scholarly journals Failure to Achieve CR with First-Line Treatment Is the Primary Cause of Treatment Failure in T-Cell Lymphoma: The Princess Margaret Cancer Centre Experience

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3005-3005
Author(s):  
Umberto Falcone ◽  
Melania Pintilie ◽  
Ri Wang ◽  
Vishal Kukreti ◽  
John G. Kuruvilla ◽  
...  
Keyword(s):  
T Cell ◽  
Cell Lymphoma ◽  
Primary Treatment ◽  
T Cell Lymphoma ◽  
Line Treatment ◽  
First Line ◽  
Limited Stage ◽  
Stage Disease ◽  
First Line Treatment

Abstract Introduction: T-cell lymphomas (T-NHL) represent rarer entities compared to B-NHL, accounting for 5% -10% of NHL in Western countries and 15%-20% in Asia. They are divided into clinico-pathologic subtypes based on etiology, morphology, and clinical behavior. Because of the rarity and the lack of specific histologic features for the different subtypes, the diagnosis is difficult and clinical picture is usually very helpful to establish the diagnosis. We conducted a retrospective analysis of patients (pts) with T-NHL treated at our Centre, with the purpose of studying overall outcome and possible prognostic factors, including histologic subtypes, from our database. Patients and methods: Consecutive T-NHL pts (excluding Adult T-cell leukemia/lymphoma, NK/T NHL, and primary cutaneous T-NHL), receiving primary treatment at the Princess Margaret Cancer Centre (PMCC) between 2001-2014 were included. Data were extracted from a prospective patient database and the medical record regarding baseline characteristics, treatment, response and outcome. Response assessment was with CT imaging as per 1999 Working Group criteria. Results: Of a total of 2155 pts with aggressive histology NHL treated at PMCC between 2001-2014, 2031 pts had B-NHL and 124 (5.7%) T-NHL. Median age was 56 years (18-90), male/female ratio: 2.4; 63% presented with advanced stage (III-IV) disease, 22% had bone marrow involvement; 63% had elevated LDH and 44% had B symptoms. Observed subtypes were: Peripheral T-cell lymphoma, NOS 58 pts (PTCL NOS, 47%), Anaplastic large cell lymphoma, ALK-negative 16 pts (ALCL-ALK-, 13%), ALCL, ALK-positive 22 pts (ALCL-ALK+, 18%), Angioimmunoblastic T-cell lymphoma 13 pts (AITL, 10.5%), Enteropathy-associated T-cell lymphoma 7 pts (EATL, 5.6%), Hepatosplenic T-cell lymphoma 8 pts (HSTCL, 6%). 105/124 pts (85%) received induction chemotherapy; CHOP-like regimens were used in 94 pts (90%), and involved field radiation therapy (RT) was included in primary treatment in 24 pts (19%). Nineteen pts were treated palliatively, 5 pts with RT alone, 14 pts received palliative chemotherapy or supportive care only. Complete response (CR) was obtained in 63/105 pts (60%; Table 2), PR in 2 pts (1.9%) and 40 pts had no response or progressive disease (SD and PD; 38%). Considering together the most common subtypes (ALCL-ALK+/-, AITL, PTCL NOS), CR rate was 84% in limited stage vs 52% in advanced stage disease. Among patients with CR, 24 relapsed (38%). Fourteen pts received autologous stem cell transplant (8 at relapse, 6 for PD); 7/14 (50%) were alive at last follow-up. At a median follow-up of 5.3 years, 57/124 (46%) pts are alive. Cause of death was T-NHL in 50/124 (40%) pts. Two pts died of second malignancy (1.6%). Median overall survival (OS) and progression-free survival (PFS) were 4.57 years (95%CI: 2.23-9.53; 5yOS: 48%) and 1.5 years (0.87-3.17; 5yPFS: 37%), respectively (Table 2). For pts with limited stage disease median PFS was 4.57 years (5yPFS: 49%) and median OS 10.0 years (5yOS: 62%), while for pts with stage III/IV, median PFS was 0.82 years (5yPFS: 31%) and OS 1.81 years (5yOS: 38%). Median OS for pts who did not experience relapse (39/63; 62%) was 13.38 years (95%CI: 9.53-NA; 5yOS: 93%) vs 3.12 years (95%CI: 1.69-4.07 years; 5yOS: 25%) in pts who had relapse after CR1 (p<0.001). Pts failing to achieve CR (PR, SD, PD) had a very poor outcome with median OS 1.15 years (95%CI: 0.62-1.32 years; 5yOS: 17%). For PTCL NOS pts, outcomes were poor while those with ALCL had more favorable results regardless of ALK status (Table 2). Conclusions: Failure to achieve CR with first-line treatment was the main cause of treatment failure in patients with T-NHL treated with anthracycline-based chemotherapy. Patients with limited stage lymphoma and with ALCL ALK+/- subtypes have more favorable outcomes. For PTCL NOS, the most common subtype, and less common entities (HSTCL, EATL), results are poor and new induction strategies are needed. Disclosures Kukreti: Celgene: Honoraria; Amgen: Honoraria; Lundbeck: Honoraria.

LOPP chemotherapy as a first-line treatment for dogs with T-cell lymphoma

2017 ◽  
Vol 16 (1) ◽  
pp. 108-113 ◽  
Author(s):  
P. M. Brown ◽  
S. Tzannes ◽  
S. Nguyen ◽  
J. White ◽  
V. Langova
Keyword(s):  
T Cell ◽  
Cell Lymphoma ◽  
T Cell Lymphoma ◽  
Line Treatment ◽  
First Line ◽  
First Line Treatment

First Line Treatment of Aggressive Cutaneous NK/T Cell Lymphomas Based on High Dose Cytarabine and Stem Cell Transplantation Does Not Lead to Durable Remissions.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4669-4669
Author(s):  
C.J.M. Halkes ◽  
M.H. Vermeer ◽  
E.M. Noordijk ◽  
R. Willemze ◽  
Roelof Willemze
Keyword(s):  
Stem Cell ◽  
T Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Cell Lymphoma ◽  
T Cell Lymphoma ◽  
Line Treatment ◽  
First Line ◽  
Nk T Cell ◽  
First Line Treatment

Abstract Aggressive cutaneous NK/T-cell lymphomas are extremely rare with an estimated yearly incidence of less than 1 per 2,000,000 and a disease-specific 5 year survival of 0–16%. This dismal prognosis seems independent of the presence of extracutaneous localizations at diagnosis. Only a minority of patients respond to CHOP-like multiagent chemotherapy. Sustained complete remissions (CR) have been observed after stem cell transplantation of some heavily pre-treated patients. We hypothesized that stem cell transplantation may be the only treatment modality that may induce long term remissions in this very resistant disease. In order to get as many possible patients eligible for a stem cell transplantation we designed an intensive protocol in which patients with newly diagnosed aggressive cutaneous NK/T-cell lymphoma were treated with AML-like induction and consolidation courses followed by an allogeneic or an autologous stem cell transplantation. All patients with newly diagnosed aggressive cutaneous NK/T-cell lymphoma who were referred to our centre between 06-2003 and 06-2006 were screened for this study. Patients who were able to undergo this intensive therapy, were enrolled after informed consent. Induction treatment consisted of etoposide 120 mg/m2 and amsacrine 115 mg/m2 on days 1 and 7, methylprednisolone 60 mg/m2 on days 1–7, intrathecal methotrexate on day 1 and cytarabine on days 1–6: either 1000 mg/m2 twice daily (age &lt;61) or 100 mg/m2 daily (age &gt; 60). In case of partial remission (PR), induction treatment was repeated. In case of CR, consolidation treatment was given consisting of amsacrine and etoposide in similar doses as during induction, and cytarabin 3000 mg/m2 twice daily on days 1–4 or 300 mg/m2 twice daily on days 1–4 in older patients. In case of persisting CR after consolidation therapy, patients were eligible for allogeneic stem cell transplantation with total body irradiation (TBI) and high dose cyclophosphamide as conditioning regimen. In the absence of a HLA matched donor, autologous transplantation was planned. Six patients (3 males, 3 females) were treated for cutaneous peripheral T cell lymphoma not otherwise specified (n=3), cutaneous blastic NK cell lymphoma (n=2) or cutaneous NK-T cell lymphoma, nasal type (n=1). Mean age was 52 years (range 33–65). In two patients no extracutaneous localizations were found. After induction treatment two patients had progressive disease, and one patient showing PR died suddenly during leukopenic period after the second induction cycle. Three patients achieved the CR. One of them died due to an intracerebral hemorrhage just before transplantation. Two patients underwent stem cell transplantation (one autologous and one allogeneic) but both relapsed, 204 and 218 days after transplantation, respectively and died within weeks. Median overall survival was 214 days (range 30–382).First line treatment of aggressive cutaneous NK/T cell lymphoma using an intensive AML-like chemotherapy approach resulted in CR in 3 out of 6 patients. Only two of them reached a stem cell transplantation, but both patients died of relapsing disease. Based on these outcomes, first line treatment of aggressive cutaneous NK/T-cell lymphoma consisting of AML-like induction and consolidation therapy did not result in durable remissions, necessary to perform stem cell transplantation.

The Outcome of T-Cell Lymphoma Patients Failing First-Line Treatment: Results of a Population Based-Study From the Modena Cancer Registry

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1611-1611 ◽  
Author(s):  
Irene Biasoli ◽  
Marina Cesaretti ◽  
Stefano Luminari ◽  
Monica Bellei ◽  
Alessandra Dondi ◽  
...  
Keyword(s):  
T Cell ◽  
Cell Lymphoma ◽  
Initial Therapy ◽  
Population Based ◽  
Salvage Treatment ◽  
T Cell Lymphoma ◽  
Line Treatment ◽  
First Line ◽  
Population Based Study ◽  
First Line Treatment

Abstract Abstract 1611 Introduction: For many T-cell lymphoma (TCL) patients (pts), current treatment strategies are largely ineffective. In particular, pts failing first line therapy are expected to have a dismal outcome but little is known about them. The purpose of this population-based study was to establish the outcome of TCL pts following relapse/progression. Material and methods: All TCL pts diagnosed in the province of Modena, Italy between January 1, 1997 and December 31, 2010 were identified from the archives of the Modena Cancer Registry that covers a population of approximately 600.000 people. Additional data on disease characteristics, treatment modalities, together with response assessments and outcome were actively retrieved and collected. Results: A total of 146 TCL pts were initially identified, and 18 excluded because of missing data; therefore 128 were available for the present analysis. The most common subtypes were Peripheral T-cell lymphoma not otherwise specified in 46 pts (36%), Anaplastic large T-cell lymphoma in 46 patients (36%) Angioimmunoblastic T-cell lymphoma in 15 (12%), and other subtypes in 21 (16%). The male to female ratio (M/F) for the entire population was 1.7 and the median age was 64 years (16–90). A total of 100 (78%) pts received initial treatment within 3 months of their diagnosis: 74 received combination chemotherapy (CT), 9 received radiation therapy (RT) only, 10 underwent surgery and 7 were addressed to high dose therapy and autologous stem cell transplant (ASCT) as part of initial therapy. Among the remaining 28 patients, 24 (19%) died within 3 months of their diagnosis and 4 (3%) received only palliative therapy because of their comorbidities. The majority of pts received anthracyclines (ADM) containing regimens as part of their initial therapy (71/74, 96%). At the end of first line treatment, 59 (59%) pts achieved complete remission (CR), 13 pts partial remission (PR), 8 pts stable disease (SD) and 20 cases had disease progression (PD). Overall, 59 pts presented relapse/progression; 23 (39%) of them died before receiving any salvage treatment, 14 pts received DHAP (7 of whom were subsequently addressed to ASCT), 8 received gemcitabine-containing regimens, 6 received ADM containing regimes and 8 other CT regimens; 2 patients were treated with RT. At a median follow-up for living patients after relapse/progression of 28 months (range 9–111 months), 49 patients died, and the cause of death was found to be lymphoma progression in all of them. The median overall survival (OS) following relapse/progression was 1.9 months. Among the 36 pts that received salvage treatment median OS was not reached for those who received ASCT and was 4.5 months for those who received conventional dose salvage treatment (p=0.003). A Cox regression analysis was performed in order to identify prognostic factors among these 59 pts: age at relapse (≥60 years, HR=2.35, CI95% 1.04–5.28, P=0.038) and advanced stage (HR=3.24, 1.31–7.98) were associated with a higher risk of death and salvage treatment ASCT was associated with a better survival (HR=0.04, IC95% 0.006–0.36). No other clinical characteristic (gender, histology, LDH and performance status) at diagnosis was associated with higher risk of death among relapsing/progressing patients. Conclusion: In the general population, outside clinical trials, the outcome of TCL pts is dramatically poor. First, about 20% of the whole cohort is not able to receive any kind of therapy mainly due to early death; second, the rate of pts failing first line therapy that could not receive any salvage therapy rose to 39%. As a result, progression during initial therapy or relapse after first line treatment entails a very dismal prognosis with less than 2 months of median survival. Only a few patients that could receive ASCT after relapse had promising chances of long lasting remission. Based on the results of this population based study, it is evident that there is urgent need for novel agents to be offered to TCL pts requiring second line treatment. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Peripheral T-Cell Lymphomas in Spain: Profiling Clinical, Phenotypic and Genetic Characteristics in Spanish Population

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2938-2938
Author(s):  
Raul Cordoba ◽  
María Socorro Rodriguez-Pinilla ◽  
Narvaez Javier ◽  
Fina Climent ◽  
Joaquin Sanchez ◽  
...  
Keyword(s):  
T Cell ◽  
Cell Lymphoma ◽  
Prognostic Index ◽  
T Cell Lymphoma ◽  
Common Finding ◽  
Line Treatment ◽  
First Line ◽  
Lymphoid Neoplasms ◽  
First Line Treatment

Abstract Purpose The objective of this study was to investigate clinicopathologic features and prognostic factors of patients diagnosed with PTCL in 13 sites across Spain. Patients and Methods A multicenter, retrospective study was carried out between September 2015-November 2017.Medical charts of patients diagnosed with PTCLs between January 2008 and December 2013 that have signed the approved informed consent form were reviewed. PTCLs were then classified according to the 2016 revision of the WHO classification of lymphoid neoplasms. Clinical characteristics,history, standard immunohistochemistry (IHC) data, International Prognostic Index (IPI) and Prognostic Index for T-cell lymphoma (TCL) (PIT) were also assessed. Medians (range), mean (standard deviation) and frequency as the number of patients (n) and percentages (%) with confidence intervals at 95% (CI95%) were calculated. Overall Survival (OS) and Progression Free Survival (PFS) were analyzed using the Kaplan Meier method. Results 175 (88.4%) patients were successfully analyzed, the male/female ratio was 1.7:1.0, and the median age was 67.2 years (range: 24.8 years -95.8 years). ECOG performance status >1 was reported for 31.9% patients. Ann Arbor stages were III and IV 27.4% and 45.7%, respectively, and LDH levels were elevated to 92 patients (52.6%). Those with B symptoms accounted for 39.4%, while soft tissue was the most frequent location (23,7%) among the 76 patient with extranodal disease; bone marrow infiltration was confirmed in 18.3% patients. Relevant clinical antecedents related to immunological aspects were also frequently reported, including previous neoplasia (18.9%), autoimmune disease (16%), immunosuppressive treatments (7.3%) and previous viral diseases (HIV, HBV or HCV, 5.7%, 4.6% and 7.4%, respectively). Most patients presented with angioimmunoblastic TCL (31.4%); similar proportions of patients were observed among nodal PTCL with TFH phenotype (13.1%, PTCL not otherwise specified (12.0%) and extranodal NK/TCL nasal type (11.4%). CD30 expression and staining pattern (ranged 1-4) allowed the stratification of patients according CD30 intensity (n= 121; weak: 35, moderate: 57, and intense: 29); Patients were also classified based on CD30 expression considering the median value of quantitative CD30 in our sample (15%) the cut-off point: n=132; Negative <15%: 64; Positive, ≥15%: 68). First-line treatment with a CHOP/CHOP-like regimen was the most common finding (69.7%). Best response was observed after a median of 4 months since the start of first-line treatment (range 0.0 months - 65.2 months). Overall response rate after first-line treatment was 66.9%, with 61/151 patients reaching complete response (CR). Median PFS (n=157) and OS (n=175) of this series were 7.87 months (CI95%: 4.98 months-10.75months) and 15.77 months (CI95%: 10.23 months -21.30 months), respectively. Overall, IPI and PIT scores influenced the PFS and OS (p<0.001). A higher number of adverse factors was associated with a shorter survival. Reaching a CR was associated with a better PFS (CR: 62.6m; CI95%: 20.2 months -105.1 months) than the rest of patients (3.97m: CI95%: 3.08 months -4.85m; p<0.001). Response was also associated with OS; patients with CR showed an average OS of 67.01 months (CI95%: 58.2 months -75.9 months) that were significantly longer than that of patients with No-CR (median: 7.34 months; CI95%: 5.85 months -8.83 months; p<0.001). Conclusion This is the largest series of T cell Lymphoma reported in Spain and has allowed the description of distribution of PTCL subtypes, analyzed through central hematopathologists reanalysis and reclassification of samples from 175 PTCL patients, according to the WHO 2016 classification of lymphoid neoplasms. Our data confirm the poor prognosis of these patients, as well as the impact of prognostic indexes and the response to first line treatment on their outcome. Disclosures Rodriguez-Pinilla: Takeda: Honoraria. Piris:Takeda: Honoraria; Janssen: Honoraria; Gilead: Honoraria; Kura: Honoraria. Ruiz-Zorrilla:Takeda: Employment. Montoto:Takeda: Employment.

scholarly journals A Single-Center Retrospective Clinical Study of Chidamide in the Treatment of Adult Peripheral T-Cell Lymphoma

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4551-4551
Author(s):  
Maogui Hu ◽  
Kaiyang Ding ◽  
Dongyao Wang ◽  
Xinchen Wang ◽  
Xiaoyu Zhu
Keyword(s):  
Stem Cell ◽  
T Cell ◽  
Stem Cell Transplantation ◽  
Maintenance Treatment ◽  
Cell Lymphoma ◽  
Line Treatment ◽  
First Line ◽  
Peripheral T Cell Lymphoma ◽  
First Line Treatment

Abstract Background: Peripheral T-cell lymphoma (PTCL) is a group of aggressive non-Hodgkin's lymphomas (NHL) with high heterogeneity. The first-line treatment commonly used for firstly-diagnosed PTCL is the CHOP-like regimen. However, in addition to ALK+ALCL, these regimens present poor long-term survival rate in other subtypes, mostly less than 30-40%. Even with the consolidation of autologous hematopoietic stem cell transplantation, studies have reported that the 5-year overall survival rate is barely about 50%. Therefore, for PTCL patients who have achieved remission and undergone autologous hematopoietic stem cell transplantation, there is an urgent need to explore a maintenance treatment strategy. Chidamide is an oral type of selective HDAC inhibitor with subtype specificity for HDAC 1, 2, 3, and 10. It has a regulatory effect on abnormal epigenetic functions of tumors and a novel induction and activation of cellular immune function. In China, it has been approved for relapsed or refractory PTCL at a dose of 30 mg/time, twice a week. The study of chidamide has proved its satisfactory efficacy and safety characteristics for PTCL again. This study preliminarily evaluates the near term effects of chidamide combined with chemotherapy in the first-line treatment and maintenance value of PTCL through retrospective analysis. Methods: We collect adult peripheral T-cell lymphomas inducing by CHOP-like regimen with chidamide or not. The complete response rate (CR), objective response rate (ORR), progression-free survival time (PFS) and overall survival time (OS) of patients in the combined chidamide group and non-combined group were separately analyzed and evaluated. Meanwhile, the OS in the chidamide-maintenance and non-chidamide maintenance of the PTCLs were also brought to study. Results: A total of 82 patients recruited, with a median age of 60 years (14-79 years), including 45 peripheral T-cell lymphoma (PTCL-NOS), 23 angioimmunoblastic lymphoma (AITL), 14 anaplastic large cell lymphoma (ALCL), and the follow-up time cutoff was April 30, 2021. Among 82 patients, 39 patients were treated with chidamide+CHOP-like as the first-line treatment, and 43 patients were treated with CHOP-like as the first-line treatment. The CR rate of the first-line combined chidamide group was 62%, and the ORR was 87%. The CR rate of the first-line non-combined chidamide group was 42% and the ORR was 74%. There was no significant difference in CR rate and ORR between the two groups, but the CR rate has potential clinical benefits. The median PFS of the combined chidamide group was longer than that of the non-combined group by 8 months (18.9m VS 10.9m), but there was no significant statistical difference (p=0.255). Among 82 patients, regardless of first-line treatment or salvage treatment, 42 patients in the maintenance treatment group of chidamide did not reach the median OS, and the median OS of 40 patients in the non-maintenance group was 18.9 months. The difference between the groups was statistically significant (p &lt;0.001). There were totally 66 patients responding to the first-line treatment (CR+PR). 8 patients with sequential autologous stem cell transplantation (ASCT), 34 patients with chidamide maintenance treatment, and both groups didn't reach the median OS. The third group including 24 patients who did not undergo ASCT or chidamine maintenance presenting a median OS of 45.5 months. However, due to the limitation of follow-up time, the difference between the groups was not statistically significant, but the first two groups showed a trend of clinical benefit, which requires further follow-up. During the follow-up period, 48 patients had disease progression with first-line treatment, 23 patients had disease progression using combined chidamide as salvage treatment, and 25 patients in the non-combined chidamide group suffered disease progression. There was a statistically significant difference in OS between the groups (mOS: less than 11.8 months of VS, p =0.03). Subgroup analysis showed that chidamide maintenance treatment in the PTCL-NOS group provided a significant improvement in the prognosis (mOS: 21m VS 5.6m). Conclusion: It preliminarily suggested that chidamide maintenance therapy for PTCL provided an ideal survival benefit, especially In patients with PTCL-NOS subtypes. First-line treatment combined with chidamide and chidamide maintenance therapy may improve the poor survival prognosis. Disclosures No relevant conflicts of interest to declare.

Phase II/III randomized trial of CID-ATT with radiotherapy compared with CHOP with radiotherapy as first-line treatment for previously untreated early staging extranodal NK/T-cell lymphoma, nasal type (ENKL).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 8508-8508 ◽  
Author(s):  
Tongyu Lin ◽  
He Huang ◽  
Chao Yong Liang ◽  
Chengcheng Guo ◽  
Ying Tian ◽  
...  
Keyword(s):  
T Cell ◽  
Phase Ii ◽  
Cell Lymphoma ◽  
T Cell Lymphoma ◽  
Line Treatment ◽  
First Line ◽  
Chop Regimen ◽  
Nasal Type ◽  
Nk T Cell ◽  
First Line Treatment

8508 Background: Extranodal NK/T cell lymphoma, nasal type (ENKL) is more prevalent in Asia and has worse prognosis than B-NHL. No therapeutic strategy is currently identified for ENKL. This phase II/III study was undertaken to compare CHOP-B/IMVD/DHAP-Alternating Triple Therapy (CID-ATT) and standard CHOP regimen as first-line treatment prospectively. Methods:109 patients (pts) initially diagnosed as ENKL (16-70 ys old) with Ann Abor Stage I to II were randomized to receive CID-ATT or CHOP regimen from Jan 2006 to Jan 2012. CID-ATT alternated among CHOP-B, IMVD, and DHAP, given in alternating sequence for a total of 6 courses (2 circle). Involved field radiation was administered after 6 courses(2 circle) of CID-ATT regimen or 6 cycles of CHOP regimen. All pts received prophylactic granulocyte colony-stimulating factor, interleukin-11and thrombopoietin for each DHAP cycle. Results: 109 pts were evaluable (54CID-ATT; 55 CHOP). With a median follow-up of 40.3months,OS and PFS was significantly prolonged with CID-ATT compared with CHOP (1yOS :80.2% vs 78.6%, 3yOS:68.0% vs 42.3%, 5yOS: 64.2% vs 34.5%,P=0.023; 1yPFS: 74.9% vs 59.6%, 3yPFS:60.5% vs 32.0%, 5yPFS: 60.5% vs 32.0% ; P=0.016). Compared to CHOP group, CID-ATT group has a much higher complete remission rate (CID-ATT:47/54,87.0 % vs CHOP:29/55,52.7%, P<0.001). The survivals for pts who achieved CR after One circle (3 courses) were significantly better than those who were in non-CR group.(5yOS: CR group in ATT:75.3%, non-CR group in ATT:51.5%, CR group in CHOP:39.3%, non-CR group in CHOP:31.0%; P=0.003). No treatment related death was observed, although Grade III/IV neutropenia (30/54,55.6%) and thrombocytopenia (33/54,61.1%) were observed in CID-ATT regimen, especially in DHAP cycle. Conclusions: Our study has demonstrated that the CID-ATT regimen as an optimal first-line therapy achieved promising clinical activity with safe and tolerated toxicity under close monitoring and good supportive care of untreated early staging ENKL pts. CR of induce chemotherapy following radiotherapy is very important for ENKL survival. Clinical trial information: CSWOG0002.

scholarly journals Response to First-Line Treatment in Patients with N/K T-Cell Lymphoma. Experience of a Third Level Mexican Institute

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5286-5286
Author(s):  
Katheryn Betsabe Garzón ◽  
Silvia Rivas-Vera ◽  
Brenda L. Acosta-Maldonado
Keyword(s):  
T Cell ◽  
Cell Lymphoma ◽  
Combined Therapy ◽  
Clinical Information ◽  
Line Treatment ◽  
First Line ◽  
Clinical Stages ◽  
Advanced Stages ◽  
First Line Treatment

Background NK/T -cell lymphoma (NK/TCL) is a type of non-Hodgkin lymphoma common in México; however, there are few clinical studies of prevalence and clinical characteristics in non-Asian population. The objective was to identify the response to first line treatment in patients with NK/TCL and determine overall survival (OS) and disease-free survival (DFS). Methods We conducted a retrospective study from April 2006 to December 2018; clinical information was collected from electronic medical records from patients with NK/TCL without prior treatment. Pearson Chi-square tests were used to compare categorical variables, and t-test for quantitative variables. The Kaplan-Meier was used to determine OS and DFS. A bivariate analysis of factors that could influence OS and DFS was performed. Data analysis was done using the SPSS 23 statistical program. Results We included 173 patients with NK/TCL and complete clinical information. Male predominance was 1.8:1, median age 40 years old (16-85). Nasal type lymphoma occurred in 90.2% of cases and extranasal in 9.8%.The most frequent location site was nose (69%), follow by palate (15%), pharynx, larynx and Waldeyer´s ring (6.4%), skin and soft tissues (5.2%). At diagnosis, 68% were in ECOG<2 and 69% had B symptoms. More than 60% of cases presented as early clinical stages (stage I 35%, stage II 30.4%, stage III 5.3% and stage IV 29.2%). In advanced stages, the most frequent sites of infiltration were CNS (30%), skin and soft tissue (22%), intestine and lung (18%), bone marrow (<10%). The elevation of LDH as well as β2 micro globulin was reported in 44.4% and 50.7%, respectively. We applied four prognostic scales (IPI, K-IPI, PINK and PINK-β); regardless which one we used, more than 50% of patients presented a low risk, with the exception of stratification with the K-IPI scale, where more than 50% corresponded to an intermediate to risk. Nineteen patients did not receive treatment (due to scarce economic resources) and, in two patients, it was not possible to assess the response to treatment. We analyze 152 cases; monotherapy was administrated in 42.4% (38.4% received radiotherapy (RT), while 61.6% received only chemotherapy (CT)). The 57.8% received combined therapy (CT+RT). The modalities used were sequential (58%), sandwich (26%) and concurrent treatment (16%). The chemotherapeutic regimens used were divided into three groups chemotherapy anthracycline based therapy (CHOP: 38%), with L-asparaginase (48%) and others (14%). Of the entire population at the end of the study, 50.7% achieved complete response (CR), 11.8% partial response (PR), 3.3% stable disease (SD), 21.7% progression and 12.5% had died. Sixty-four percentage of patients who received combined therapy achieved CR. Outcome, as progression and death were more frequent in patients receiving only CT, 30.7% and 33.3%, respectively. CR greater than 50% was found with VLP and CHOP; meanwhile progression is less common with the use of SMILE (17.4%) (Table 1). The 3-year OS was 52% with a median follow-up of 3.6 years. The type of treatment, type of chemotherapy and chemotherapy regimens had a statistically significant impact (Table 1). In early stages OS was greater than 50% with CT+RT and with only RT. The 3-year OS was less than 50% in advanced stages regardless of the type of treatment however, the use of SMILE improves OS (3y) to 69% (Table 2). The scales that allow a greater separation between high or low risk groups were IPI and K-IPI, and have an impact on OS (p = 0.000). The 3-year SLE was 49%, with a median follow-up of 2.6 years, in this case only the type of treatment had a statistically significant influence (p 0.000). SLE (3y) with CT + RT was 58% vs 6% with RT and 0% with CT. Mortality was 45.7%, the most frequent cause of death was infection during treatment (85%) followed by disease activity (15%). Fifty-four percent is alive, 43% of them in RC. Conclusions NK/TCL lymphoma predominated in our male patients of productive age and in advanced clinical stages. The prognosis had greater clinical impact with the use of IPI and K-IPI scores. In early clinical stages, patients should receive radiation therapy and consider chemotherapy (VLP). In advanced stages, combined treatment is required, with the use of L-asparaginase chemotherapeutic regimens (like SMILE). Disclosures No relevant conflicts of interest to declare.

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