Impact of etoposide and ASCT on survival among patients aged <65 years with stage II to IV PTCL: a population-based cohort study

Abstract

Patients <65 years with peripheral T-cell lymphoma are treated with cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP). While the addition of etoposide and consolidation with autologous stem cell transplantation (ASCT) are preferred in some countries, randomized trials are lacking. This nationwide population-based study assessed the impact of etoposide and ASCT on overall survival (OS) among patients aged 18-64 years with stage II-IV anaplastic large T-cell lymphoma (ALCL), angioimmunoblastic T-cell lymphoma (AITL) and peripheral T-cell lymphoma not otherwise specified (PTCL-NOS), diagnosed between 1989-2018, utilizing the Netherlands Cancer Registry. Patients were categorized into two calendar periods, which represent the pre- and post-era of etoposide and ASCT implementation, respectively. A total of 1,427 patients were identified (35% ALCL, 21% AITL and 44% PTCL-NOS). OS increased from 39% in 1989-2009 to 49% in 2009-2018 (p<0·01). The 5-year OS was superior for patients treated with CHOEP, as compared to patients with CHOP (64% and 44%, respectively; p<0·01). When adjusted for subtype, IPI-score, and ASCT, the risk of mortality was similar between the two groups, except for ALK+ ALCL patients for whom risk of mortality was 6.3 times higher when treated with CHOP as compared to CHOEP. Patients consolidated with ASCT demonstrated a superior 5-year OS of 81% as compared to 39% for patients not receiving an ASCT (p<0·01), regardless of whether a complete remission was achieved. In patients <65 years with advanced stage ALK- ALCL, AITL and PTCL, the use of ASCT consolidation, but not the addition of etoposide, was associated with improved OS.

Angioimmunoblastic T-cell lymphoma and correlated neoplasms with T-cell follicular helper phenotype: from molecular mechanisms to therapeutic advances

“…However, after adjustment for histological subtype, this benefit was maintained only for patients with ALK1+ ALCL, with a 6.3-fold increased risk of mortality among those treated with CHOP. In this analysis, patients < 65 years with ALK1-negative ALCL, AITL, and PTCL, NOS subtypes did not have increased OS with addition of etoposide to CHOP ( 125 ). In 2021, Kim J et al., conducted a meta-analysis involving 34 cohorts from 28 studies and a pool of 1424 patients with nMTCL.…”

Final results of a phase II study of CHOEP plus lenalidomide as initial therapy for patients with stage II–IV peripheral T‐cell lymphoma

“…In nonrandomized prospective and retrospective reports, adding etoposide to CHOP appears to improve response rates and event-free survival predominantly in younger patients, although OS benefits have not been demonstrated. 5,6 In a recent analysis of over 1400 patients from the Netherlands Cancer Registry, the CR rate was higher in those receiving CHOEP versus CHOP (60% vs. 40%, p = 0.02). However, there was no difference in OS when adjusting for age, subtype, IPI and receipt of HDT/ASCR.…”

The added prognostic values of baseline PET dissemination parameter in patients with angioimmunoblastic T‐cell lymphoma

“…The model based on TMTV and Dmax could effectively differentiate three different risk groups and was most significant for OS. That is, the concise PET model can identify a group of high‐risk patients with poor prognosis, for whom clinicians may also consider consolidation with other treatments, such as autologous stem cell transplantation [ 26 ]. Dmax remained an independent prognostic value for PFS, the combination of Dmax with PIAI or AITL score showed a slightly stronger efficiency of risk stratification for PFS than the combination of Dmax with TMTV, especially for patients in low‐risk and intermediate‐risk groups.…”