Treatment Selection for Peripheral T-cell Lymphoma

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Peripheral T-cell lymphomas (PTCL) comprise approximately 6-10% of non-Hodgkin lymphomas and generally have a poor prognosis. Studies are evaluating the efficacy and safety of new agents in combination regimens for patients with both newly diagnosed and relapsed/refractory disease.

The FDA approved romidepsin in 2009 as a treatment for patients with cutaneous T-cell lymphoma following progression on at least 1 prior therapy, explains Andrei R. Shustov, MD. In general, Shustov notes that he utilizes romidepsin in the palliative setting. For the 15% of patients who achieve a complete remission, the duration of response is generally long lasting, Shustov notes.

Fatigue with romidepsin appears to be more prominent in clinical use than reported in trials, Shustov believes. However, myelosuppression, neuropathy, and mucositis are less than with other agents. Additionally, changes in the sense of taste have been reported following treatment, Shustov notes.

There are several ways to utilize romidepsin, notes Lauren C. Pinter-Brown, MD. In patients with angioimmunoblastic T-cell lymphoma, it can be utilized when chemotherapy is not an option. Additionally, it could have benefit in patients with transformed mycosis fungoides, Pinter-Brown believes.

For patients with PTCL, HDAC inhibitors represent a promising new treatment options. In July 2014, belinostat received FDA approval as a treatment for patients with relapsed or refractory PTCL, based on an improvement in overall response rate.

Other treatments for patients with PTCL are commonly utilized, including stem cell transplant as consolidation therapy, notes Steven M. Horowitz, MD. However, at this point, large randomized clinical trial data do not exist to support this approach.

In phase II studies, consolidated autologous stem cell transplantation resulted in long-term remissions in 45% of patients, Horowitz states. However, since these results are not from randomized trials, they could be biased, notes Shustov. In some patients with PET-negative disease, the response rate with consolidated autologous transplant may be even higher than 45%, Horowitz suggests. In general, transplantation in this setting remains an area of debate.