T-Cell Lymphomas, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology

Horwitz, Steven M.; Ansell, Stephen M.; Ai, Weiyun Z.; Barnes, Jeffrey A.; Barta, Stefan K.; Brammer, Jonathan E.; Clemens, Mark W.; Doğan, Ahmet; Foss, Francine M.; Ghione, Paola; Goodman, Aaron M.; Guitart, Joan; Halwani, Ahmad; Haverkos, Bradley M.; Hoppe, Richard T.; Jacobsen, Eric; Jagadeesh, Deepa; Jones, Allison; Kallam, Avyakta; Kim, Youn H; Kumar, Kiran A; Mehta‐Shah, Neha; Olsen, Elise A.; Rajguru, Saurabh; Rozati, Sima; Said, Jonathan; Shaver, Aaron C.; Shea, Lauren; Shinohara, Michi M.; Sokol, Lubomir; Torres‐Cabala, Carlos A.; Wilcox, Ryan A.; Wu, Peggy; Zain, Jasmine; Dwyer, Mary A.; Sundar, Hema

doi:10.6004/jnccn.2022.0015

Cited by 91 publications

(52 citation statements)

References 129 publications

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“…In contrast with previous studies, 10,18 Aspa-based regimens are preferred according to guidelines. 16,22 In our study, although Aspa-based regimens did not display significant superiority in multivariate analysis, univariate analysis already showed that Aspa-based regimens significantly improved PFS1 and partly improved OS compared to non-Aspa-based ones. The lack of statistical significance may be attributed to the confounding factors, particularly the concomitant application of Aspa and other agents, and the prominent hematological toxicity of the SMILE regimen [23][24][25] which often led to suboptimal dosage in clinical practice.…”

Section: Discussioncontrasting

confidence: 49%

“…However, for advanced‐stage patients, current treatment modalities especially comprehensive therapy still have certain shortcomings, with a 5‐year OS <20% according to most previous literature reports 11‐15 . The National Comprehensive Cancer Network (NCCN) guideline recommend multidisciplinary therapy for advanced‐stage ENKTL, including asparaginase (Aspa)‐based CT, RT and hematopoietic stem cell transplantation (HSCT) consolidation as appropriate; clinical trials are preferred as there is no established consensus on the optimal treatment 16 . Previous studies mostly focused on early‐stage disease, while few large‐sample researches specifically investigated newly diagnosed advanced‐stage ENKTLs yet.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Intensive therapy can improve long‐term survival in newly diagnosed, advanced‐stage extranodal NK/T‐cell lymphoma: A multi‐institutional, real‐world study

Wei,

Qi,

Zheng

et al. 2023

Intl Journal of Cancer

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The study investigated the treatment and prognosis of advanced‐stage extranodal natural killer/T‐cell lymphoma (ENKTL). With a median follow‐up of 75.03 months, the median overall survival (mOS) for the 195 newly diagnosed stage III/IV ENKTL patients was 19.43 months, and estimated 1‐, 2‐, 3‐ and 5‐year OS were 59.5%, 46.3%, 41.8% and 35.1%, respectively. Chemotherapy (CT) + radiotherapy (RT) compared to CT alone (P = .007), and hematopoietic stem cell transplantation (HSCT) compared to non‐HSCT (P < .001), both improved OS. For patients ≤60 years and ineligible for HSCT, other therapies with complete remission led to comparable OS (P = .141). Nine patients ever treated with chidamide achieved a median progression‐free survival (mPFS) and mOS of 53.63 (range, 3.47‐92.33) and 54.80 (range, 5.50‐95.70) months, and four with chidamide maintenance therapy (MT) achieved a mPFS and mOS of 55.83 (range, 53.27‐92.33) and 60.65 (range, 53.70‐95.70) months, possibly providing an alternative option for non‐HSCT patients. Non‐anthracycline (ANT)‐ compared to ANT‐, asparaginase (Aspa)‐ compared to non‐Aspa‐ and gemcitabine (Gem)‐ compared to non‐Gem‐based regimens, prolonged PFS (P = .031; P = .005; P = .009) and OS (P = .010; P = .086; P = .003), respectively. Multivariate analysis demonstrated that Gem‐based regimens improved PFS (HR = 0.691, P = .061) and OS (HR = 0.624, P = .037). Gem + Aspa combinations slightly improved PFS and OS compared to regimens containing Gem or Aspa alone (P > 0.05). First‐line “intensive therapy,” including CT (particularly Gem + Aspa regimens), RT, HSCT and alternative chidamide MT, was proposed and could improve long‐term survival for advanced‐stage ENKTLs. Ongoing prospective clinical studies may shed further light on the value of chidamide MT.

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Section: Discussioncontrasting

confidence: 49%

Section: Introductionmentioning

confidence: 99%

Intensive therapy can improve long‐term survival in newly diagnosed, advanced‐stage extranodal NK/T‐cell lymphoma: A multi‐institutional, real‐world study

Wei,

Qi,

Zheng

et al. 2023

Intl Journal of Cancer

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“…After the initial stage assessment, all patients were given 6–8 cycles of first-line chemotherapy regimens with or without radiotherapy according to the latest NCCN guidelines, and patient tolerance and comorbidities. 6 , 30 Serial ctDNA profiling was conducted during the patient’s therapy course. The Eastern Cooperative Oncology Group (ECOG) performance status was also assessed.…”

Section: Methodsmentioning

confidence: 99%

The Novel Prognostic Index Model of Combining Circulating Tumor DNA and PINK-E Predicts the Clinical Outcomes for Newly Diagnosed Extranodal NK/T-cell Lymphoma

Huang

et al. 2022

HemaSphere

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Extranodal NK/T-cell lymphoma (ENKTL) is a highly aggressive and heterogeneous disease with poor clinical outcome. Our previous work had demonstrated that circulating tumor DNA (ctDNA) analyses were feasible in ENKTL, and dynamic tracing of ctDNA could be used to monitor the disease status. However, the prognostic value of ctDNA in ENKTL has not been fully investigated. Patients with newly diagnosed ENKTL from February 2017 to December 2021 (n = 70) were enrolled. The pretreatment ctDNA concentration (hGE/ mL) was measured. The prognostic value of ctDNA, international prognostic index (IPI), Korean prognostic index (KPI), PINK-E, and the combination of PINK-E and ctDNA (PINK-EC) were investigated in our cohort. The IPI and PINK-E risk categories had a significant difference in progression-free survival (PFS) and overall survival (OS) between the low-risk and intermediate-risk groups. The KPI risk category had a difference in PFS and OS between the intermediate-risk and high-risk groups. Furthermore, integrating ctDNA into the PINK-E model could overcome the shortcomings of other prognostic models, which could significantly distinguish the different-risk groups. Overall, our results demonstrated that PINK-EC showed a superior prognostic prediction value and stability compared with IPI, KPI, and PINK-E. The integration of molecular features of the tumor into classic risk categories might better characterize a high-risk group where novel treatment approaches are most needed.

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“…Similarly, long-term outcomes have been highly unsatisfactory for AITL patients treated with anthracycline-based regimens as reported by different groups, with 5-year PFS estimates of 18%, 13%, and 20% according to the ITCLP , British Columbia Cancer Agency (BCCA) group, and Swedish National Lymphoma Registry , respectively ( 10 , 115 , 116 ). This has led to several guidelines, including that of the National Comprehensive Cancer Network (NCCN), to recommend enlisting patients with AITL in clinical trials as preferred primary therapeutic strategy ( 117 ).…”

Section: Treatmentmentioning

confidence: 99%

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

et al. 2023

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Angioimmunoblastic T-cell lymphoma (AITL) is the second most frequent subtype of mature T-cell lymphoma (MTCL) in the Western world. It derives from the monoclonal proliferation of T-follicular helper (TFH) cells and is characterized by an exacerbated inflammatory response and immune dysregulation, with predisposition to autoimmunity phenomena and recurrent infections. Its genesis is based on a multistep integrative model, where age-related and initiator mutations involve epigenetic regulatory genes, such as TET-2 and DNMT3A. Subsequently, driver-mutations, such as RhoA G17V and IDH-2 R172K/S promote the expansion of clonal TFH-cells (“second-hit”), that finally begin to secrete cytokines and chemokines, such as IL-6, IL-21, CXCL-13 and VEGF, modulating a network of complex relationships between TFH-cells and a defective tumor microenvironment (TME), characterized by expansion of follicular dendritic cells (FDC), vessels and EBV-positive immunoblasts. This unique pathogenesis leads to peculiar clinical manifestations, generating the so-called “immunodysplastic syndrome”, typical of AITL. Its differential diagnosis is broad, involving viral infections, collagenosis and adverse drug reactions, which led many authors to use the term “many-faced lymphoma” when referring to AITL. Although great advances in its biological knowledge have been obtained in the last two decades, its treatment is still an unmet medical need, with highly reserved clinical outcomes. Outside the setting of clinical trials, AITL patients are still treated with multidrug therapy based on anthracyclines (CHOP-like), followed by up-front consolidation with autologous stem cell transplantation (ASCT). In this setting, the estimated 5-year overall survival (OS) is around 30-40%. New drugs, such as hypomethylating agents (HMAs) and histone deacetylase inhibitors (HDAi), have been used for relapsed/refractory (R/R) disease with promising results. Such agents have their use based on a biological rationale, have significant potential to improve the outcomes of patients with AITL and may represent a paradigm shift in the therapeutic approach to this lymphoma in the near future.

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T-Cell Lymphomas, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology

Cited by 91 publications

References 129 publications

Intensive therapy can improve long‐term survival in newly diagnosed, advanced‐stage extranodal NK/T‐cell lymphoma: A multi‐institutional, real‐world study

Intensive therapy can improve long‐term survival in newly diagnosed, advanced‐stage extranodal NK/T‐cell lymphoma: A multi‐institutional, real‐world study

The Novel Prognostic Index Model of Combining Circulating Tumor DNA and PINK-E Predicts the Clinical Outcomes for Newly Diagnosed Extranodal NK/T-cell Lymphoma

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

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