title: Analysis of Peripheral T-cell Lymphoma Diagnostic Workup in the United States.
abstract: With increased understanding of the unique entities, subtype-specific approaches for peripheral T-cell lymphoma (PTCL) are emerging, and more precise diagnoses are becoming increasingly important. PATIENTS AND METHODS: We analyzed the approach to the histopathologic diagnosis of PTCL using data from the comprehensive oncology measures of peripheral T-cell lymphoma (COMPLETE) study. The COMPLETE trial is a large prospective cohort study of patients with newly diagnosed PTCL in the United States.
  
  
  
  A total of 499 patients were enrolled from 40 academic and 15 community-based centers. Baseline assessment forms were collected for 493 patients, of which 435 (88%) were available for analysis. The most common diagnoses were PTCL, not otherwise specified (PTCL-NOS), anaplastic large cell lymphoma, and angioimmunoblastic T-cell lymphoma (AITL). A mean of 10 markers (range, 0-21) was assessed per patient. CD30 was assessed frequently but not uniformly in cases that were not anaplastic large cell lymphoma. Only 17% of PTCL-NOS cases were assessed for PD1. CXCL13 was a relatively sensitive marker in AITL, expressed in 84% of tested cases; however, only 3% of PTCL-NOS cases were tested. T follicular helper cell marker assessment differed between academic and community practices, with PD1 more often evaluated by academic centers in cases of AITL (62% vs. 12%; P = .01).
  
  
  
  The diagnostic workup for PTCL in the United States varies widely and often lacks important phenotypic information to fully characterize the lymphoma. Gaps in testing of selected markers should be filled, given the impending revision to the World Health Organization classification. The accuracy of diagnosis will become increasingly important as we enter the era of targeted treatment for PTCL.
authors.affiliation: Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH. Electronic address: HSIE@ccf.org.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Hsi
authors.affiliation: Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Horwitz
authors.affiliation: Department of Medicine, Washington University, St Louis, MO.
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Carson
authors.affiliation: Department of Medicine, University of California, Los Angeles, Los Angeles, CA.
authors.forename: Lauren C
authors.initials: LC
authors.lastname: Pinter-Brown
authors.affiliation: Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA.
authors.forename: Steven T
authors.initials: ST
authors.lastname: Rosen
authors.affiliation: Department of Medicine, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Pro
authors.affiliation: Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Federico
authors.affiliation: Department of Hematology-Oncology, Hôpital Saint Louis, Paris, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Gisselbrecht
authors.affiliation: MedNet Solutions, Minnetonka, MN.
authors.forename: Marc
authors.initials: M
authors.lastname: Schwartz
authors.affiliation: MedNet Solutions, Minnetonka, MN.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Bellm
authors.affiliation: Research and Development, Spectrum Pharmaceuticals, Inc, Irvine, CA.
authors.forename: Mark
authors.initials: M
authors.lastname: Acosta
authors.affiliation: Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Collie
authors.affiliation: Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Gruver
authors.affiliation: Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH.
authors.forename: Bartosz J
authors.initials: BJ
authors.lastname: Grzywacz
authors.affiliation: Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH.
authors.forename: Samir
authors.initials: S
authors.lastname: Turakhia
authors.affiliation: Department of Medicine, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Andrei R
authors.initials: AR
authors.lastname: Shustov
authors.affiliation: Department of Medicine, Stanford University Medical Center, Stanford, CA.
authors.forename: Ranjana H
authors.initials: RH
authors.lastname: Advani
authors.affiliation: Department of Hematology/Oncology, Hackensack University Medical Center, Hackensack, NJ.
authors.forename: Tatyana
authors.initials: T
authors.lastname: Feldman
authors.affiliation: Department of Hematology and Oncology, Emory University, Atlanta, GA.
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Lechowicz
authors.affiliation: Department of Medicine, University of Chicago, Chicago, IL.
authors.forename: Sonali M
authors.initials: SM
authors.lastname: Smith
authors.affiliation: Department of Medicine, Dartmouth Hitchcock Medical Center, Hanover, NH.
authors.forename: Frederick
authors.initials: F
authors.lastname: Lansigan
authors.affiliation: Department of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Anil
authors.initials: A
authors.lastname: Tulpule
authors.affiliation: Department of Medicine, West Virginia University, Morgantown, WV.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Craig
authors.affiliation: Department of Hematology, Vanderbilt University, Nashville, TN.
authors.forename: John P
authors.initials: JP
authors.lastname: Greer
authors.affiliation: Department of Medicine, University of Wisconsin, Madison, WI.
authors.forename: Brad S
authors.initials: BS
authors.lastname: Kahl
authors.affiliation: Minnesota Oncology, Virginia Piper Cancer Institute, Minneapolis, MN.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Leach
authors.affiliation: Overlook Medical Center, Summit, NJ.
authors.forename: Neil
authors.initials: N
authors.lastname: Morganstein
authors.affiliation: Department of Medicine, University of Rochester, Rochester, NY.
authors.forename: Carla
authors.initials: C
authors.lastname: Casulo
authors.affiliation: Department of Internal Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC.
authors.forename: Steven I
authors.initials: SI
authors.lastname: Park
authors.affiliation: Department of Medical Oncology, Yale University, New Haven, CT.
authors.forename: Francine M
authors.initials: FM
authors.lastname: Foss
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism; D054382:Chemokine CXCL13 / Q000378:metabolism; D005260:Female; D006801:Humans; D007119:Immunoblastic Lymphadenopathy / Q000175:diagnosis / Q000473:pathology; D017728:Lymphoma, Large-Cell, Anaplastic / Q000175:diagnosis / Q000473:pathology; D016411:Lymphoma, T-Cell, Peripheral / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014481:United States; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; C110663:CXCL13 protein, human; D054382:Chemokine CXCL13
keywords: Biomarkers; Diagnosis; Histopathologic type; Practice; Prospective studies