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1687 Clinical Features, Therapy Patterns and Survival Outcomes of Limited-Stage Peripheral T-Cell Lymphomas: A Cross-Continental Study

Program: Oral and Poster Abstracts
Session: 625. T Cell, NK Cell, or NK/T Cell Lymphomas: Clinical and Epidemiological: Poster I
Hematology Disease Topics & Pathways:
Research, Lymphomas, Clinical Practice (Health Services and Quality), Epidemiology, Clinical Research, T Cell lymphoma, Diseases, Real-world evidence, Lymphoid Malignancies
Saturday, December 7, 2024, 5:30 PM-7:30 PM

Juan Esteban Garcia-Robledo, MD1*, Henry Quintero, MD2,3*, Denisse Castro, MD4, Brady E Beltran, MD5,6*, Daniel J Enriquez, MD7*, Jule F Vasquez, MD8, Claudia Roche, MD9*, Daniel Artiles, MD10*, Fabiola Valvert, MD, FRCP11, Luis Mario Villela Martinez, MD, MSc12*, Juliana Pereira, MD, PhD13, Ana Carolina Oliver, MD14, Jamila Vaz Tavarez, MD15*, Sergio Augusto B Brasil, MD, PhD16*, Karin Z Cecyn, MD17*, Nelson S Castro, MD18*, Renata Lyrio R Baptista, MD19*, Samuel S. Medina, MD20*, Davimar Miranda Maciel Borducchi, PhD21, Marcelo Bellesso, MD22*, Danielle Leão Cordeiro De Farias, MD, MSc, MBA23, Yung Gonzaga, MD24*, Laura Korin, MD25*, Patricio Pereyra, PhD26*, Camila Peña, MD27, Macarena Roa, MD28*, Maria Alejandra Torres Viera, MD29*, Kelly Meza, MD30*, Seisha Von Glasenapp, PhD31, Alfredo Quiroz, MD32*, Cesar Samanez-Figari, MD33*, Rosa Oliday Rios Jimenez34*, Sally Paredes, MD4*, Thais Fischer, MD35*, Asaad Trabolsi, MD36, Jonathan H. Schatz, MD37, Swaminathan P Iyer, MD38*, Ranjit Nair, MD39, Eduardo Edelman Saul, MD40, Casey Bermack, MD38, Jorge J. Castillo, MD41, Carmino De Souza, MD, PhD42*, Eliana Miranda, PhD, MEd42*, Bryan Valcarcel, MD, MPH43, Carlos Chiattone, MD, PhD44 and Luis Enrique Malpica Castillo, MD45

1Department of Hematology/Oncology, Instituto Oncológico Ospedale, Cali, Colombia
2Universidad Tecnológica de Pereira, Pereira, Colombia
3Clinica Central del Eje, Pereira, Colombia
4Hospital Edgardo Rebagliati Martins, Lima, Peru
5Servicio Oncología Médica, Hospital Edgardo Rebagliati, Lima, Peru
6Instituto de Investigación en Ciencias Biomédicas, Universidad Ricardo Palma, Lima, Peru
7Instituto Nacional De Enfermedades Neoplasicas, Lima, Peru
8Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
9Hospital Armando Milan Castro, Vila Clara, Cuba
10Hospital Arnoldo Milan Castro, Vila Clara, Cuba
11INCAN, Ciudad de Guatemala, Guatemala
12Hospital Fernando Ocaranza, Hermosillo, Mexico
13University of São Paulo, Department of Hematology, Hemotherapy & Cell Therapy, University of São Paulo, São Paulo, São Paulo, Brazil
14Bone marrow transplant unit, British Hospital, Montevideo, Uruguay
15Ophir Loyola Hospital, Belém, Brazil
16Hospital Santa Paula. São Paulo – Brazil, Sao Paulo, Brazil
17Federal University of Sao Paulo, Sao Paulo, Brazil
18Hospital de Cancer de Barretos, Barretos, São Paulo, BRA
19State University of Rio de Janeiro, Rio De Janeiro, Brazil
20University of Campinas, São Paulo, BRA
21Medical School of ABC, Santo Andre, Brazil
22HemoMed, Instituto de Ensino e Pesquisa – IEP, Sao Paulo, Brazil
23Beneficencia Portuguesa Hospital, Sao Paulo, Brazil
24Cancer National Institute, Rio De Janeiro, Brazil
25CABA- Alexander Fleming Institute, Olivos, Argentina
26Hospital Nacional Posadas, Buenos Aires, Argentina
27Hospital Del Salvador, Santiago, Chile
28Santiago Hospital del Salvador, Santiago, Chile
29Clinica Santa Sofia, Caracas, Venezuela (Bolivarian Republic of)
30Baylor College of Medicine, Houston, TX
31Hospital Central Instituto de Previsión Social, Asuncion, Paraguay
32Departamento de Hematología, Hospital Central Instituto de Previsión Social, Asunción, Paraguay
33Oncosalud, AUNA, Lima, Peru
34Hospital Clínico Quirúrgico Hermanos Amejeiras, La Habana, Cuba
35AC Camargo Cancer Center, Sao Paulo, AC, Brazil
36University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL
37Department of Hematology, University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL
38University of Texas MD Anderson Cancer Center, Houston, TX
39University of Texas MD Anderson Cancer Center, Pearland, TX
40Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
41Dana-Farber Cancer Institute, Bing Center for Waldenström Macroglobulinemia, Boston, MA
42Centro de Hematologia e Hemoterapia (HEMOCENTRO), Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
43Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Houston, TX
44Santa Casa Medical School of Sao Paulo, Sao Paulo, Brazil
45Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX

Introduction: Peripheral T-cell lymphomas (PTCL) encompass a diverse group of mature T-cell neoplasms characterized by unfavorable prognosis, with limited-stage (LS) disease presentation being particularly rare. Current clinical practice in LS PTCL varies, with some clinicians employing abbreviated courses of chemotherapy in conjunction with radiotherapy (RT) (combined modality therapy, CMT), while others adopt more aggressive approaches. This variability is due to the high relapse rates observed in PTCL and the lack of supporting evidence from clinical trials. Most evidence for management arises from real-world studies encompassing all stages of PTCL, with the limited available studies involving small cohorts, leaving the optimal management of LS PTCL undefined. To reduce this knowledge gap, we describe the presentation and management of LS PTCL, and compared outcomes across therapy approaches.

Methods: We conducted a retrospective international pooled cohort study of patients (pts) aged ≥18 with newly diagnosed LS PTCL during 2000-2023. Data were obtained from the Grupo de Estudio Latinoamericano de Linfoproliferativos (GELL) registry, the Brazilian T Cell Project (BTCP), and two academic US cancer centers. Primary and secondary endpoints were overall survival (OS) and progression-free survival (PFS). We stratified PTCL subtypes as anaplastic large cell lymphoma (ALCL, regardless of ALK status) and non-ALCL groups (i.e., PTCL not otherwise specified [NOS]; angioimmunoblastic T cell lymphoma [AITL]; and lymphomatous type adult T cell leukemia/lymphoma [L-ATL]). Chemotherapy regimens were classified as brentuximab vedotin (BV)-based (i.e., BV-CH[E]P); CHOP and intensive chemotherapy [iCT] (e.g., CHOEP, EPOCH, HyperCVAD) with or without RT. A pre-pooled analysis confirmed no heterogeneity in endpoints based on regions (i.e., US vs Latin America), suggesting the feasibility of combining the data. Outcomes of first-line therapy are presented by PTCL stratification. Time-to-event endpoints were analyzed using Kaplan-Meier.

Results: We enrolled 333 pts (GELL 44%, BTCP 30%, US 26%). The overall median age at diagnosis was 56 years (18-95); most were male (60%), had stage II disease (62%), nodal presentation (65%), ECOG 0-1 (86%), lacked B symptoms (65%), normal serum LDH (54%) and serum albumin >3.5 g/dL (81%). PTCL NOS was the most common non-ALCL subtype (53% vs 8% AITL and 8% L-ATL); 31% were ALCL (ALK+ 15%, ALK- 14%, unknown 2%). Most pts (91%) received first-line therapy with curative intent. CHOP (40%) and iCT (40%) were the most common approaches; only 12% received BV-based therapy and were generally treated at US centers. CMT was given to 27% of LS PTCL.

With a median follow-up of 36.2 months in all pts, the 3-year OS and PFS rates were 67% and 52%, respectively. Better survival was seen in ALCL than non-ALCL pts (OS 87% [95% CI 79-94] vs 56% [48-65]; PFS 70% [61-81] vs 42% [35-51], both p<0.001, respectively). The overall response and complete response (CR) rates of BV-, CHOP- and iCT-based approaches were 91% (CR 77%), 81% (CR 62%) and 80% (CR 57%), respectively. None of the chemotherapy regimens offered OS or PFS advantage for ALCL and non-ALCL subtypes. However, in ALCL pts, CMT conferred superior OS (100% [100-100] vs 80% [71-92], p=0.025) and PFS (100% [100-100] vs 57% [45-73], p<0.001) than chemotherapy alone. This effect remains positive even in those managed with abbreviated courses (e.g. 3-4 chemo cycles followed by RT). A non-statistically significant trend towards improved OS (p=0.072) and PFS (p=0.10) was seen in non-ALCL pts treated with CMT; yet, pts aged >70 had better OS (83% [58-100] vs 31% [14-67] p=0.027) and PFS (42% [15-100] vs 21% [8-55] p=0.025) with CMT.

Conclusion: In this large study evaluating LS PTCL, most pts were middle-aged, fit, and presenting with nodal disease. Our findings suggest no survival benefit of BV-based over other chemotherapy approaches in LS PTCL, contrasting previous studies that included all PTCL stages. However, RT consolidation provided a survival advantage in ALCL and elderly non-ALCL pts. This research provides critical insights into the management and outcomes of this rare subset of aggressive lymphomas, contributing to optimizing therapeutic strategies in LS PTCL. Future prospective studies should validate our findings. Additional data, including response rates in specific PTCL subtypes, will be presented at the meeting.

Disclosures: Oliver: Abbvie: Consultancy; Servier: Consultancy; Roche: Consultancy. De Farias: Libbs/mAbxcience: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Independent data monitoring committee, Speakers Bureau; BMS: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Pfizer: Speakers Bureau; Sanofi: Speakers Bureau; Pintfarma: Speakers Bureau; Knight Therapeutics/United Medical: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Kite/Gilead: Consultancy, Membership on an entity's Board of Directors or advisory committees; Europharma: Consultancy, Membership on an entity's Board of Directors or advisory committees; Viracta: Research Funding; Celltrion: Research Funding; MEDAC: Research Funding; Agios: Research Funding; Sandoz: Research Funding; Onconova: Research Funding; MSD: Research Funding; Roche: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Amgen: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Zodiac: Speakers Bureau; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Takeda: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; AstraZeneca: Research Funding, Speakers Bureau; Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Steering committee member, Research Funding, Speakers Bureau; Abbvie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Lilly: Research Funding; Regeneron: Research Funding; GSK: Research Funding. Iyer: Merck: Research Funding; Astra Zeneca: Research Funding; Salarius: Consultancy; Crispr: Membership on an entity's Board of Directors or advisory committees, Research Funding; Ono: Research Funding; Trillium: Research Funding; Yingli: Membership on an entity's Board of Directors or advisory committees, Research Funding; Legend: Research Funding; Secura Bio: Membership on an entity's Board of Directors or advisory committees; IMPaRT.AI: Other: Stock, Founder; Acrotech: Membership on an entity's Board of Directors or advisory committees, Research Funding; Innate: Research Funding; Seagen/Pfizer: Membership on an entity's Board of Directors or advisory committees, Research Funding; JCO-CCI: Other: Editor. Nair: 280 Bio Inc.: Membership on an entity's Board of Directors or advisory committees. Castillo: Janssen: Consultancy; Pharmacyclics: Consultancy, Research Funding; Kite Pharmaceuticals: Consultancy; BeiGene: Consultancy, Research Funding; AstraZeneca: Consultancy, Research Funding; Mustang Bio: Consultancy; LOXO: Consultancy, Research Funding; AbbVie: Consultancy, Research Funding; Cellectar Biosciences: Consultancy, Research Funding.

*signifies non-member of ASH