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Dismal outcome of refractory/relapsed PTCL
Among the 633 refractory/relapsed patients, 436 (69%) were classified as refractory and 197 (31%) as relapsed patients. The median time to relapse was 8 months (range 2-73 months). Among the relapsed patients, 125 (63%) pre- sented with an early relapse (≤12 months) and 72 (37%) presented with late relapse (>12 months). Main baseline patients’ characteristics of refractory/relapsed patients and all of the analyzed subset are shown in Table 1. The medi- an age at diagnosis of refractory patients was 59 years (range 18-89 years) and that of relapsed patients was 58 years (range 21-88 years). Thirty-three percent of refracto- ry patients and 16% of relapsed patients had ECOG per- formance status over 1 at diagnosis, respectively. A similar number of patients with AITL and PTCL had refractory (AITL: 16%, PTCL-NOS: 42%) or relapsed (AITL: 21%, PTCL-NOS: 42%) disease (Table 1). Patients with ALCL ALK- were more likely to have refractory disease than ALCL ALK+ (14% vs. 5%), but the frequency of relapsed disease was similar between both groups (11% vs. 7%).
The majority of patients (n=844, 90%) received chemotherapy +/- radiotherapy as first-line treatment and 75 (8%) were consolidated with high-dose therapy (HDT) and hematopoietic cell transplantation (HCT) (Table 1). HCT was considered to be part of first-line therapy when it was given within six weeks from the end of the induc- tion chemotherapy; in addition, patients who received HCT after six weeks from the end of initial chemotherapy,
Figure 1. Flow chart of patients included in the analysis. CR: complete remission. Table 1. Main characteristics at diagnosis of 436 refractory and 197 relapsed patients, and of all 937 patients analyzed.
Parameter
Median age (range), years
Age, >60 years, N, % Sex,male,N,%
ECOG-PS, >1, N, %
Serum LDH, > ULN, N, % [578] Ann Arbor staging, III-IV, N, % [591] ENS,>1,N,%[568]
Serum albumin, <3.5 g/dL, N, % [562] NLR, >6.5, N, % [598]
PIT, high-risk (2-4), N, % [503]
IPI, high-risk (3-5), N, % [551]
Histology subtype PTCL,NOS
AITL ALCL,ALK- ALCL,ALK+ NKTCL
Other
1st line therapy
CHT+/-RT
RT alone
CHT/consolidation HCT 12 3
Refractory Relapsed All (n=436) (n=197) (n=937)
N%N%N%
59 (18-89) 203 273 143 234 325 148 204 125 172 184
185 70 60 21 35 65
58 (21-88) 56 (18-89)
47 90 46 63 136 69 33 31 16 54 82 42 75 128 65 34 43 22 47 70 36 29 48 24 39 52 26 42 53 27
42 83 42 16 42 21 14 22 11
401 43 579 62 214 23 404 43 605 65 250 27 359 38 231 25 283 30 294 31
346 37 154 16 140 15
5 14 8 21 15 15
7 77 8 11 109 12 8 80 9
844 90 18 2 75 8
474 51 164 18 299 32
Response to 1st line therapy CR
PR
<PR
-- 17086 137 31 27 14 299 69 --
422
2 <1
88 22 11
97 174
1 <1
ECOG-PS: perfomance status according to the Eastern Cooperative Oncology Group (ECOG) definition; LDH: lactate dehydrogenase; ULN: upper limit of normal; ENS: number of extra-nodal sites involved; NLR: neutrophil-to-lymphocyte ratio; PIT: Prognostic Index for T-cell lymphoma; IPI: International Prognostic Index; PTCL, NOS: peripheral T-cell lymphoma not otherwise specified; AITL: angioimmunoblastic T-cell lymphoma; ALCL: anaplastic large cell lymphoma; ALK: anaplastic lymphoma kinase; NKTCL: extra-nodal NK/T-cell lymphoma; CHT: chemotherapy; RT: radiotherapy; HCT: hematopoietic cell transplantation; CR: complete remission; PR: partial remission.
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