Predictive Factors of Event-Free Survival at 24 Months in Patients with Peripheral T-cell Lymphoma: A Retrospective Study

Prognostic impact of pre-treatment and post-treatment plasma Epstein-Barr virus DNA in peripheral T-cell lymphomas

BACKGROUND

Plasma Epstein-Barr virus (EBV) DNA levels predict the prognosis of extranodal NK/T-cell lymphoma, nasal type (NK/TCL), but its role in other peripheral T-cell lymphomas (PTCL) remains undetermined. This study aimed to determine the prognostic impact of plasma EBV DNA in PTCL patients.

METHODS

We retrospectively enrolled 134 PTCL patients diagnosed between April 2008 and March 2022, with plasma EBV DNA data available at diagnosis in 124 patients and during post-treatment follow-up in 73 patients.

RESULTS

International Prognostic Index or prognostic index for T-cell lymphoma scores > 1 was associated with higher median plasma EBV DNA levels in all analyzed patients. Plasma EBV DNA positivity at the time of diagnosis was not associated with treatment response, overall survival (OS), or progression-free survival (PFS) in non-NK/TCL patients. In NK/TCL patients, an EBV DNA level < 3255 copies/mL at diagnosis was significantly associated with higher five-year PFS (64.2% vs. 16.7%, p < 0.001) and OS rates (64.4% vs. 20.8%, p < 0.001). Plasma EBV DNA positivity at the time of complete remission and during post-treatment follow-up was significantly linked to lower PFS and OS rates in NK/TCL patients. Multivariate analysis revealed that advanced-stage disease, elevated β2-microglobulin, and EBV DNA level ≥ 3255 copies/mL at diagnosis were independent predictors for OS and PFS in NK/TCL patients.

CONCLUSIONS

Plasma EBV DNA at diagnosis and during follow-up predict survival for NK/TCL patients but not for patients with other PTCL subtypes. Detection and monitoring of plasma EBV DNA levels at diagnosis and post-treatment follow-up for NK/TCL patients is recommended.

Clinical significance and predictive risk factors for event-free survival at 24 months in patients with PTCL, NOS

Peripheral T cell lymphoma, not otherwise specified (PTCL, NOS), is a heterogeneous and aggressive type of non-Hodgkin's lymphoma with a bleak prognosis. This study was designed to assess the value of EFS24 as an alternative clinical endpoint and identify prognosis-related factors in PTCL, NOS. Patients diagnosed with PTCL, NOS were retrospectively collected and slides were reviewed by two hematopathologists. EFS was defined as the time from diagnosis to the occurrence of disease progression after initial treatment, retreatment, or death. Subsequent overall survival (OS) was defined from EFS24 or time of progression, if it occurred within 24 months, to the last follow-up or death. 97 cases with complete follow-up were selected. Approximately 66 patients (68.04%) failed to achieve ES24, with the median OS of 12.17 months, and 5-year OS rate of 15.17%. While patients who reached EFS24 had a median OS of 60.57 months and a 5-year OS rate of 68.77%. Multivariate Cox analysis indicated that bone marrow involvement and elevated β2 Microglobulin (β2-MG) were associated with a poor prognosis. B symptoms, extranodal involvement more than one site, and a high Ki67 index were significant factors in predicting the failure of EFS24. EFS24 can help stratify the subsequent outcomes of PTCL, NOS. Patients who achieve EFS24 have a favorable prognosis, although it does not reach that of the general population. On the other hand, patients who do not achieve EFS24 have an extremely poor prognosis. Therefore, EFS24 can be used for patient risk stratification, patient counseling, and study design.