Comprehensive analysis of peripheral T-cell and natural killer/T-cell lymphoma in Asian patients: A multinational, multicenter, prospective registry study in Asia

Yoon SE 1 , Song Y 2 , Kim SJ 1 , Yoon DH 3 , Chen TY 4 , Koh Y 5 Show all authors , Kang KW 6 , Lee HS 7 , Tay KKW 8 , Lim ST 9 , Poon M 10 , Irawan C 11 , Zhao W 12 , Do YR 13 , Lee MH 14 , Ng SC 15 , Lee WS 16 , Guo Y 17 , Zhang H 18 , Kang HJ 19 , Yun HJ 20 , Kim HJ 21 , Lung DTC 22 , Kwak JY 23 , Han JJ 24 , Mun YC 25 , Oh SY 26 , Shim H 27 , Kwon JH 28 , Sohn BS 29 , Park SK 30 , Jo JC 31 , Ko YH 32 , Jun Z 2 , Kim WS 1

Affiliations 

  • 1 Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  • 2 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
  • 3 Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
  • 4 National Cheng Kung University Hospital, Tainan, Taiwan
  • 5 Department of Internal Medicine, Seoul National University Hospital, Seoul National University School of Medicine, Seoul, South Korea
  • 6 Division of Hematology and Oncology, Department of Internal Medicine, Korea University, College of Medicine, Seoul, South Korea
  • 7 Division of Hematology-Oncology, Kosin University Gospel Hospital, Busan, South Korea
  • 8 Oncocare Cancer Center, Singapore
  • 9 National Cancer Centre, Singapore
  • 10 Department of Haematology-Oncology, National University Health System, Singapore
  • 11 Indonesia Cipto Mangunkusumo National Central General Hospital, Indonesia
  • 12 Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
  • 13 Division of Hematology and Oncology, Department of Internal Medicine, Dongsan Medical Center, Keimyung University College of Medicine, Daegu, South Korea
  • 14 Department of Hematology-Oncology, Konkuk University Medical Center, Seoul, Korea
  • 15 Subang Jaya medical center, Kuala Lumpur, Malaysia
  • 16 Division of Hemato-Oncology, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
  • 17 Fudan University Shanghai Cancer Center, Shanghai, China
  • 18 Tianjin Medical University Cancer Institute and Hospital, China
  • 19 Division of Hematology/Oncology, Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
  • 20 Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, South Korea
  • 21 Division of Hematology and Oncology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
  • 22 Raffles Cancer Centre, Singapore
  • 23 Division of Hematology-Oncology, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonbuk National University, Jeonju, South Korea
  • 24 Department of Hematology and Medical Oncology, College of Medicine, Kyung Hee University, Seoul, South Korea
  • 25 Division of Hematology-Oncology, Ewha Womans University Mokdong Hospital, Ewha Womans University, Seoul, South Korea
  • 26 Division of Hematology and Oncology, Department of Internal Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, South Korea
  • 27 Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, South Korea
  • 28 Department of Internal Medicine, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine
  • 29 Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea
  • 30 Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, South Korea
  • 31 Division of Hematology and Oncology, Department of Internal Medicine, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, South Korea
  • 32 Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Lancet Reg Health West Pac, 2021 May;10:100126.
PMID: 34327343 DOI: 10.1016/j.lanwpc.2021.100126

Abstract

Background: Peripheral T-cell lymphomas (PTCLs) are uncommon and their frequency is regionally heterogeneous. Several studies have been conducted to evaluate the clinical features and treatment outcomes of this disease entity, but the majority of these were conducted in limited areas, making it difficult to comprehensively analyze their relative frequency and clinical features. Furthermore, no consensus treatment for PTCLs has been established. Therefore, we conducted an Asia-specific study to understand the relative frequency of PTCLs and assess treatments and their outcomes in Asian patients.

Methods: We performed a multinational, multicenter, prospective registry of adult patients with PTCLs that was named as the International Cooperative non-Hodgkin T-cell lymphoma prospective registry study where thirty-two institutes from six Asian countries and territories (Korea, China, Taiwan, Singapore, Malaysia, and Indonesia) participated.

Findings: A total of 486 patients were registered between April 2016 and February 2019, and more than a half of patients (57%) had stage III or IV. Extranodal natural killer (NK)/T- cell lymphoma was the most common subtype (n = 139,28.6%), followed by angioimmunoblastic T-cell lymphoma (AITL, n = 120,24.7%), PTCL-not otherwise specified (PTCL-NOS, n = 101,20.8%), ALK-positive anaplastic large cell lymphoma (ALCL, n = 34,6.9%), and ALK-negative ALCL (n = 30,6.2%). The median progression-free survival (PFS) and overall survival (OS) were 21.1 months (95% CI,10.6-31.6) and 83.6 months (95% CI, 56.7-110.5), respectively. Upfront use of combined treatment with chemotherapy and radiotherapy showed better PFS than chemotherapy alone in localized ENKTL whereas consolidation with upfront autologous stem cell transplantation (SCT) provided longer PFS in advance stage ENKTL. In patients with PTCLs other than ENKTL, anthracycline-containing chemotherapies were widely used, but the outcome of those regimens was not satisfactory, and upfront autologous SCT was not significantly associated with survival benefit, either. The treatment outcome of salvage chemotherapy was disappointing, and none of the salvage strategies showed superiority to one another.

Interpretation: This multinational, multicenter study identified the relative frequency of each subtype of PTCLs across Asian countries, and the survival outcomes according to the therapeutic strategies currently used.

Funding: Samsung Biomedical Research Institute.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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