Peripheral T-Cell Lymphoma: Treatment

Peripheral T-Cell Lymphoma: overview

This algorithm outlines treatment of nodal peripheral T-cell lymphoma, with CD30 expression as the first branch point. For CD30-positive disease, including anaplastic large cell lymphoma (ALCL), frontline therapy is brentuximab vedotin plus CHP (ECHELON-2). In the site's ECHELON-2 summary, brentuximab plus CHP improved both PFS and OS over CHOP in CD30-positive PTCL, the first phase III regimen to show an OS benefit in this setting, establishing it as standard of care, particularly for systemic ALCL. For CD30-negative disease, frontline therapy is anthracycline-based chemotherapy with CHOP or CHOEP.

Responders in first remission are consolidated with autologous stem cell transplant. For relapsed or refractory disease, the chart lists single-agent histone deacetylase inhibitors, belinostat or romidepsin, and the antifolate pralatrexate (PROPEL).

Trials behind this algorithm

ECHELON-2 Horwitz S et al, Lancet, 2019; PMID: 30522922
BELIEF O'Connor OA et al, JCO, 2015; PMID: 26101246
PROPEL O'Connor OA et al, JCO, 2011; PMID: 21245435

Peripheral T-Cell Lymphoma: the algorithm in words

Starting point: Peripheral T-cell lymphoma (nodal).

Frontline: CD30+ (ALCL) (first-line): BV-based: Brentuximab + CHP (ECHELON-2).
Frontline: CD30-negative (first-line): Chemo: CHOP / CHOEP (anthracycline-based).
Consolidation (first-line): First remission: Autologous HSCT (in responders).
Relapsed / refractory (second-line): HDACi: Belinostat / romidepsin (BELIEF / romidepsin); Antifolate: Pralatrexate (PROPEL).