Characterising the findings of the peripheral T-cell lymphoma registry

Published: 8 Dec 2014

Rating:

Save

Prof Massimo Federico - University of Modena and Reggio Emilia, Modena, Italy

Prof Massimo Federico talks to ecancertv at ASH 2014 about the Comprehensive Oncology Measures for Peripheral T-Cell Lymphoma Treatment (COMPLETE) registry, the largest registry of peripheral T-cell lymphoma patients in the United States.

Data on demographics, clinical characteristics, diagnosis, therapy, and outcomes are collected.

Examining this data, Federico notes that beyond CHOP-based therapy, there is little consensus on initial management of these patients.

Peripheral T-cell lymphoma are a group of rare diseases where the standard treatment is not enough so the majority of patients do not respond or relapse or are refractory of the treatment. So there is a huge interest to better characterise this disease and see if we can develop prognostic or predictive factors to better treat these patients. This is the reason because we created two large international co-operations; one is the T-cell project and the other is the COMPLETE project. Both of them register new cases of peripheral T-cell lymphoma and follow them and see what happens over time.

So what did you find in this study?

In the COMPLETE study that has been presented at ASH, what we found is that the majority of patients are treated with CHOP, it’s the standard treatment for aggressive lymphoma, but unfortunately do not respond very well. So there is room for improvement and this huge database is of paramount relevance to investigate the reasons of failure. Unfortunately we have no other chances so we stay on the hope of new compounds that will be more effective compared to CHOP.

This is a very aggressive disease, we live in an era of targeted medicines, do you see any hope coming down the road?

Only in the small group of T-cell lymphoma that express the anti-CD30 receptor on the cell surface it is possible to use drugs like brentuximab vedotin. For the others there is no target for specific treatment. There are some new drugs like alisertib or pralatrexate or romidepsin that probably will enhance our ability to treat these patients. But unfortunately we lack of the right target to treat these patients.

In the meantime what’s your recommendation about the prudent way forward for treating peripheral T-cell lymphomas?

Start with CHOP or CHOEP adding also etoposide to the classical CHOP regimen and in patients that respond well consider and discuss with patients the role of autologous stem cell transplantation as a consolidation procedure after achievement of a good response. There are no definite data on the value of high dose therapy but retrospective analyses suggest that probably high dose therapy could be an opportunity for patients who respond to maintain their response and probably to be considered cured from their disease.

So the brief message, in five seconds or so, to doctors for taking home about this would be what?

The message is start with CHOP and then, if it’s possible, add also autologous stem cell transplantation.