Chemotherapeutic advancements in peripheral T-cell lymphoma

The peripheral T-cell lymphomas (PTCLs) include a pathologic and clinically heterogeneous group of mature aggressive T-cell lymphomas, with overall inferior prognoses compared with aggressive B-cell lymphomas. Diagnosis by expert pathologic analysis is paramount in differentiating the multiple different clinicopathologic subtypes. The clinical presentations of PTCLs are variable, from that of an indolent nature to an aggressive behavior, although most have natural histories as aggressive lymphomas. First-line treatment for most PTCLs should include multi-agent chemotherapy with consideration of inclusion of etoposide chemotherapy for younger patients, as well as consolidation with autologous stem cell transplantation (SCT) in select cases. For patients with disease relapse, salvage therapy followed by autologous or allogeneic SCT should be considered. Additionally, several novel therapeutic agents have been approved by the US Food and Drug Administration (FDA) for relapsed/refractory PTCL, including romidepsin, pralatrexate, and brentuximab vedotin, the latter specifically for anaplastic large cell lymphoma. Furthermore, there are a number of new, targeted agents being studied. In order to improve outcomes for PTCL, it remains critical to consider these patients for clinical studies. In this article, we examine the recent progress and changing landscape of treatment of PTCL.