OS is worse with refractory vs relapsed PTCL
Photo by Larry Young
SAN FRANCISCO—Patients with refractory peripheral T-cell lymphoma (PTCL) have significantly worse overall survival (OS) than patients with relapsed PTCL, according to data from the COMPLETE registry.
The data also showed that patients treated with a curative intent had significantly better OS than patients who received palliative care.
However, there was no significant difference in OS according to disease subtype or between patients who received conventional chemotherapy and those who received novel agents.
Frederick Lansigan, MD, of Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, presented these data at the 9th Annual T-cell Lymphoma Forum. Data were also presented at the 2016 ASH Annual Meeting (abstract 4150).
Dr Lansigan and his colleagues analyzed COMPLETE data on patients with mature T-cell lymphomas, focusing on patients in first relapse and those with primary refractory disease.
Refractory disease was defined as no response to initial treatment or disease progression during or within 1 month of completing front-line therapy.
Relapsed disease was defined as progression more than 1 month after completing induction therapy in patients who initially achieved a complete response (CR) or partial response (PR).
Patients
There were 138 patients in the analysis—58 with relapsed disease and 80 with refractory disease.
The median time from informed consent to diagnosis of relapsed disease was 11.4 months, and the time to diagnosis of refractory disease was 2.2 months.
Disease subtypes included:
- PTCL not otherwise specified (NOS)—35% of relapsed and 28% of refractory patients
- Angioimmunoblastic T-cell lymphoma—22% and 16%
- ALK- anaplastic large-cell lymphoma (ALCL)—10% and 14%
- ALK+ ALCL—3% and 4%
- Natural killer/T-cell lymphoma, nasal type—9% and 8%
- Enteropathy-associated T-cell lymphoma—5% and 3%
- Hepatosplenic T-cell lymphoma—3% and 5%
- Adult T-cell leukemia/lymphoma—2% and 5%
- Transformed mycosis fungoides—0% and 10%
- “Other”—10% and 9%.
Treatment
Most patients received combination regimens as front-line therapy—81% in the relapsed group and 68% in the refractory group. Nineteen and 32%, respectively, received single-agent treatment.
A majority of patients in both groups received chemotherapy or novel agents as second-line therapy—65% in the relapsed group and 71% in the refractory group. (Novel agents include histone deacetylase inhibitors, monoclonal antibodies, immunoconjugates, pralatrexate, bendamustine, denileukin diftitox, alisertib, and lenalidomide.)
Fifteen percent of relapsed patients and 16% of refractory patients received palliative care/best supportive care/observation as second-line therapy. Fifteen percent and 7%, respectively, had a transplant. Four percent and 6%, respectively, received chemotherapy and radiotherapy.
Of the patients who received systemic therapy second-line, 53% of relapsed patients received novel therapies, and 47% received conventional chemotherapy. Twenty-five percent of the refractory patients received novel therapies, and 75% received chemotherapy (P=0.005 for relapsed/refractory comparison of novel vs traditional therapy).
Most patients with relapsed disease received single agents (74%) rather than multi-agent regimens (26%) as second-line therapy. However, single-agent treatment was about as common as multi-agent regimens for refractory patients—53% and 47%, respectively (P=0.03 for relapsed/refractory comparison).
The objective response rates to second-line therapy were 61% for relapsed patients and 37% for refractory patients (P=0.02). The CR rates were 37% and 12%, respectively (P=0.003).
Survival
The median OS was significantly better for patients with relapsed PTCL—15.7 months, compared to 6.1 months for refractory patients (P=0.0237).
OS was also significantly better for patients who achieved a CR. The median OS was not reached for patients with a CR, 14.6 months for those with a PR, 13.7 months for those with stable disease, and 3.2 months for those who progressed (P<0.0001).
There was no significant difference in median OS for patients who received novel agents and those who received traditional chemotherapy—14.6 months and 11.1 months, respectively (P=0.2362).
