title: Changing the paradigms of treatment in peripheral T-cell lymphoma: from biology to clinical practice.
abstract: Despite enormous advances in our understanding of aggressive lymphomas, it is clear that progress in the peripheral T-cell lymphomas (PTCL) has lagged well behind other B-cell malignancies. Although there are many reasons for this, the one commonly cited notes that the paradigms for diffuse large B-cell lymphoma (DLBCL) were merely applied to all patients with PTCL, the classic "one-size-fits-all" approach. Despite these challenges, progress is being made. Recently, the FDA has approved four drugs for patients with relapsed/refractory PTCL over the past 5 years, and if one counts the recent Japanese approval of the anti-CCR4 monoclonal antibody for patients with adult T-cell leukemia/lymphoma, five drugs have been approved worldwide. These efforts have led to the initiation of no fewer than four randomized clinical studies exploring the integration of these new agents into standard CHOP (cyclophosphamide-Adriamycin-vincristine-prednisone)-based chemotherapy regimens for patients with newly diagnosed PTCL. In addition, a new wave of studies are exploring the merits of novel drug combinations in the disease, an effort to build on the obvious single-agent successes. What has emerged most recently is the recognition that the PTCL may be a disease-characterized by epigenetic dysregulation, which may help explain its sensitivity to histone deacetylase (HDAC) inhibitors, and open the door for even more creative combination approaches. Nonetheless, advances made over a relatively short period of time are changing how we now view these diseases and, hopefully, have poised us to finally improve its prognosis. See all articles in this CCR Focus section, "Paradigm Shifts in Lymphoma."
authors.affiliation: Center for Lymphoid Malignancies, Department of Medicine, Columbia University Medical Center, The New York Presbyterian Hospital, New York, New York. owenoconnor@columbia.edu.
authors.forename: Owen A
authors.initials: OA
authors.lastname: O'Connor
authors.affiliation: Division of Hematopathology, Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York.
authors.forename: Govind
authors.initials: G
authors.lastname: Bhagat
authors.affiliation: Division of Hematopathology, Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York.
authors.forename: Karthik
authors.initials: K
authors.lastname: Ganapathi
authors.affiliation: Department of Hematology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Martin Bjerregaard
authors.initials: MB
authors.lastname: Pedersen
authors.affiliation: Department of Hematology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Francesco
authors.initials: F
authors.lastname: D'Amore
authors.affiliation: Center for Lymphoid Malignancies, Department of Medicine, Columbia University Medical Center, The New York Presbyterian Hospital, New York, New York.
authors.forename: Dejan
authors.initials: D
authors.lastname: Radeski
authors.affiliation: Developmental Therapeutics Branch, National Cancer Institute, Bethesda, Maryland.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Bates
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002471:Cell Transformation, Neoplastic / Q000235:genetics / Q000378:metabolism; D020022:Genetic Predisposition to Disease; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016411:Lymphoma, T-Cell, Peripheral / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D009364:Neoplasm Recurrence, Local