Prof. Dehui Zou: Clinical Features and Efficacy Analysis of Peripheral T-Cell Lymphoma The 6th Anti-leukemia·Lymphoma International Summit Forum

In order to further promote the communication and development in the field of leukemia and lymphoma diagnosis at home and abroad, "The 6th Anti-leukemia·Lymphoma International Summit Forum and CSCO Anti-Leukemia Alliance & Anti-Lymphoma Alliance Tour Lecture-Harbin Station" in July 2021 Held in Harbin on 8-10
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This forum brought together many outstanding leukemia and lymphoma experts at home and abroad, and will conduct in-depth discussions and exchanges on new drug development and clinical applications
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At this forum, Professor Zou Dehui from the Hospital of Hematology, Chinese Academy of Medical Sciences gave a keynote report on "Peripheral T-cell Lymphoma (PTCL) Clinical Features and Efficacy Analysis: Real World Database Analysis of the Institute of Hematology, Chinese Academy of Medical Sciences".
The content is organized as follows
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Current status of PTCL treatment PTCL is a rare and highly heterogeneous disease.
The 2016 WHO classification classified PTCL into as many as 29 different disease subtypes
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Due to its diversified immune phenotypes, difficulty in identifying clonality, lack of characteristics in cytogenetics, and few characteristics in tumor genes, PTCL is more likely to be misdiagnosed and missed
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 There is currently no standard treatment plan for PTCL.
Although some PTCL subtypes can be treated with CHOP regimen-based treatment, there are also some PTCL subtypes that are not recommended for CHOP regimen-based treatment.
At the same time, some PTCL subtypes are relatively rare.
There is a lack of treatment-related information
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The results of related prospective studies show that compared with treatment alone, autologous hematopoietic stem cell transplantation (ASCT) after the first disease remission can improve the prognosis of PTCL patients, but the prognosis improvement brought by transplantation is limited, and the prognosis of most PTCL patients is still poor
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At the same time, the results of AATT randomized clinical trials showed that first-line allogeneic hematopoietic stem cell transplantation (Allo-SCT) did not improve the prognosis of patients with PTCL
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Except for ALK-positive and CD30-positive PTCL, the current guidelines for most PTCL treatment recommendations are clinical trials
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Real-world database analysis of the Institute of Hematology, Chinese Academy of Medical Sciences The Institute of Hematology, Chinese Academy of Medical Sciences conducted a retrospective study that included PTCL cases seen from 1992 to 2019, and analyzed the distribution of PTCL subtypes and the characteristics of rare subtypes of PTCL The PTCL efficacy and patient survival under the current treatment model, the efficacy of ASCT first-line consolidation treatment of nodular PTCL, and the prognostic factors of aggressive PTCL were explored
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 In the prognosis study of aggressive PTCL, most of the patients included were aggressive PTCL (71%), most of which were unspecified peripheral T-cell lymphoma (PTCL-NOS, 34%) and extranodal NK/T-cell lymphoma (ENKTL , 17%)
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The proportion of patients with high-risk aggressive PTCL in the study was relatively high.
50.
7% (154 cases) of patients had bone marrow invasion, and 86.
8% (264 cases) of patients were in advanced stage (stage III/IV)
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At a median follow-up of 43 months (range: 1-162), the median progression-free survival (PFS) of patients with aggressive PTCL was 13.
0 months, and the median overall survival (OS) was 24.
0 months; 4-year PFS The rate was 31.
2%, and the 4-year OS rate was 35.
3%
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The survival of these patients is significantly worse than that of patients with B-cell lymphoma
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 The treatment strategy of nodular PTCL This retrospective study of the first-line treatment plan analysis of newly diagnosed nodular PTCL shows that the current CHOP/CHOP-like regimen is still the cornerstone of the treatment of newly diagnosed nodular PTCL
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Compared with the new drug combination chemotherapy regimen and other regimens, the CHOP/CHOP-like regimen can achieve a higher remission rate
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Survival analysis showed that the 4-year PFS rate of newly diagnosed nodular PTCL patients was 39.
7%, and the 4-year OS rate was 47.
3%, which is better than international data
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However, the prognosis of patients with relapsed and refractory nodular PTCL is extremely poor, with median PFS and OS only 3.
0 months and 9.
0 months
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Professor Zou Dehui said that the treatment of nodular PTCL needs to be as good as possible in the first line, and it is relatively difficult to treat once the disease is relapsed and refractory
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 The current clinical guidelines recommend ASCT for patients with nodular PTCL who achieve partial remission (PR) or better efficacy, but for patients who achieve complete remission (CR), whether ASCT can further improve the efficacy is still controversial
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In this retrospective study, a cohort analysis of ASCT versus chemotherapy in patients with nodular PTCL after CR1 showed that the ASCT group had a 4-year PFS rate (59.
8% vs 32.
4%) and a 4-year OS rate (67.
7% vs 44.
4%) compared with chemotherapy alone.
Both are better
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In addition, univariate prognosis analysis of patients with CR1 obtained through chemotherapy showed that ECOG score, bone marrow invasion, IPI score, and whether to perform first-line consolidation ASCT have an impact on the prognosis of patients with nodular PTCL
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Professor Zou Dehui emphasized the timing of ASCT for patients with nodular PTCL, and ASCT after CR1 can play a better role in consolidation therapy
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 Prognosis and treatment options for hepatosplenic T-cell lymphoma (HSTCL) This retrospective study also included 39 HSTCL patients, most of whom had splenomegaly (38 cases, 97.
4%) and bone marrow involvement (36 cases, 92.
3%)
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The effective rate of induction therapy in this part of patients is low, and only 5 patients reached CR after induction therapy
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At the same time, compared with the CHOP regimen, the intensive regimen did not significantly improve the PFS (median PFS: 10.
0 months vs 8.
0 months; P=0.
545) and OS (median OS: 24.
0 months vs 11.
7 months; P =0.
070)
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But for some younger HSTCL patients who have achieved CR through induction therapy, Allo-HSCT can improve the survival of these patients
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Summary Professor Zou Dehui concluded: PTCL is highly heterogeneous, and different subtypes have large differences in clinical features, treatment options and prognosis
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For newly diagnosed nodular PTCL, there is no better treatment than the CHOP/CHOP-like regimen
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ASCT consolidation therapy in stage CR1 of nodular PTCL patients can improve the efficacy
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Not all patients with subtypes can benefit from ASCT.
For patients with more aggressive subtypes, relapsed and refractory, Allo-SCT can improve the survival of some patients
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In the future, further studies on the genetics and molecular pathogenesis of PTCL are needed to explore effective targeted therapy
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Professor Zou Dehui, Chief Physician, Lymphoma Diagnosis and Treatment Center, Hematology Hospital, Chinese Academy of Medical Sciences (Institute of Hematology, Chinese Academy of Medical Sciences) Member of Lymphoma Professional Committee of Chinese Anti-Cancer Association Associate Leader of Lymphoma Group of Hematological Oncology Professional Committee of Chinese Anti-Cancer Association Chinese Geriatrics Member of the Standing Committee of the Society of Hematology, Member of the Lymph and Hematology Committee of the Chinese Society of Geriatric Oncology, Vice Chairman of the Lymphoma Professional Committee of Tianjin Anti-Cancer Association, Deputy Director of the Oncology Critical Care Professional Committee of Tianjin Anti-Cancer Association, Member of China Multiple Myeloma Research Alliance "Learning Magazine" newsletter editor stamp "read the original", we make progress together