Outcome of combined modality treatment in first-line for stage I(E) peripheral T-cell lymphoma; a nationwide population-based cohort study from the Netherlands
Frederik O. Meeuwes,
Mirian Brink,
Wouter Plattel,
Marjolein W.M. van der Poel,
Marie José Kersten,
Mariëlle Wondergem,
Lara Böhmer,
F.J. Sherida H. Woei-A-Jin,
Otto Visser,
Rimke Oostvogels,
Patty M. Jansen,
Karen J. Neelis,
Anne P.G. Crijns,
Laurien A. Daniëls,
Tjeerd J.F. Snijders,
Joost S.P. Vermaat,
Gerwin A. Huls,
Marcel Nijland
Affiliations
Frederik O. Meeuwes
Department of Hematology, Treant Hospital, Emmen, The Netherlands; Department of Hematology, University Medical Center Groningen, Groningen
Mirian Brink
Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht
Wouter Plattel
Department of Hematology, University Medical Center Groningen, Groningen
Marjolein W.M. van der Poel
Department of Hematology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht
Marie José Kersten
Department of Hematology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam
Mariëlle Wondergem
Department of Hematology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam
Lara Böhmer
Department of Hematology, Haga Hospital, The Hague
F.J. Sherida H. Woei-A-Jin
Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
Otto Visser
Department of Hematology, Isala Hospital, Zwolle
Rimke Oostvogels
Department of Hematology, University Medical Center Utrecht, Utrecht
Patty M. Jansen
Department of Pathology, Leiden University Medical Center, Leiden
Karen J. Neelis
Department of Radiotherapy, Leiden University Medical Center, Leiden
Anne P.G. Crijns
Department of Radiotherapy, University Medical Center Groningen, Groningen
Laurien A. Daniëls
Department of Radiotherapy, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam
Tjeerd J.F. Snijders
Department of Hematology, Medisch Spectrum Twente, Enschede
Joost S.P. Vermaat
Department of Hematology, Leiden University Medical Center, Leiden
Gerwin A. Huls
Department of Hematology, University Medical Center Groningen, Groningen
Marcel Nijland
Department of Hematology, University Medical Center Groningen, Groningen
Peripheral T-cell lymphomas (PTCL) comprise a heterogeneous group of mature T-cell neoplasms with an unfavorable prognosis; presentation with stage I(E) disease is uncommon. In clinical practice, an abbreviated chemotherapy treatment regimen combined with radiotherapy (combined modality treatment [CMT]) is commonly used, although evidence from clinical trials is lacking. The aim of this nationwide population-based cohort study is to describe first-line treatment and outcome of patients with stage I(E) PTCL. All newly diagnosed patients ≥18 years with stage I(E) anaplastic large cell lymphoma (ALCL), angioimmunoblastic T-cell lymphoma (AITL) and peripheral T-cell lymphoma NOS (PTCL not otherise specified [NOS]) in 1989-2020 were identified in the Netherlands Cancer Registry. Patients were categorized according to treatment regimen, i.e., chemotherapy (CT), radiotherapy (RT), CMT, other therapy and no treatment. The primary endpoint was overall survival (OS). Patients with stage I(E) ALCL, AITL and PTCL NOS (n=576) were most commonly treated with CMT (28%) or CT (29%), 2% underwent SCT. RT only was given in 18%, and 8% received other therapy and 16% no treatment. Overall, the 5-year OS was 59%. According to subtype, 5-year OS was superior for ALCL as compared to PTCL NOS and AITL (68% vs. 55% and 52%, respectively; P=0.03). For patients treated with CMT, 5-year OS was significantly higher (72%) as compared to patients treated with either CT or RT alone (55% and 55%, respectively; P<0.01). In multivariable analysis, age per year increment (hazard ratio [HR] =1.06, 95% confidence interval [CI]: 1.05-1.07), male sex (HR=1.53, 95% CI: 1.23-1.90), and CT, or no treatment (HR=1.64, 95% CI: 1.21-2.21, and HR=1.55, 95% CI: 1.10-2.17, respectively) were associated with a higher risk of mortality. For stage I(E) ALCL, AITL and PTCL NOS, 5-year OS is 59%, comparing favorably to historical outcome in advanced-stage disease. Superior outcome estimates were observed in patients treated with CMT.
