Findings from a registry study presented at the ESMO Asia Virtual Congress 2020, held from 20 to 22 November 2020 provided the first step in formulating cohesive treatment strategies for T-cell non-Hodgkin lymphomas (NHLs) by identifying the prevalence of subtypes, treatments, and patient outcomes across several Asian countries.
Sang Eun Yoon of the Hematology, Samsung Medical Center in Seoul, Republic of Korea, discussed the difficulties in treating peripheral T-cell lymphomas (PTCLs), which are uncommon and regionally heterogeneous malignancies. Furthermore, there is no consensus regarding treatment of T-cell NHLs with most studies being conducted individually in each country, with no assessment of the incidence across Asia.
In order to resolve these issues, Professor Yoon and collegues conducted this Asian-specific study to determine the incidence of T-cell NHLs and identified majority-approved treatments across the region. They initiated the multinational, multicentre prospective intercontinental registry study by reviewing the registries of 32 institutes in China, Taiwan, Singapore, Indonesia, and the Republic of Korea from April 2016 to February 2019 to identify patients with PTCLs.
The investigators determined the most often used therapies and the corresponding patient outcomes
The registry review identified 486 cases; across all subtypes of T-cell NHLs, the median patient age was 57 (range, 19-89) years, about 60% of patients were men and had B-symptoms. The percentage of patients with stage 3 or 4 diseases was about 60%.
Extranodal natural killer (NK)/T-cell lymphoma, nasal type (ENKTL) was the most prevalent subtype with an incidence of 28.6%, followed by angioimmunoblastic T-cell lymphoma (AITL; 24.7%), and peripheral T-cell lymphoma-not otherwise specified (PTCL-NOS; 20.8%).
Incidence of non-Hodgkin T-cell lymphoma subtypes in prospective registry study in Asia.
© Sang Eun Yoon.
We compared the PFS and OS according to the five most common subtypes (ENKTL, AITL, PTCL-NOS, ALK-positive ALCL, ALK-negative ALCL), ALK-positive anaplastic large cell lymphoma (ALCL) had more favorable PFS compared to the others.
Progression-free survival curves for most prevalent subtypes in the registry.
© Sang Eun Yoon.
Overall survival curves for most prevalent subtypes in the registry.
© Sang Eun Yoon.
Patients treated with chemoradiotherapy had demonstrated superior objective response rates and PFS, as compared to chemotherapy only (p = 0.03). Advanced ENKTL patients who underwent upfront autologous stem cell transplantation (auto-SCT) after frontline cytotoxic chemotherapy achieved superior outcomes compared to those who did not (p = 0.04).
The predominant treatments for PTCL-NOS, AITL, and ALCL were CHOP-like (cyclophosphamide, doxorubicin, vincristine, and prednisolone) and CHOEP-like (CHOP plus etoposide) regimens across Asia. However, no significant difference was found in the survival benefit between these regimens (CHOP-like versus CHOEP like, versus others; p = 0.68). Besides, CHOP-like and CHOEP-like regimes showed no critical difference in PFS across all age groups as well as in age-dependent groups.
Regarding treatments used in the salvage setting, cytotoxic chemotherapy showed disappointing efficacy, and superiority was not decisive yet for any salvage strategies regardless of all subtypes.
Conclusions
The investigators were able to determine the relative incidence of T-cell lymphoma and the corresponding survival outcomes across Asia. They concluded that the intercontinental study was meaningful as the first PTCLs registry study in Asia.
They noted that the study may be limited by bias in the registration of patients due to the large number of patients registered in some countries.
No external funding was disclosed.
Reference
257O – Yoon SE, Song Y, Kim SJ et al. Intercontinental cooperative non-Hodgkin T-cell lymphoma prospective registry study in Asia: ICT study. ESMO Asia Virtual Congress 2020 (20-22 November).