Recent advances and future perspectives in frontline treatment of peripheral T-cell lymphoma

Peripheral T-cell lymphoma (PTCL) represents a heterogeneous group of lymphomas with a generally poor prognosis. With recent advances in our understanding of the cellular origins and genomic profiles of PTCL, lymphomas of follicular helper T-cell (TFH) origins with distinct markers and gene mutation profiles are categorized as a single entity, nodal TFH lymphomas-angioimmunoblastic type, follicular type, and not otherwise specified, in the fifth edition of the WHO classification. The standard treatment for PTCL has been CHOP or CHOP-like regimens for decades. The ECHELON-2 trial marked a significant advance in the treatment of PTCL by demonstrating significantly longer survival with BV-CHP than with CHOP for CD30-positive PTCL, establishing BV-CHP as the standard of care for this group of patients. However, attempts to integrate other novel agents into CHOP have largely been unsuccessful, primarily due to increased toxicity, and, thus, CHOP remains the standard treatment for CD30-negative PTCL. Upfront autologous stem cell transplantation is currently controversial, and ongoing randomized controlled trials are expected to clarify its role. With advances in our understanding of the molecular and genetic characteristics of PTCL and potential predictive biomarkers, the future development of treatment will focus on more stratified approaches, and ongoing trials are expected to provide further insights into optimizing these treatment strategies.