Peripheral T-cell lymphoma: a case-based discussion of recent advances in patient management

Peripheral T-cell lymphomas (PTCLs) are relatively rare, and data from large, comparative studies are limited. There are several histologic subtypes, which can be difficult to distinguish. Prognosis and management approaches can vary according to subtype. The standard management for PTCL patients is cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or CHOP-like regimens. Most patients will respond to CHOP, but a common drawback is the limited durability of response. Several recent trials have examined whether the addition of agents such as etoposide, alemtuzumab, and denileukin diftitox to CHOP can improve outcome. Data appear to suggest that such additions provide only a small amount of benefit, which may be limited to patients who are younger or who have a better prognosis. The newer agent pralatrexate may be beneficial, including when a fast remission is needed prior to a stem cell transplant. Upfront transplants are often used in patients in first remission. In this case-based discussion, Drs. Franco and Popplewell focus on the management of several PTCL subtypes: PTCL-not otherwise specified (PTCL-NOS), PTCL with cutaneous involvement, and angioimmunoblastic lymphoma (AITL).