Outcomes in early stage peripheral T-cell lymphoma by stage, histology, and treatment patterns

Peripheral T-cell lymphomas are rare, generally aggressive lymphomas. Early stage disease represents a minority, and current treatment guidelines generally do not distinguish by stage or do so based on limited evidence. In order to understand practices and outcomes in this setting, we evaluated a multicenter cohort of patients with early stage nodal T-cell lymphomas (peripheral Tcell lymphoma, not otherwise specified [PTLC-NOS], nodal T-follicular helper cell lymphoma [TFHL], and anaplastic lymphoma kinase-negative anaplastic large cell lymphoma [ALK-negative ALCL]) from 2001 to 2022. We evaluated differences in outcomes by stage, histology, and treatment strategy, including consolidation after chemotherapy, which often includes radiation therapy (RT) and sometimes includes autologous stem cell transplant (ASCT). In total, we identified 132 patients. All patients received chemotherapy, 78 (59%) received chemotherapy plus RT, and 18 (14%) received ASCT. For the entire cohort, five-year progression-free (PFS) and overall survival (OS) was 56% and 68%. Outcomes were particularly encouraging in stage I disease, with five-year PFS and OS of 66% and 79%. Among patients with stage I disease responding to chemotherapy, patients treated with chemoradiation had especially favorable outcomes (five-year PFS: 70%, OS: 86%). Among patients with stage II disease responding to chemotherapy, outcomes were inferior to those with stage I disease and were similar regardless of treatment strategy. These findings show improved outcomes in early stage nodal T-cell lymphomas compared to historical data for allcomers. In addition, favorable outcomes in stage I disease treated with chemoradiation support such strategy as an excellent treatment option in this setting.