-three patients (10%) underwent stem-cell transplantation (SCT) in first remission. The overall response rate was 73% (61% complete); 24% had primary refractory disease. With 39-month median follow-up, 3-year progression-free survival (PFS) and overall survival (OS) were 32% and 52%. PFS and OS for PTCL patients were significantly inferior to matched patients with DLBCL. On multivariate analysis, stage I-II disease was the only significant pretreatment prognostic factor [PFS: hazard ratio (HR) 0.54, 95% confidence interval (CI) 0.34-0.85, P = 0.007; OS: HR 0.42, 95% CI 0.22-0.78, P = 0.006]. ALK positivity in ALCL was prognostic on univariate analysis, but lost significance on multivariate analysis. The most dominant prognostic factor was response to initial therapy (complete response versus other), including adjustment for stage and SCT [PFS: HR 0.19, 95% CI 0.14-0.28, P < 0.0001; OS: HR 0.26, 95% CI 0.17-0.40, P < 0.0001]. No overall survival difference was observed based on choice of upfront regimen or SCT in first remission.
  
  
  CONCLUSIONS
  This analysis identifies early-stage disease and initial treatment response as dominant prognostic factors in PTCL. No clear benefit was observed for patients undergoing consolidative SCT. Novel therapeutic approaches for PTCL are critically needed.
authors.affiliation: Center for Lymphoma, Massachusetts General Hospital Cancer Center, Boston.
authors.forename: J S
authors.initials: JS
authors.lastname: Abramson
authors.affiliation: John Theurer Cancer Center, Hackensack University Medical Center, Hackensack.
authors.forename: T
authors.initials: T
authors.lastname: Feldman
authors.affiliation: Department of Hematology/Oncology, University of Massachusetts Medical School, Worcester.
authors.forename: A R
authors.initials: AR
authors.lastname: Kroll-Desrosiers
authors.affiliation: Department of Hematology/Oncology, University of Chicago, Chicago.
authors.forename: L S
authors.initials: LS
authors.lastname: Muffly
authors.affiliation: Department of Hematology/Oncology, Rhode Island Hospital, Providence.
authors.forename: E
authors.initials: E
authors.lastname: Winer
authors.affiliation: Department of Hematology/Oncology, Emory University School of Medicine, Atlanta.
authors.forename: C R
authors.initials: CR
authors.lastname: Flowers
authors.affiliation: Department of Hematology/Oncology, Dartmouth-Hitchcock Medical Center, Lebanon.
authors.forename: F
authors.initials: F
authors.lastname: Lansigan
authors.affiliation: Department of Hematology/Oncology, University of Chicago, Chicago.
authors.forename: C
authors.initials: C
authors.lastname: Nabhan
authors.affiliation: Department of Hematology/Oncology, Emory University School of Medicine, Atlanta.
authors.forename: L J
authors.initials: LJ
authors.lastname: Nastoupil
authors.affiliation: Department of Hematology/Oncology, University of Massachusetts Medical School, Worcester.
authors.forename: R
authors.initials: R
authors.lastname: Nath
authors.affiliation: John Theurer Cancer Center, Hackensack University Medical Center, Hackensack.
authors.forename: A
authors.initials: A
authors.lastname: Goy
authors.affiliation: Department of Hematology/Oncology, Miriam Hospital, Providence.
authors.forename: J J
authors.initials: JJ
authors.lastname: Castillo
authors.affiliation: Department of Hematology/Oncology, University of Massachusetts Medical School, Worcester.
authors.forename: D
authors.initials: D
authors.lastname: Jagadeesh
authors.affiliation: Department of Hematology/Oncology, University of Massachusetts Medical School, Worcester.
authors.forename: B
authors.initials: B
authors.lastname: Woda
authors.affiliation: Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago.
authors.forename: S T
authors.initials: ST
authors.lastname: Rosen
authors.affiliation: Department of Hematology/Oncology, University of Chicago, Chicago.
authors.forename: S M
authors.initials: SM
authors.lastname: Smith
authors.affiliation: Department of Hematology/Oncology, Tufts Medical Center, Boston, USA. Electronic address: aevens@tuftsmedicalcenter.org.
authors.forename: A M
authors.initials: AM
authors.lastname: Evens
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology*; D016411:Lymphoma, T-Cell, Peripheral / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011241:Prednisone / Q000008:administration & dosage; D011379:Prognosis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: PTCL; anaplastic large-cell lymphoma; angioimmunoblastic T-cell lymphoma; peripheral T-cell lymphoma; stem-cell transplantation