Optimizing chemotherapeutic strategies for peripheral T-cell lymphomas

Peripheral T-cell lymphomas are a heterogenous mix of histology, as well as clinical presentation, and outcome and remain a challenging group of diseases to treat. Because of difficulty and variability in diagnosis, improvements in diagnostic technology, and changing classification systems over time, the interpretation of studies is complicated. In addition, the response to current treatments and long-term outcome is generally poor. This review outlines these problems and discusses the current status of treatment strategies, including the disappointing results with standard anthracycline-based therapy as well as experience with modifications to CHOP (cyclophosphamide/doxorubicin/vincristine/prednisone); increasing dose intensity; antimetabolites; and T-cell-targeted therapies. We conclude with a description of a new agent, pralatrexate, including the preclinical and early clinical experience as well as a description of a large phase II prospective trial. Because of the relative rarity of this group of diseases, large-scale prospective clinical trials are difficult to implement. New treatment strategies are needed if we hope to improve patient outcomes.