NOT OTHERWISE SPECIFIED T-CELL LYMPHOMA: OUTCOMES OF A SINGLE CENTER STUDY

BACKGROUND

The peripheral T-cell lymphoma not otherwise specified (PTCL-NOS) is the most common subtype of peripheral T-cell lymphoma (PTCL). It constitutes approximately 25% of all PTCLs and accounts for more than 15% of all lymphomas. The results of the first Ukrainian prospective study of patients with PTCL-NOS are presented in the article. The aim of the study was to analyze the morbidity of PTCL patients and the treatment performed, to evaluate overall survival and progression-free survival, and to determine the factors that predict the treatment response.

PATIENTS AND METHODS

An analysis was performed on the data of 31 patients diagnosed with peripheral PTCL-NOS from February 2018 to the present. T-cell lymphoid neoplasms were diagnosed according to the 2016 WHO classification. The treatment regimens were in alignment with ESMO and NCCN guidelines. More than 90% of patients were prescribed anthracycline-based regimens (CHOP; CHOEP - cyclophosphamide, doxorubicin, etoposide, vincristine, prednisone). An initial treatment was performed with CHOP-based regimens in 38.70% (n = 12) of patients, with the addition of etoposide in 58.06% of patients (n = 18).

RESULTS

The response was assessed according to the response criteria for malignant lymphoma (Cheson, 2008, 2014). The overall response to therapy was 58.06% (n = 18), with complete responses in 29.03% of patients and partial responses in 29.03% of patients. The stabilization of the disease occurred in 3.44%, while the disease progression in 41.37% of patients. The 12-month and 24-month survival rates were 75.44% and 50.81%, respectively. The 12-month and 24-month progression-free survivals were 47.68% and 33.1%, respectively. Ki-67 overexpression (> 65%) was a negative prognostic factor.

CONCLUSIONS

The results of the treatment of PTCL obtained in a Ukrainian population study are similar to those in other European studies, all of which remain unsatisfactory. Further research is required to develop a new strategy for examination and therapy to improve treatment outcomes. The emphasis should be placed on the pragmatic clinical trials comparing the efficacy of first-line treatment in PTCL patients with both favorable and unfavorable clinical factors.

THE ROLE OF RADIATION THERAPY IN THE TREATMENT OF PTCL-NOS

Peripheral T-cell lymphomas (PTCLs) are a heterogeneous group of lymphoproliferative disorders, accounting for about 10 % of all non-Hodgkin lymphomas. The most common subtype is peripheral T-cell lymphoma, unclassified (PTCL-NOS), accounting for about 26 % of all PTCLs. PTCL-NOS is associated with less favorable overall survival (OS) and progression-free survival (PFS) compared with aggressive B-cell lymphomas. The role of radiation therapy in the treatment of PTCL-NOS is still not definitively defined. The results of many studies show that the addition of radiation therapy to the treatment regimen is associated with a significant improvement in survival in patients with early-stage PTCL-NOS, but in the later stages, the benefit of radiation therapy is not obvious.

OBJECTIVE

peripheral T-cell lymphoma, unspecified is a clinically and biologically heterogeneous disease with a poor prognosis. Since the role of radiation therapy is still unclear, a study was conducted to evaluate the effectiveness of radiation therapy in peripheral T-cell lymphoma, unspecified.

MATERIALS AND METHODS

The work is based on clinical observations and treatment results of patients who were diagnosed between 2013 and 2023 at the National Cancer Institute (in the period from 2020 to 2023, patients were observed and treated as part of research). 56 patients were included in the study.

RESULTS

The work analyzed the immediate results of the treatment of patients with peripheral T-cell lymphoma, unspecified depending on the stage and type of treatment, as well as the overall survival of these patients. When analyzing the overall response to the treatment of patients with I/II stages of the disease, it was proven that this indicator is higher in the group of patients who received chemoradiotherapy, compared to patients who received only chemotherapy (100 % versus 83.3 %), and this indicator was higher due to patients who demonstrated a complete response to therapy (75 % vs. 50 %). Analyzing the response to treatment of patients with III/IV stages of the pathological process, it was established that there was no difference in the overall response to treatment, the level of complete and partial response to treatment. Analysis of the overall survival of patients with I/II stages of the disease, with a median follow-up of 60 months, demonstrated a significant improvement in overall survival in the group of patients who received chemoradiotherapy compared to the group of patients who received only radiation therapy (median 48 vs. 22 months). Overall 1-year (78 % vs. 69 %), 3-year (64 % vs. 40 %), and 5-year (48 % vs. 35 %) were also higher in the chemoradiotherapy group. In the group of patients with III/IV stages of the disease, there was no difference in overall survival between patients who received chemoradiotherapy and patients who received only chemotherapy (median 16 vs. 13 months, 1-year survival 54 vs. 52, 3-year survival 33 vs. 30 and 5-year overall survival of 23 vs. 20 %.

CONCLUSIONS

The addition of radiation therapy to the treatment plan demonstrated a significant improvement in the overall response and overall survival of patients with peripheral T-cell lymphomas, unspecified with I and II stages of the pathological process, but in III and IV stages of the disease, the benefit of radiation therapy has not been proven.

Ukrainian prospective study in patients with T-cell non-Hodgkin lymphomas

BACKGROUND

T-cell lymphoma (TCL) is a heterogeneous group of lymphoproliferative diseases that account for 10-15% of all non-Hodgkin lymphomas. The aim of the study was to analyze the incidence of TCL in Ukraine, distribution according to subtypes and to assess the results of treatment of patients with TCL depending on lymphoma subtype and clinical-and-laboratory risk factors.

PATIENTS AND METHODS

Data from 70 patients with TCL were analyzed from February 2018 to May 2021. T-cell lymphoid neoplasms were diagnosed according to the 2016 WHO classification. The patients were divided into 4 groups: 1^st (A) - leukemic forms (n = 13) (received SMILE or HyperCVAD +/- auto/alloSCT); 2^nd (B) - nodal T-cell lymphomas (n = 43) (CHOP-like regimens); 3^rd (C) - cutaneous T-cell lymphomas (n = 9) (PUVA therapy, interferon, and methotrexate); 4^th (D) - extranodal T-cell lymphomas (n = 5) (CHOP-like regimens). The response was determined according to the Lugano 2014 criteria.

RESULTS

According to the study results, 5-6% of all non-Hodgkin lymphoma registered in Ukraine in 2018-2020 were T-cell lymphomas. The most common subtype was peripheral TCL (61%). In the studied groups of TCL patients, the overall response rate was 50% (n = 35). 2-years event-free survival rate was 62.27%. 2-years overall survival rate was 65.76%. 18-month progression-free and overall survival in group B was higher versus groups A, C and D. The factors of unfavorable prognosis were bone marrow involvement and the expression of Ki67 > 65% (p = 0.03 and p = 0.006, respectively).

CONCLUSIONS

Histologic subtype of T-cell non-Hodgkin lymphoma influence the treatment outcome. The best overall response rate, overall survival rate, progression-free survival were in group of patients with nodal T-cell non-Hodgkin lymphomas, the worst - in patients from leukemic group. Poor prognostic factors are bone marrow involvement, and Ki-67 expression > 65%.

Once-per-week selinexor, bortezomib, and dexamethasone versus twice-per-week bortezomib and dexamethasone in patients with multiple myeloma (BOSTON): a randomised, open-label, phase 3 trial

BACKGROUND

Selinexor combined with dexamethasone has shown activity in patients with heavily pre-treated multiple myeloma. In a phase 1b/2 study, the combination of oral selinexor with bortezomib (a proteasome inhibitor) and dexamethasone induced high response rates with low rates of peripheral neuropathy, the main dose-limiting toxicity of bortezomib. We aimed to evaluate the clinical benefit of weekly selinexor, bortezomib, and dexamethasone versus standard bortezomib and dexamethasone in patients with previously treated multiple myeloma.

METHODS

This phase 3, randomised, open-label trial was done at 123 sites in 21 countries. Patients aged 18 years or older, who had multiple myeloma, and who had previously been treated with one to three lines of therapy, including proteasome inhibitors, were randomly allocated (1:1) to receive selinexor (100 mg once per week), bortezomib (1·3 mg/m2 once per week), and dexamethasone (20 mg twice per week), or bortezomib (1·3 mg/m2 twice per week for the first 24 weeks and once per week thereafter) and dexamethasone (20 mg four times per week for the first 24 weeks and twice per week thereafter). Randomisation was done using interactive response technology and stratified by previous proteasome inhibitor therapy, lines of treatment, and multiple myeloma stage. The primary endpoint was progression-free survival in the intention-to-treat population. Patients who received at least one dose of study treatment were included in the safety population. This trial is registered at ClinicalTrials.gov, NCT03110562. The trial is ongoing, with 55 patients remaining on randomised therapy as of Feb 20, 2020.

FINDINGS

Of 457 patients screened for eligibility, 402 were randomly allocated-195 (49%) to the selinexor, bortezomib, and dexamethasone group and 207 (51%) to the bortezomib and dexamethasone group-and the first dose of study medication was given between June 6, 2017, and Feb 5, 2019. Median follow-up durations were 13·2 months [IQR 6·2-19·8] for the selinexor, bortezomib, and dexamethasone group and 16·5 months [9·4-19·8] for the bortezomib and dexamethasone group. Median progression-free survival was 13·93 months (95% CI 11·73-not evaluable) with selinexor, bortezomib, and dexamethasone and 9·46 months (8·11-10·78) with bortezomib and dexamethasone (hazard ratio 0·70 [95% CI 0·53-0·93], p=0·0075). The most frequent grade 3-4 adverse events were thrombocytopenia (77 [39%] of 195 patients in the selinexor, bortezomib, and dexamethasone group vs 35 [17%] of 204 in the bortezomib and dexamethasone group), fatigue (26 [13%] vs two [1%]), anaemia (31 [16%] vs 20 [10%]), and pneumonia (22 [11%] vs 22 [11%]). Peripheral neuropathy of grade 2 or above was less frequent with selinexor, bortezomib, and dexamethasone (41 [21%] patients) than with bortezomib and dexamethasone (70 [34%] patients; odds ratio 0·50 [95% CI 0·32-0·79], p=0·0013). 47 (24%) patients in the selinexor, bortezomib, and dexamethasone group and 62 (30%) in the bortezomib and dexamethasone group died.

INTERPRETATION

A once-per-week regimen of selinexor, bortezomib, and dexamethasone is a novel, effective, and convenient treatment option for patients with multiple myeloma who have received one to three previous lines of therapy.

FUNDING

Karyopharm Therapeutics.

Ukraine Data on Prognostic Factors and Treatment Outcomes in Patients with Peripheral T-Cell Lymphomas

BACKGROUND

Peripheral T-cell lymphomas (PTCLs) is a diverse group of lymphomas (10-15% of all non-Hodgkins lymphomas) with aggressive behavior. Despite the standard of 1st line anthracycline-containing regimens, clinical outcomes are poor compared to B-cell lymphomas. In addition, there are still debates about specific prognostic factors (PF) in PTCLs.

AIMS

Primary endpoints - event-free survival (EFS) and overall survival (OS). To evaluate the prognostic significance of five PTCLs scores (International Prognostic Index - IPI, International Peripheral T-cell lymphoma Project Score - IPTCL, Prognostic Index for T-cell lymphoma - PIT, modified Prognostic Index for T-cell lymphoma - mPIT and T-cell score).

PATIENTS AND METHODS

From 67 enrolled patients, only 50 were included: PTCL not otherwise specified (22, 44%), anaplastic large cell lymphoma ALK+ (anaplastic lymphoma kinase-positive) (10, 20%) and ALK (anaplastic lymphoma kinase-negative) (18, 36%). Patients received CHOP-like regimens (CHOP, CHOEP, EPOCH).

RESULTS

The overall rate response was observed in 66% of cases (complete response 78%). There were 48% of relapses after the 1st line therapy during follow-up (median 11 months; range 1-85 months). Median age 57 (range 22-80) with male predominance 62%. In total, 40% of patients were > 60 years old, 48% had stage III-IV. Majority of patients were assessed by five prognostic scores. IPI (45 patients): the 3-year EFS and OS were higher for IPI 1 vs. IPI > 2 (80 vs. 18% and 87 vs. 27%, respectively; p = 0.0002). Receiver operating characteristic analysis confirmed poor clinical outcome to patients with PF > 1 (Se = 88 %; Sp = 68 %; AUC = 0.7; p = 0.0081). IPTCLP (41 patients): the presence of PF = 1-2 showed EFS and OS reduction. A 3-year EFS rate for 1-2 PF was 25 vs. 70% for PF = 0 (p = 0.003). Thus, 3-year OS in patients with PF = 0 vs. PF = 1-2 was 100 vs. 20% (p = 0.0001). PIT (42 patients): better 3-year EFS and OS in patients with PF = 0 vs. PF = 1-3 (88 vs. 28% and 100 vs. 34%, respectively, p = 0.001). Patients with PF = 1-3 have a higher rate of relapses vs. PF = 0 (p = 0.0005 by Cox-test). mPIT (21 patients): no significant difference between PF and clinical outcomes. T-cell score (18 patients): higher survival rates with PF 2. More than 2 PF have an impact on EFS (p = 0.005). The 3-years OS in patients with PF 2 was 77 vs. 25% in cases with PF 3 (p = 0.001).

CONCLUSION

IPI, PIT, IPTCLP are still very useful in defining risk stratification. As to mPIT and T-cell score, more patients to evaluate their prognostication possibility are needed.

[Primary bone lymphoma]

Presented literature data on the occurrence, diagnosis and treatment of primary lymphoma of bone. Case reports described in medical practice.