scholarly journals Efficacy of Orally VP16 Plus Prednisone with or without Cyclophosphamide for Refractory and Relapsed Peripheral T-Cell Lymphoma: A Retrospective Single Center Experience

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 6020-6020
Author(s):  
Anne-Blandine Boutin ◽  
Marjan Ertault de la Bretonnière ◽  
Helene Monjanel ◽  
Marlene Ochmann ◽  
Hélène Doyen ◽  
...  
Keyword(s):  
Adverse Event ◽  
T Cell ◽  
Progressive Disease ◽  
Cell Lymphoma ◽  
T Cell Lymphoma ◽  
Peripheral T Cell Lymphoma ◽  
End Of Treatment ◽  
Time To Initiation ◽  
Haematological Adverse Event

Abstract Background: Peripheral T-cell lymphoma represents a heterogeneous group of mature T/NK lymphoma with an aggressive presentation course and a poor outcome. Disease history is characterized by a high degree of relapsed or refractory disease and an inferior outcome. Etoposide phosphate (VP16) is a non-specific antineoplastic agent frequently used in combination in oncology since 50 years. The major mechanism of action of etoposide is the inhibition of DNA topoisomerase II involved in the unwinding of the DNA molecule during replication. A recent preclinical study suggests an immunomodulatory effect of etoposide by selectively eliminating activated T cells. Specific efficacy of VP16 in T-cell lymphoma and especially in AITL had not been described. Methods: We retrospectively analyzed data on adult patients with refractory or relapsed angioimmunoblastic T-cell lymphoma (AITL), anaplastic large cell lymphoma and peripheral T-cell lymphoma not otherwise specified (PTCL-NOS) treated in the university hospital center of Tours (France) by VP16 with or without cyclophosphamide between January 1992 and June 2014. VP16 was administrated orally at 75mg daily continuously or at 100 mg/m² daily for 3 days in 15-day cycles if it was associated with oral cyclophosphamide (150mg/m² daily for 3 days). Treatment was associated with prednisone 60 mg/m²/day. All responses were described according to Cheson criteria (2007). Adverse event were reported according to CTCAE (Common Toxicity Criteria of Adverse Events). Treatment was prescribed until progressive disease, intensive therapy or death, and could be stopped according to clinician appreciation after prolonged remission. Overall survival (OS) and event-free survival (EFS) were estimated since time to initiation of VP16 using the method of Kaplan and Meier. Event was defined as disease progression, death or change of treatment for any cause (toxicity, allograft etc.). Results: A total of 23 patients were enrolled : 13 AITCL, 2 anaplastic lymphoma (all of them were ALK-negative) and 8 PTCL-NOS. Median age at diagnostic was 57.3 years (range, 31-80) with a male preponderance (14/9). Most patients had B-symptoms (n=14) and advanced stage (n=19) with more than one extranodal site for 10 patients. Lactate deshydrogenase was upper normal value for 14 patients. The median number of prior systemic therapies was two (range, 2 to 4). Five patients received VP16 with cyclophosphamide. The overall response rate (ORR) was 65.2% (15 of 23), including 39.1% complete response (CR) (9 of 23). With a median follow up of 64.8 months (range, 33.7 to 96), the median OS was 39 months (95% IC: 4 months-not reached), and EFS 5 months (95% IC: 3 to 39) (Figure 1 and 2). Median duration of treatment was 15 months (range, 1 to 91). For AITL, the ORR was 69.2% (9 of 13), including 46.2% CR (6 of 13). The median OS was 77 months (95% IC : 5 months-not reached), and EFS 39 months (95% IC : 3-73). One haematological adverse event ≥grade 3 induced end of treatment, none extra-haematological adverse event was reported. Three patients received intensive regimen follow by allogenic stem cells transplantation and two of them (both AITL) after the response obtained with VP16. Progressive disease was the main cause of end of treatment (n=15) and of death (n=9). Patients treated with VP16 and cyclophosphamide had the same outcome than those treated with VP16 alone. For the 9 patients who reached a CR, 7 are still under CR at the end of follow up with median time of response of 67.4 months (range, 3 to 244). Conclusion: With or without cyclophosphamide, VP16 seems to be an effective and safe treatment for relapsed and refractory PTCL. AITL could have a higher sensibility to VP16 than other subtypes with durable responses. A prospective study should confirm these results, even for patient eligible for transplant program. Finally, orally VP16 can be an effective alternative treatment for unfit patients who cannot be included in clinical studies evaluating novel agents for PTCL. Figure 1: Survival since time to initiation of VP16 with or without cyclophosphamide (n=23) Figure 1:. Survival since time to initiation of VP16 with or without cyclophosphamide (n=23) Figure 2 Figure 2. Disclosures No relevant conflicts of interest to declare.

Late Relapses Characterize Autologous Transplantation (ASCT) in First Complete Remission (CR) for Peripheral T-Cell Lymphoma (PTCL).

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 5110-5110 ◽  
Author(s):  
Tarun Kewalramani ◽  
Steve Horwitz ◽  
Andrew D. Zelenetz ◽  
Stephen D. Nimer ◽  
Craig H. Moskowitz
Keyword(s):  
T Cell ◽  
Median Time ◽  
Progressive Disease ◽  
Cell Lymphoma ◽  
Autologous Transplantation ◽  
Conditioning Regimen ◽  
Allogeneic Transplantation ◽  
T Cell Lymphoma ◽  
Time To Progression

With the exception of ALK-positive anaplastic large cell lymphoma (ALCL), standard-dose chemotherapy is curative in a minority of patients (pts) with PTCL, and most pts have progressive disease less than 2 years from completing treatment. Several studies suggest that ASCT in 1st CR significantly improves the short-term outcome of pts with PTCL, but its long-term efficacy is not known. To address this, we assessed the outcome of sequential patients who underwent ASCT in 1st CR (n=15). Histologic subtypes were PTCL, unspecified, in 6 pts, angioimmunoblastic T-cell lymphoma in 5 pts, ALK-negative ALCL in 3 pts and hepatosplenic gamma delta T-cell lymphoma in 1 pt. Induction chemotherapy was CHOP (n=2) or CHOP-ICE hybrid (n=12) in 93% of pts. The age-adjusted IPI (AAIPI) was 2–3 in 9 of 14 assessable patients (64%), and 11 pts (73%) had stage III–IV disease. The conditioning regimen consisted of BEAM or CBV in 10 pts and TBI/Cy/VP-16 in 5 pts. All patients received peripheral blood progenitor cells for hematopoietic support. The median follow-up of all patients is 24 months (range 4.5–70). Five pts (33%) have progressed, with a median time to progression of 50 months (range 10–70). Four of the 5 pts who progressed did so more than 2 years from ASCT; they comprise 57% of patients with more than 2-years of follow-up. Four of 5 patients with progressive disease have died, with a median time from progression to death of 1 month (0.6–14.6). In this small series the AAIPI was not predictive of PFS or OS. While our results confirm the that ASCT in 1st CR significantly delays the time to progression, they suggest that it may not be curative in the majority of patients. If confirmed in ongoing larger prospective studies, this observation warrants trials of post-ASCT maintenance treatment and, for younger patients, trials of allogeneic transplantation in 1st CR or sequential ASCT followed by allogeneic transplantation. Figure Figure

Cutaneous Toxicity Associated with Pralatrexate in Cutaneous and Peripheral T-Cell Lymphoma

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3660-3660 ◽  
Author(s):  
Terri L. Parker ◽  
Lisa Barbarotta ◽  
Michael Girardi ◽  
Francine M. Foss
Keyword(s):  
Adverse Event ◽  
Data Analysis ◽  
T Cell ◽  
Cell Lymphoma ◽  
Median Number ◽  
T Cell Lymphoma ◽  
Cutaneous T Cell Lymphoma ◽  
Peripheral T Cell Lymphoma ◽  
Cutaneous Toxicity ◽  
Off Label

Abstract Abstract 3660 Background: Pralatrexate is a folate analogue metabolic inhibitor that is approved for the treatment of relapsed or refractory peripheral T-cell lymphoma (PTCL) (O'Connor, O.A. et al. JCO. 2011 29: 1181–1189). More recently, pralatrexate has been investigated for the treatment of relapsed or refractory cutaneous T-cell lymphoma (CTCL) (Horowitz, S.M. et al. Blood. 2012 119: 4115–4122). The most common adverse event (AE) observed with pralatrexate has been mucositis with other reported AEs consisting of fatigue, nausea, and cutaneous toxicity. Methods: We retrospectively analyzed the data of 22 patients who had received pralatrexate for a diagnosis of either PTCL or CTCL at our institution since 2010 in order to determine the incidence of cutaneous toxicity. Results: Of the 22 patients, 4 had a diagnosis of PTCL, 18 had CTCL. In the PTCL cohort, the median age was 66.5 with the median number of prior treatments (nonsystemic and systemic) being 2.75. One patient (25%) developed cutaneous toxicity which resulted in death. A skin biopsy revealed toxic erythema of chemotherapy and the skin lesions progressed to bullae and moist desquamation. In the CTCL cohort, the median age was 60 with the median number of treatments being 5. A total of 14 patients (78%) developed cutaneous toxicity. The toxicity included worsening erythema, skin breakdown, ulceration, and pain at the CTCL lesion sites. The majority of patients (n= 10; 71%) developed the toxicity following cycle 1 week 1 of treatment. The development of cutaneous toxicity was seen in 8 patients at a dose of 15mg/m2, in 3 patients at a dose of 10mg/m2, and in 2 patients who underwent dose escalations to 17.5mg/m2 and 20mg/m2respectively. Of those patients who developed cutaneous toxicity, 8 (57%) required the pralatrexate to be held and 2 patients (14%) required hospitalization and treatment with intravenous antibiotics for superimposed skin infection. The cutaneous toxicity observed was not associated with any other adverse event. Seven patients (39%) in the entire CTCL cohort developed grade I/II mucositis and 3 (17%) developed grade I diarrhea. In 7 patients (50%) the pralatrexate was restarted at a lower dose, 3 patients were changed to an every other week dosing schedule, and 2 patients continued on pralatrexate with no change following resolution of their symptoms. Only 2 patients were not continued on pralatrexate following the cutaneous toxicity. In all 12 patients who were retreated with pralatrexate, cutaneous toxicity did not reoccur and the dose was able to be escalated. At the time of data analysis, 7 patients remained on treatment with pralatrexate while the remainder had discontinued therapy secondary to disease progression. Conclusions: In this retrospective review, a high incidence of cutaneous toxicity was seen in CTCL patients who were treated with pralatrexate. The cutaneous toxicity might be interpreted as a “skin flare” since it may be concentrated at sites of CTCL lesions. The majority of patients developed the toxicity with the first dose and were able to continue on pralatrexate at a lower dose with eventual dose escalation. Based on data analysis, the “skin flare” is not dose dependent or associated with disease response. Disclosures: Off Label Use: Pralatrexate is FDA approved for the treatment of relapsed or refractory peripheral T-cell lymphoma. Our abstract discusses its use, specifically the cutaneous toxicity observed, in both peripheral and cutaneous T-cell lymphoma. The use of pralatrexate in relapsed or refractory cutaneous T-cell lymphoma is off-label. Barbarotta:Genentech: Speakers Bureau; Allos: Speakers Bureau. Foss:Seattle Genetics: Consultancy; Celgene: Consultancy; Eisai: Consultancy; Celgene: Study Grant, Study Grant Other; Merck: Study Grant, Study Grant Other; Allos: Consultancy.

Utility of Interim and Post-Therapy PET/CT in T-Cell and NK-Cell Lymphoma: A Single Institutional Analysis over 9 Years

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3915-3915
Author(s):  
Kota Fukumoto ◽  
Manabu Fujisawa ◽  
Yasuhito Suehara ◽  
Yoshiaki Usui ◽  
Kentaro Narita ◽  
...  
Keyword(s):  
T Cell ◽  
Nk Cell ◽  
Cell Lymphoma ◽  
T Cell Lymphoma ◽  
Peripheral T Cell Lymphoma ◽  
Index Lesion ◽  
Pet Ct ◽  
Post Therapy ◽  
Initial Staging

Abstract Introduction: Positron emission tomography combined with computed tomography (PET-CT) is functional imaging test and has been widely used in malignant lymphoma (ML) for initial staging and monitoring response to treatment. Interim PET-CT (iPET) and post-therapy PET-CT (ePET) is also used to assess the early response and guide subsequent treatment, although its role is still controversial other than in Hodgkin's disease and diffuse large B cell lymphoma. Peripheral T cell lymphoma (PTCL) and natural killer (NK) cell lymphomas are relatively rare and heterogeneous types of ML. The prognosis of T and NK (T/NK) cell lymphoma is poor and no standard treatment is available. Therefore, there is a need to find better prognostic factors or tools for these patients. PET-CT is both sensitive and specific for initial staging of T/NK cell lymphoma, although there have been few studies using i- and ePET in these lymphomas. We investigated the prognostic value of i- and ePET in T/NK cell lymphoma in a retrospective single-center study. Methods: Between June 2006 and June 2015, 79 patients with T/NK cell lymphomas had iPET after 2 to 4 courses of treatment and at the end of treatment at Kameda Medical Center, Japan. iPET was performed just before the next cycle of treatment. Treatment responses were scored according to the Deauville score using a 5-point scale (DS). We defined DS scores 1 - 3 as complete metabolic response (CMR). Standardized uptake value (SUV) measurement was normalized relative to the injected dose and lean body mass. The SUV was measured for all lesions and the highest value for each scan was recorded as maximum SUV (SUVmax). These lesions were identified as indicator lesions. For mid- and end-treatment scans, we recorded the change in SUVmax (DSUV), comparing the index lesion and the highest SUVmax in the scan regardless of the index lesion. Differences in overall survival (OS) and progression-free survival (PFS) were calculated by two-sided log-rank test. PET-CT status was assessed for its ability to predict PFS and OS. Results: The study population consisted of 48 men and 31 women with a median age of 70 years. The most frequent lymphoma diagnoses were peripheral T cell lymphoma-not otherwise specified (PTCL-NOS) (n  = 29), angioimmunoblastic T cell lymphoma (AITL) (n  = 21), anaplastic large cell lymphoma (ALCL) (n  = 6), adult T cell leukemia/lymphoma (ATLL) (n  = 12), enteropathy-associated T cell lymphoma (EATL) (n  = 2), and NK/T cell lymphoma (NKTCL) (n  = 9). Most patients except for ATLL and NK cell lymphoma were instituted with the CHOP-like regimen. Baseline PET scan was positive in all cases and median SUVmax was 13.7 (range, 2.6 - 37.4). iPET results were negative in 17 cases (26%), and ePET results were negative in 22 of 46 (48%) cases. With a median follow up of 30 months, 5-year PFS rate was 66% for obtaining CMR vs. 9.2% for not obtaining CMR (P  < 0.001). The percentages of patients that obtained CMR were 48% (14/29), 62% (13/21), 67% (4/6), 33% (3/9), 50% (1/2), and 56% (5/9) for those with PTCL-NOS, AITL, ALCL, ATLL, EATL, and NKTCL, respectively. The patients who obtained CMR showed significantly longer PFS and OS compared to those who did not. We also analyzed DSUVmax. Using the ROC curve, DSUVmax values between baseline and iPET of > 62% and > 85% were predictive of better PFS and OS (sensitivity 96%, specificity 67%, area under the curve (AUC) 0.89, 95% confidence interval (CI) = 0.82 - 0.97 and sensitivity 49%, specificity 97%, AUC 0.80, 95% CI = 0.70 - 0.90, respectively). We examined the positive and negative predictive values (PPV and NPV) and accuracy in predicting PFS and OS in 66 patients who underwent iPET. Of 35 iPET-positive patients, 31 (89%) showed progression, and 26 (74%) died during the follow-up. On multivariate Cox regression analysis, obtaining CMR at iPET emerged as an independent prognostic factor for PFS and OS (P<0.001 and P<0.001, respectively). Conclusions: Our data suggest that patients with positive results on i- or ePET should be considered candidates for intensive therapeutic strategies to improve their clinical outcome. Large prospective studies of patients with tumors of a homogeneous histological subtype within the T/NK cell lymphoma, treated with a uniform protocol, and evaluated on the basis of standardized criteria are warranted. Figure 1. Figure 1. Disclosures No relevant conflicts of interest to declare.

Economic assessment of diagnostic revision in peripheral T-cell lymphoma.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e20039-e20039
Author(s):  
Julie M. Lisano ◽  
Nicholas Liu ◽  
Kristina Yu-Isenberg ◽  
Deepak Singh ◽  
David Campbell ◽  
...  
Keyword(s):  
T Cell ◽  
Cell Lymphoma ◽  
T Cell Lymphoma ◽  
Health Plans ◽  
Outpatient Services ◽  
Medical Claim ◽  
Potential Cost ◽  
Peripheral T Cell Lymphoma ◽  
Current Scenario

e20039 Background: Peripheral T-cell lymphoma (PTCL) is a rare disease that is challenging to diagnose. A retrospective claims analysis and parallel electronic health records analysis estimated the rate of PTCL diagnostic revision (DR) either to or from other lymphomas at 29.3%, with significantly higher costs for DR than non-DR patients during follow-up. The current study used data from this analysis to estimate the cost of DR in PTCL to US health plans and quantify the potential impact of reducing DR in this population. Methods: A cost calculator was developed using pharmacy and medical costs for adult patients in the IBM MarketScan Commercial and Medicare Supplemental Databases with a PTCL diagnosis from 01/10-06/17, with or without DR (≥1 medical claim for a non-PTCL lymphoma in the year prior to or after the index PTCL diagnosis). Cost data were incorporated for non-DR, DR to PTCL, and DR from PTCL cohorts, and for the DR period (time from initial PTCL diagnosis to non-PTCL diagnosis or vice versa) and subsequent follow-up period. In the current scenario (based on the analysis of MarketScan data), rates of DR were 29.3%, of which 51.4% were DR to PTCL and 48.6% from PTCL. DR periods were 5.0 and 3.7 months, respectively, over a 1-year time horizon. A ‘new’ scenario was included that assumed a 50% reduction in the rate of DR to and from PTCL, and a 50% reduction in the length of DR period. Results: Total per patient per month (PPPM) costs for adults in a Medicare health plan diagnosed correctly or incorrectly with PTCL were estimated at $13,064 in the current scenario and $12,131 in the new scenario, representing a savings of $933 PPPM assuming a 50% reduction in both the rate of DR and the DR period. Savings were largely derived from reduced costs associated with other outpatient services ($385 PPPM) and inpatient services ($367 PPPM) in the new scenario (Table). In a hypothetical 1 million member Medicare plan, the estimated total plan savings annually in the new scenario would be $906,801, based on an estimated 81 PTCL patients among all plan members. Conclusions: Accurate and timely diagnosis of PTCL is essential to enable appropriate treatment. Interventions that reduce the rate of DR in PTCL are likely to result in potential cost-savings to US health plans. [Table: see text]

Marqibo (Vincristine Sulfate Liposomes Injection (OPTISOME™) Demonstrates Activity in Patients with Relapsed and Refractory Peripheral T-Cell Lymphoma.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4466-4466
Author(s):  
M. Alma Rodriguez ◽  
Jane N. Winter ◽  
Biao Lu ◽  
Gary Huang ◽  
Gavin S. Choy ◽  
...  
Keyword(s):  
Adverse Event ◽  
T Cell ◽  
Cell Lymphoma ◽  
International Workshop ◽  
Objective Response ◽  
Complete Response ◽  
T Cell Lymphoma ◽  
Low Grade ◽  
Peripheral T Cell Lymphoma ◽  
Best Response

Abstract Introduction: New and more effective agents are needed to improve treatment outcomes for patients with relapsed and refractory peripheral T-cell lymphoma (PTCL). Marqibo is a novel formulation of vincristine (VCR) encapsulated in sphingomyelin/cholesterol liposome called OPTISOME. In preclinical studies, OPTISOME technology has been shown to provide targeted, increased, and sustained delivery of VCR to tumor cells compared to non-encapsulated VCR or VCR encapsulated in conventional liposomes. Methods: PTCL patients from two multi-center phase 2 studies of Marqibo in relapsed and refractory lymphoid malignancies are integrated for safety and efficacy evaluation. In both studies, Marqibo (2.0 mg/m2 without dose capping IV over 60 minutes) was administered every 14 days for up to 12 cycles or until toxicity or progressive disease was observed. The primary efficacy endpoint of the 2 studies was the objective response rate (ORR) defined as the percentage of patients whose best response was complete response (CR), complete response unconfirmed, or partial response (PR). Best response was determined according to the International Workshop Response Criteria. Secondary endpoints included adverse event evaluation, time to progression (TTP) and overall survival (OS). Results: Six (3M/3F) patients diagnosed with PTCL received at least one dose of Marqibo. At baseline, the median age was 59 years (range, 34–86). All six patients had aggressive disease and most were heavily pretreated. The median number of prior lines of chemotherapy and immunotherapy regimens was 3 (range, 1–6) and four patients (66.7%) had received prior autologous bone marrow transplant. All patients had prior exposure to neurotoxic therapy: platinum compounds (33.3%), taxanes (16.7%) and VCR (100%). All patients had achieved a CR or PR to their frontline therapy and 50% (3/6) had achieved a CR or PR to their last line of therapy prior to receiving Marqibo. Patients received a median of 4 cycles of Marqibo (range, 1–9). Median cumulative dose of Marqibo was 7 mg/m2 (range, 2–17.4). The most commonly reported adverse event was peripheral sensory neuropathy (3 of 6 patients) and all of Grade 1 severity. Three patients had PR, 1 patient had stable disease, 1 patient experienced disease progression, and 1 patient was unevaluable. Median OS and TTP were 194 and 70 days, respectively. Conclusions: These preliminary results suggest encouraging activity and tolerability of Marqibo in heavily pre-treated relapsed and refractory PTCL patients. Given the high proportion of exposure to neurotoxic agents preceding Marqibo, the low grade neurotoxicity noted following Marqibo is a favorable finding.

Romidepsin in Relapsed/Refractory HTLV-1 Associated Adult T-Cell Lymphoma/Leukemia: A Case Series

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5113-5113 ◽  
Author(s):  
Nikhil Mukhi ◽  
Vaibhav Verma ◽  
Anam Ahmed ◽  
Hana Lim ◽  
Jason Gonsky ◽  
...  
Keyword(s):  
T Cell ◽  
Disease Progression ◽  
Phase Ii ◽  
Progressive Disease ◽  
Cell Lymphoma ◽  
Skin Lesions ◽  
T Cell Lymphoma ◽  
Severe Thrombocytopenia ◽  
Peripheral T Cell Lymphoma ◽  
Cell Neoplasm

Abstract Introduction: Adult T-cell lymphoma/leukemia (ATLL) is a mature T-cell neoplasm associated with human T-cell lymphotropic virus -1 (HTLV-1) infection. The aggressive subtypes(acute/lymphomatous) have a median survival of 6-13 months. Presently, there is no established therapy for patients with relapsed/refractory disease. Romidepsin is bicyclic class 1 selective histone deacetylase inhibitor approved by the US Food and Drug Administration for the treatment of patients with peripheral T-cell lymphoma who have received ≥ 1 prior systemic therapy, after demonstrating objective response rate of 25% (33 of 130), including 15% (19 of 130) complete remissions. Approaches for relapsed/refractory Peripheral T cell lymphoma(PTCL) are often applied to ATLL, although there is little data for this subtype. Neither of the two Phase II trials leading to its approval had ATLL cases. Reactivation of latent DNA viruses has been described as a consequence of immune suppression associated with this drug although its impact on HTLV-1 associated neoplasm is not known. Here we present 3 cases of relapsed refractory ATLL treated with romidepsin. Methods: We reviewed all patients with relapsed/refractory ATLL treated with romidepsin at King's County Hospital between 2012 and 2015. Results: Case 1: 43 year old male presented with multiple hyperpigmented nodules on the trunk and a 4 cm draining ulcerated left shoulder lesion. Complete blood count (CBC) was normal. Peripheral smear showed atypical lymphocytes with clover leaf pattern. CT scan Chest/abd/pelvis showed no enlarged lymphadenopathy. Punch biopsy of the skin confirmed involvement with peripheral T cell neoplasm HTLV-1 positive. Treated was initiated with EPOCH (etoposide/prednisone/vincristine/cisplatin/adriamycin) with partial response. He progressed on therapy after 4 cycles with new axillary/inguinal and retroperitoneal lymphadenopathy. Romidepsin was started at 14 mg/m2 IV Day 1, 8, 15 Q28 days. He tolerated cycle 1 well but continued to have progressive disease as evidenced by worsening hypercalcemia, atypical lymphocytosis and lymphadenopathy. Patient died 40 days after initiation of therapy from wound infection. Case 2: 37 year old male presented with diffuse lymphadenopathy and massive hepatosplenomegaly. CBC revealed white cell count (WBC) of 103.9k/mm3 with 94% lymphocytes. Bone marrow biopsy and lymph node biopsy confirmed involvement with peripheral T cell neoplasm HTLV-1 positive. He was treated with EPOCH x 2, ICE (Iphosphamide, carboplatin, etoposide) x 1 and high dose methotrexate x 1 with disease progression. He was started on Romidepsin 10 mg/m2 IV Day 1, 8, 15 Q28 days (dose reduced due to T. bili 3.5gm/dl). After first dose, patient developed severe thrombocytopenia to 20k/mm3 necessitating treatment delay and dose reduction to 6mg/m2. He had temporary response as evidenced by reduction in WBC count from 103kmm3 to 5k/mm3 and improvement in liver function. Patient received 1 cycle of therapy and died on Day 50 from disease progression. Case 3: 47 year old male presented with a 6x4 cm exophytic left forearm lesion, diffuse lymphadenopathy and normal CBC and metabolic profile. Skin biopsy confirmed CD30 positive peripheral T cell neoplasm HTLV-1 positive. Patient received 6 cycles of CHOP with complete resolution of lymphadenopathy and skin lesions. Patients stayed in remission for 12 months however relapsed with lymphocytosis to 57k/mm3, recurrence of skin lesions and diffuse lymphadenopathy. He received brentuximab x 2 cycles and ICE x 2 cycles with progressive disease. He was started on romidepsin 14mg/m2 IV Day 1, 8, 15 Q28 days. He received 1 dose and had prolonged Grade IV anemia/thrombocytopenia. He finally developed urosepsis and expired on Day 20. Conclusion: ATLL is a rare and difficult disease to manage. In our small experience of romidepsin in relapsed/refractory ATLL, patients appear to have modest response rates and higher rate of cytopenias when compared to other PTCL subtypes in clinical trials. A dedicated phase II study of romidepsin in relapsed/refractory ATLL is needed to assess its efficacy and toxicity profile in this population. Given the concerns for viral reactivation and lack of data for use of romidepsin in ATLL, it should be used cautiously. Disclosures No relevant conflicts of interest to declare.

FDG PET/CT As a Diagnostic and Prognostic Tool for the Evaluation of Patients with Peripheral T-Cell Lymphoma

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5347-5347
Author(s):  
Ronit Gurion ◽  
Hanna Bernsteine ◽  
Carmela Michelson ◽  
Liran Domachevsky ◽  
Pia Raanani ◽  
...  
Keyword(s):  
T Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
T Cell Lymphoma ◽  
Newly Diagnosed ◽  
Peripheral T Cell Lymphoma ◽  
Pet Ct ◽  
Tertiary Center ◽  
Fdg Avidity

Abstract Background and aims: Positron emission tomography (PET) using 18F fluorodeoxyglucose (FDG) with computed tomography (CT) is increasingly used for staging and treatment evaluation of lymphomas, especially in known avid-FDG lymphomas as diffuse large B cell lymphoma and Hodgkin lymphoma. In peripheral T cell lymphoma (PTCL), FDG avidity is variable. The purpose of this study is to evaluate FDG-avidity in PTCL and to appraise the prognostic significance of baseline and interim PET/CT in this sub-group of lymphomas. Methods: A retrospective cohort study of patients with newly diagnosed or relapsed PTCL, treated with any chemotherapy regimen between 2008 and 2015 in a single tertiary center. Patients who did not have pre-treatment PET/CT (P-PET/CT) were excluded. Patients were identified through the computerized system. Demographic, clinical and laboratory data were collected from patients' files until the latest follow-up available and for at least 6 months after completion of chemotherapy administeration. P-PET/CT, interim (I-PET/CT) and end-of-treatment (E-PET/CT) studies were centrally reviewed and reported using 3 methods of evaluation: visual assessment, maximal SUV reported and Deauville 5-point score (DS) evaluation. DS of 3 and above was considered positive. PET/CT was interpreted as positive if any of the three evaluation methods was positive. The primary outcome was the avidity of P-PET/CT in PTCL. Secondary outcomes included the prognostic role of P-PET/CT, I-PET/CT and E-PET/CT on progression free survival (PFS). Survival curves were calculated by SPSS software and Kaplan-Meier plot. Baseline characteristics were analyzed in a cox regression model: including data regarding P-PET/CT, I-PET/CT and E- PET/CT. Results: Data of 60 patients with PTCL was collected. 20 patients were excluded due to absence of P-PET/CT. Thus, 40 patients (38 with newly diagnosed disease) were included in this analysis. The most frequent histological diagnoses were PTCL-N0S and anaplastic large cell lymphoma-ALK negative (ALCL-ALK negative). Median age was 54 years. 17/40 (42.5%) patients did not have co-morbidities, 9/40 (22.5%) had another malignancy. The rest of the patients had other co-morbidities including diabetes mellitus, congestive heart failure and other cardiovascular risk factors. Patient characteristics are detailed in table 1. The median follow-up was 31 months (23-40). The median overall survival and the PFS for the whole cohort were 39 months (27-51) and 16 months (7-24), respectively. 36/40 (90%) patients had positive P-PET/CT. 23 patients had I-PET/CT, all of them with newly diagnosed disease: 10 studies were positive and 13- negative. 34/40 patients had E-PET/CT, 26 studies of them were positive and 8 - negative. Factors significantly associated with PFS on univariate analysis were: elevated lactate dehydrogenase (LDH), lymphopenia, low hemoglobin and albumin levels. In multivariate analysis, the only factor that remained prognostic for PFS was lymphopenia. P-PET/CT and I-PET/CT were not prognostic with respect to PFS. Conclusions: Our study shows that 90% of PTCL are FDG avid, as one would expect with aggressive lymphoma. Yet, neither PET was not predictive for PFS at any time point. The only predictive factor was lymphopenia. Disclosures No relevant conflicts of interest to declare.

Outcome of Patients with Peripheral T-Cell Lymphoma Undergoing Allogeneic Stem Cell in British Columbia

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5852-5852
Author(s):  
Musa Alzahrani ◽  
Kerry J Savage ◽  
Cynthia L. Toze ◽  
Laurie H Sehn ◽  
Raewyn Broady ◽  
...  
Keyword(s):  
British Columbia ◽  
T Cell ◽  
Research Funding ◽  
Cell Lymphoma ◽  
T Cell Lymphoma ◽  
Primary Therapy ◽  
Peripheral T Cell Lymphoma ◽  
Free Survival ◽  
Kaplan Meier

Abstract Background: Peripheral T-cell lymphomas (PTCL) are a rare and heterogeneous group of non-Hodgkin lymphomas (NHLs) that accounts for approximately 10% of all aggressive NHLs in Western countries. The optimal management remains unclear, however, given the poor outcome, allogeneic transplant (allo-SCT) has been integrated into the front-line treatment for some rare extranodal subtypes as well in relapsed/refractory setting. We report our provincial experience of the outcome of patients with PTCL who have undergone allo-SCT at the British Columbia Cancer Agency (BCCA). Methods: The Leukemia/BMT Program of British Columbia database and the BCCA Lymphoid Cancer Database were searched to identify all patients diagnosed with PTCL who have undergone allo-SCT between November 1990 and January 2016. Overall survival and relapse free survival were estimated using the Kaplan-Meier method. Results: We identified 36 cases of PTCL patients who have undergone allogeneic transplant from a median time of 11 months from primary diagnosis (range 4-64) with the following clinical features: median age at transplant was 45 years (range 16-58 years); 24 (67%) were male; 32 (89%) patients had advanced stage disease; 22 (61%) had B-symptoms at diagnosis. Bone marrow involvement detected in 13/34 (38%) patients. Histological diagnosis based on the WHO 2008 classification were: Peripheral T-cell lymphoma not otherwise specified (PTCL-NOS) n=15 (42%); anaplastic large cell lymphoma (ALCL) n=7 (19%) out of which three were ALK positive, angioimmunoblastic T-cell lymphoma (AITL) n=6 (17%), hepatosplenic T-cell lymphoma n=5 (14%), enteropathy associated T-cell lymphoma type I n=1, advanced primary cutaneous gamma-delta T-cell lymphoma n=1 and Sezary syndrome n=1. Ten patients (28%) underwent allo-SCT as part of planned primary therapy after achieving their first remission [6 were in complete remission 1 (CR1) and 4 were in partial remission 1 (PR1)], whereas 26 patients (72%) underwent allo-SCT for relapsed/refractory disease. CHOP was administered in 19 patients (53%) as the primary therapy. 17 (47%) patients received alternative chemotherapy regimen due to patient and/or physician preference. The clinical status at the time of transplantation was CR in 12 patients (33%), relapsed sensitive disease n=10 (28%), relapsed untreated n=5 (14%), partial remission (PR) in 5 (14%), primary progressive disease n=3 (8%) and relapsed resistant disease n=1 (3%). Thirty two patients (89%) underwent myeloablative conditioning, 4 (11%) underwent reduced intensity conditioning (RIC). The conditioning regimens included: cyclophosphamide/TBI n=24 (67%), busulfan/cyclophosphamide n=5 (14%), fludarabine containing reduced intensity n=4 (11%), and other regimens n= 3 (8%). With a median follow-up of alive patients from the time of allo-SCT of 69 months (range 1-186 months). At last follow-up, 17 (47%) patients have died, 6 from disease relapse, 5 from graft vs host disease (GVHD), 2 from regimen related toxicity and 4 from other causes. Nineteen patients (53%) still alive at last follow up post-transplant of which 14 (39%) still in remission. The 5-year event free survival (EFS) and overall survival (OS) from the time of allo-SCT of all patients were 43% and 63%, respectively. For PTCL-NOS the 5-year EFS and OS were 52% and 69%, respectively. Table 1 summarizes the patients' characteristics. Figures 1 and 2 shows the Kaplan-Meier curves for OS and EFS respectively. Conclusion: Allo-SCT can be effective strategy in select patients with relapsed/refractory PTCL and those with high risk histologies in the upfront setting PTCL with an acceptable toxicity. Disclosures Toze: Roche Canada: Research Funding. Sehn:roche/genentech: Consultancy, Honoraria; amgen: Consultancy, Honoraria; seattle genetics: Consultancy, Honoraria; abbvie: Consultancy, Honoraria; TG therapeutics: Consultancy, Honoraria; celgene: Consultancy, Honoraria; lundbeck: Consultancy, Honoraria; janssen: Consultancy, Honoraria. Scott:NanoString Technologies: Patents & Royalties: named inventor on a patent for molecular subtyping of DLBCL that has been licensed to NanoString Technologies. Villa:Lundbeck: Honoraria; Roche: Honoraria, Research Funding; Celgene: Honoraria. Connors:NanoString Technologies: Research Funding; F Hoffmann-La Roche: Research Funding; Bristol Myers Squib: Research Funding; Seattle Genetics: Research Funding; Millennium Takeda: Research Funding. Song:Janssen: Honoraria; Otsuka: Honoraria; Celgene: Honoraria, Research Funding.

scholarly journals Clinical Characteristic and Survival Outcome of Peripheral T Cell Lymphoma in a Chinese Population

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5271-5271
Author(s):  
Wenyu Li ◽  
Ling Huang ◽  
Xinmiao Jiang ◽  
Xiaojuan Wei ◽  
Hanguo Guo ◽  
...  
Keyword(s):  
T Cell ◽  
Anaplastic Lymphoma Kinase ◽  
Chinese Population ◽  
Cell Lymphoma ◽  
T Cell Lymphoma ◽  
Peripheral T Cell Lymphoma ◽  
Term Survival ◽  
Anaplastic Lymphoma ◽  
Nk T Cell

Background: Peripheral T-cell lymphoma (PTCL) is a heterogeneous group comprising about 10-15% of non-Hodgkin lymphomas in Western populations. Only a minority (~30%) of patients with the most common PTCL subtypes achieve a durable remission and long-term survival. Data on the clinical features of PTCL in a Chinese population are limited. Methods: We retrospectively reviewed 342 patients with pathologically diagnosed T cell lymphoma at Guangdong Provincial People's Hospital from June 2007 through March 2019. We evaluated the incidence of PTCL subtypes, clinical characteristics and survival status. Results: Of the 342 patients, 17.3% (n=59) had PTCL-not otherwise specified(NOS), 9.4% (n=32) had angioimmunoblastic T-cell lymphoma(AITL), 19.6% (n=67) had anaplastic large cell lymphoma(ALCL) (anaplastic lymphoma kinase positive ALCL:12.0%, n=41; anaplastic lymphoma kinase negative ALCL: 9.6%, n=26), 36.2%(N=124) had NK/T cell lymphoma, 12.9% (n=44)had lymphoblastic lymphoma(LBL), and 4.6%(n=16) had other subtypes. For next data analysis, NK/T cell lymphoma and LBL were excluded. Finally, a total of 164 patients with integrally follow-up information were analyzed. The median age was 49.5 years (range 15-87) old and the median follow-up time was 15.8 months (range 0.5-124.3). Most patients were males (62.0%) with advanced stage disease (III/IV, 74.5%), and 51.0% of patients presented with B symptoms and 83.0% with no bulky disease. For the total population, the median progression-free survival(PFS) and overall survival(OS) was 6.5 months and 13.5 months, respectively. ALCL patients had better PFS and OS than PTCL-NOS and AITL (PFS: 51.2 vs. 5.8 vs.4.7 months, P = 0. 000; OS: not reached vs. 13.4 vs. 8.8 months, P = 0.000). There were no difference of PFS and OS between PTCL-NOS and AITL(P = 0. 550 and P = 0. 333, respectively). Conclusions: ALCL has better outcome than other PTCL subtypes. However, no efficacy therapy has emerged for patients with relapsed/refractory PTCL and outcomes in this setting are still poor. Novel potential targets for PTCL, with particular focus on identifying markers of response and resistance need further investigation. Disclosures Li: Guangdong Province Hospital: Employment.

Sign in / Sign up

Export Citation Format

Share Document