Peripheral T-cell lymphoma: what's the role for transplant?

Despite great strides in the management of B-cell non-Hodgkin and Hodgkin lymphoma, peripheral T-cell lymphoma (PTCL) remains a therapeutic challenge. As Petrich and Rosen thoroughly describe in this issue of ONCOLOGY,[1] there are several new agents available for the management of PTCL. Unfortunately, however, outcomes remain poor, especially when compared with those seen in B-cell non-Hodgkin lymphoma.[2] The 5-year failure-free survival for newly diagnosed patients receiving an anthracycline-based induction regimen, currently considered the standard of care, was only 22% in a series of 1,314 cases from the Peripheral T-Cell Lymphoma Project.[3] In a systematic literature review and meta-analysis examining the complete response (CR) and overall survival (OS) rates for patients with PTCL receiving anthracycline-based chemotherapy, the CR rate ranged from 36% for enteropathy-type T-cell lymphoma to 66% for anaplastic large-cell lymphoma (ALCL); however, the 5-year OS was < 50% for all subtypes except ALCL.[4] Among patients who relapsed, the median OS was only 5.5 months in a series of 153 patients with relapsed PTCL (including 11 with anaplastic lymphoma kinase [ALK]-positive ALCL). This was only marginally improved to 6.5 months if a patient received chemotherapy at the time of relapse, an indication of the poor response to currently available therapy options.[5] Given the poor prognosis for most patients, the authors correctly point out the importance of prospective clinical investigations, which will provide more guidance on the optimal implementation of currently available agents and those in development. Whenever possible, therefore, patients should be managed at a center that has experience and expertise in the management of PTCL and that may have trials to offer.