Management of advanced-stage peripheral T-cell lymphomas

Peripheral T-cell lymphomas (PTCLs), several entities with great clinical, histologic, and biologic heterogeneity, represent 8% to 15% of all malignant lymphomas. With current treatment regimens, 5-year survival is only about 30% to 35%. Outcome is poorer with PTCL than with aggressive B-cell lymphoma because of more frequent adverse clinical features at diagnosis, a lower response rate to chemotherapy, and a higher incidence of relapses, but it is also known that the T-cell phenotype itself is associated with a poor prognosis independent of other prognostic factors. Initial treatment of patients with advanced-stage PTCL mostly consists of six to eight courses of anthracycline-based chemotherapy such as CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone). In fit elderly patients, standard therapy is still six cycles of CHOP-14, but up-front consolidation with intensive chemotherapy and autologous stem cell transplantation are often used in younger patients. The humanized CD52 monoclonal antibody alemtuzumab has shown activity in some T-cell malignancies; with appropriate antibiotic and virostatic prophylaxis, its use seems feasible for PTCL, both as a single agent and in conjunction with chemotherapy. New drugs such as denileukin diftitox, histone deacetylase inhibitors, and pralatrexate have shown promising activity in PTCL.