Current Treatment of Peripheral T-cell Lymphoma

• Published in: Oncology (Williston Park, N.Y.) Vol. 36; no. 5; pp. 293 - 305
• Main Authors: Stuver, Robert, Epstein-Peterson, Zachary D, Johnson, William T, Khan, Niloufer, Lewis, Natasha, Moskowitz, Alison J, Sauter, Craig S, Horwitz, Steven
• Format: Journal Article
• Language: English
• Published: United States Intellisphere, LLC 01.05.2022; MultiMedia Healthcare Inc
• Subjects: Anthracyclines; Antigens; Antimitotic agents; Antineoplastic agents; B cells; Biopsy; Care and treatment; Cytotoxicity; Drug approval; Epstein-Barr virus; Genotype & phenotype; Leukemia; Lymphatic system; Lymphocytes; Lymphoma; Morphology; Non-Hodgkin's lymphomas; Remission (Medicine); Stem cells; T cells; Transplantation
• ISSN: 0890-9091; 2767-7389
• DOI: 10.46883/2022.25920960

The peripheral T-cell lymphomas (PTCLs) are a notoriously diverse family of non-Hodgkin lymphomas with generally aggressive biology. Clinical management is challenging given a largely inadequate literature base comprised of few randomized trials and heterogeneous observational reports. Herein, we provide an account of our practice in the treatment of the 3 most common nodal PTCLs: PTCL, not otherwise specified, angioimmunoblastic T-cell lymphoma, and anaplastic large cell lymphoma (ALCL). In the up-front setting, we employ anthracycline-based induction, with the incorporation of brentuximab vedotin for all those with ALCL and consideration in those with other CD30-expressing PTCLs based on improved progression-free and overall survival in the absence of additional toxicity in the ECHELON-2 trial. We strongly consider high-dose therapy with autologous stem cell rescue in first complete remission. In the relapsed or refractory (R/R) setting, we often look to clinical trials or choose from 4 FDA-approved single agents-belinostat, brentuximab vedotin, romidepsin, and pralatrexate-based on tumor phenotype and side-effect profiles. Our goal in the R/R setting is achievement of complete remission followed by allogeneic transplant with curative intent in appropriate candidates or long-term disease control in others. Numerous investigational agents are advancing through trials and have potential to alter standards of care in the near future.