| Objuective:Peripheral T-cell lymphoma(PTCL)is a rare and heterogeneous group of non-Hodgkin lymphoma(NHL)with mostly aggressive behavior.Patients with most subtypes of PTCL present with dismal outcomes.This real-world study aimed to analyze the clinical features,treatment efficacy,survival and prognostic factors of PTCL subtypes.Methods:We identified 430 patients diagnosed of PTCL from June 1992 to December 2019 in Institute of Hematology and Blood Diseases Hospital of Chinese Academy of Medical Sciences.Clinical characteristics,laboratory results,treatment strategies and responses were reviewed.The last follow-up time was December 31st,2019.Results:There were 430 cases of PTCL patients diagnosed in our hospital over the two dacades.This series is characterized by a higher incidence of PTCL not otherwise specified(NOS),T-cell large granular lymphocyte leukemia(T-LGLL),extranodal NK/T-cell lymphoma,nasal type(ENKTL),angioimmunoblastic T-cell lymphoma(AITL),hepatospleenic T-cell lymphoma(HSTCL).The average age of patients with aggressive subtypes was 46.5 years old.The males accounted for 68.8%.86.8%of the patients present with advanced-stage disease.After a median follow-up of 43 months,the 5-year progression-free survival(PFS)and overall survival(OS)of aggressive subtypes were(26.1±3.8)%and(30.7±3.8)%,respectively.For 147 newly-diagnosed nodal patients,the overall response rate(ORR)was 86.8%.There was no statistical difference between patients received CHOP/CHOP-like regimens,novel drugs-containing regimens and other regimens.41 patients received hematopoietic stem cell transplantation(HSCT).After a median follow-up of 45 months,the five-year PFS and OS rates of newly-diagnosed nodal patients were(34.9±5.5)%and(41.4±5.8)%,respectively.The five-year PFS and OS rates of patients reveived autologous HSCT(auto-HSCT)were(44.3±11.5)%and(53.0±13.6)%.The median OS of HSTCL patients receiving intensive induction regimen and CHOP regimen were 24.0 months and 11.7 months(P=0.070),respectively.Five patients underwent allogeneic HSCT(allo-HSCT)with the median duration of response(DOR)of 15.0 months and the median OS of 33.0 months.For newly-diagnosed aggressive PTCL,elevated LDH,not response to first-line chemotherapy and not receiving HSCT were independent poor prognostic factors.Progression of disease within 12 months(POD 12)indicated inferior subsequent OS(sOS)of newly-diagnosed nodal PTCL compared with patients without POD12(4-year sOS rates(28.8 ± 12.4)%vs.(59.7 ±8.1)%,P=0.014).Multivariate analysis indicated ECOG score>1,not response to first-line chemotherapy as well as POD12 were poor factors predictive of OS.Conclusion:PTCL is a heterogeneous disease and patients with aggressive subtypes present with poor outcomes.Patients receiving traditional chemotherapy were prone to relapse or prognose.HSCT can improve survival of a part of patients.Objective:To compare the outcomes of autologous hematopoietic stem cell transplantation(ASCT)and chemotherapy alone in the first-line treatment of nodal peripheral T-cell lymphoma(PTCL)in first complete remission(CR1).Methods:The clinical data of patients with newly-diagnosed nodal PTCL in Institute of Hematology and Blood Diseases Hospital of Chinese Academy of Medical Sciences were analyzed retrospectively.All patients achieved CR1 and were divided into ASCT group and chemotherapy group according to consolidative treatment.Survival analysis and prognostic factor analysis were performed in two cohorts.Results:A total of 42 patients were enrolled.The subtypes included PTCL not otherwise specified(PTCL-NOS,34 cases,81.0%),angioimmunoblastic T-cell lymphoma(AITL,6 cases,14.3%)and ALK-negative anaplastic large cell lymphoma(ALK-ALCL,2 cases,4.7%).Each of the two cohorts consisted of 21 patients.There were no significant differences in histological subtypes,clinical features,types and courses of first-line chemotherapy in two cohorts(P>0.050).With a median follow-up of 50(4.0～151.0)months,the 4-year progression-free survival(PFS)rate and overall survival(OS)rate of the whole cohort were(47.9±10.0)%and(56.0±9.3)%.The 4-year PFS rates of ASCT group and chemotherapy group were(59.8±13.3)%and(32.4±15.5)%(P=0.020),respectively,and the 4-year OS rates were(67.7± 12.3)%and(44.4±12.9)%,respectively((P=0.047).The differences were both statistically significant.Univariate prognostic analysis showed that ECOG score>1,PIT>1 and not receiving first-line consolidative ASCT were poor prognostic factors for PFS and OS.BM involvement and high IPI score predicted inferior PFS.Conclusion:First-line consolidative ASCT can significantly improve PFS and OS compared with chemotherapy alone for nodal PTCL patients in CR1. |
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