Cancer Treatment Today » T-cell Lymphoma

T Cell Lymphoma – pro

M Levin, MD — Sun, 02 Sep 2012 16:38:39 +0000

Lay Summary: Not much is known about NK1 T lymphomas. This post briefly describes what is known.

This kind of lymphoma tend to be indolent but not all that much is known about hatural history of these neoplasms and some patients do poorly. Patients with natural killer T (NK/T) -cell lymphomas have poor survival outcome, and for this condition there is no optimal therapy. A recent review found that following treatments tend to be used: Patients received one of the following initial treatment modalities: (1) an anthracycline-containing chemotherapeutic regimen followed by radiotherapy (RT); (2) a non–anthracycline-containing chemotherapeutic regimen followed by RT; (3) anthracycline-based chemotherapy; (4) non–anthracycline-based chemotherapy; (5) involved-field RT as the primary treatment; (6) surgery alone; and (7) supportive care only. The anthracycline-based regimens used were as following: cyclophosphamide, doxorubicin, vincristine, prednisolone (CHOP); dose-escalated CHOP (deCHOP); cyclophosphamide, vincristine, prednisone, bleomycin, doxorubicin, procarbazine (COPBLAM); and (etoposide, doxorubicin, vincristine, cyclophosphamide, prednisolone (EPOCH). The non–anthracycline-containing regimens used were ifosfamide, methotrexate, etoposide (IMEP); dexamethasone, ifosfamide, cisplatin, etoposide (DICE); etoposide, methylprednisolone, cisplatin, cytarabine (ESHAP); dexamethasone, cytarabine, cisplatin (DHAP); etoposide, ifosfamide, cisplatin, dexamethasone (VIPD); and cyclophosphamide, vincristine, prednisone (CVP). In patients with localized disease, involved-field radiotherapy was given at the physician’s discretion following chemotherapy. The treatment response was assessed according to standard response criteria.
An ongoing study of EPOCH/CaMPATH is referenced below. The proposed study is described briefly as follows: “This study will examine the safety and effectiveness of combination therapy with the monoclonal antibody Campath-1H and continuous infusion of a chemotherapy regimen called EPOCH for treating non-Hodgkin’s T-cell and NK-cell lymphomas. In general, T-cell and NK-cell lymphomas are less responsive to standard treatments than B-cell lymphomas. EPOCH, which includes the drugs doxorubicin, etoposide, vincristine, cyclophosphamide, and prednisone, has shown a high degree of effectiveness in patients whose tumors have stopped responding to standard regimens. Campath-1H may improve the effects of chemotherapy.”

Stem Cell transplantation is in the infant stages for this disease.

http://clinicalstudies.info.nih.gov/detail/A_2003-C-0304.html

Jeeyun Lee, Cheolwon Suh, Yeon Hee Park, Young H. Ko, Soo Mee Bang, Jae Hoon Lee, Dae Ho Lee, Jooryung Huh, Sung Yong Oh, Hyuk-Chan Kwon, Hyo Jin Kim, Soon Il Lee, Jung Han Kim, Jinny Park, Seok Joong Oh, Kihyun Kim, Chulwon Jung, Keunchil Park, Won Seog Kim
Extranodal Natural Killer T-Cell Lymphoma, Nasal-Type: A Prognostic Model From a Retrospective Multicenter Study Journal of Clinical Oncology, Vol 24, No 4 (February 1), 2006: pp. 612-618

Au WY, Lie AKW, Liang R, et al: Autologous stem cell transplantation for nasal NK/T-cell lymphoma: A progress report on its value. Ann Oncol 14:1673-1679, 2003

L. Pagano, A. Gallamini, G. Trape, L. Fianchi, D. Mattei, G. Todeschini, A. Spadea, S. Cinieri, E. Iannitto, M. Martelli, A. Nosari, E. D. Bona, M. E. Tosti, M. C. Petti, P. Falcucci, M. Montanaro, A. Pulsoni, L. M. Larocca, G. Leone, and For the Intergruppo Italiano Linfomi NK/T-cell lymphomas ‘nasal type’: an Italian multicentric retrospective survey Ann. Onc., May 1, 2006; 17(5): 794 – 800.

Campath for T cell lymphomas – pro

M Levin, MD — Sat, 01 Sep 2012 02:18:08 +0000

Athough alemtuzumab is an anti-B antibody, several phase II studies suggest that it is effective for Tcell lymphoma, particularly, CTCL , and Mycosis Fungoides but also peripheral T-cell lymphoma. NCCN Mycosis Fungoides Guideline refers one to the T0cell guideline and it lists alemtuzumab with a notes that says that “activity has been demonstrated in small clinical trials and additional larger clinical trials are necessary”.

Lundin J, Hagberg H, Repp R, Cavallin-Stahl E, Freden S, Juliusson G, Rosenblad E, Tjonnfjord G, Wiklund T, Osterborg A. Phase 2 study of alemtuzumab (anti-CD52 monoclonal antibody) in patients with advanced mycosis fungoides/Sezary syndrome. Blood. 2003 Jun 1;101(11):4267-72. Epub 2003 Jan 23.

Enblad G, Hagberg H, Erlanson M, et al. A pilot study of alemtuzumab (anti-CD52 monoclonal antibody) therapy for patients with relapsed o chemotherapy-refractory peripheral T-cell lymphomas. Blood. 2004;103: 2920-2924.[Abstract/Free Full Text]

Kennedy GA, Seymour JF, Wolf M, et al. Treatment of patients with advanced mycosis fungoides and Sezary syndrome with alemtuzumab. Eur J Haematol. 2003;71: 250-256.[CrossRef][Medline] [Order article via Infotrieve]
Articles citing this article

Low-dose intermittent alemtuzumab in the treatment of Sezary syndrome: clinical and immunologic findings in 14 patients
haematol 2007 92:784-794

nccn.org, T-cell, TCELL-B

Stem Cell Transplantation for Cutaneous Stem Cell Lymphomas – pro

M Levin, MD — Fri, 03 Aug 2012 02:21:52 +0000

Cutaneous T-cell lymphoma (CTCL) is classified as an indolent hematologic malignancy with distinct clinicopathologic features. Although prognosis varies depending on the stage, patients who have cutaneous tumor, lymph node or visceral involvement, or peripheral blood involvement (Sézary syndrome) generally have a poor outcome. Evidence for stem cell transplantation, both autologous and allogeneic is on the level of case reports. Experts agree that more investigation is needed.

For advanced disease, systemic treatment options include low-dose methotrexate, photopheresis, biologic response modifiers such as bexarotene capsules, vorinostat (Zolinza), interferons, denileukin diftitox (Ontak), and single-agent chemotherapy. Combination therapies can be used when single agents fail or when patients have advanced or progressive disease. For advanced disease, systemic treatment options include low-dose methotrexate, photopheresis, biologic response modifiers such as bexarotene capsules, vorinostat (Zolinza), interferons, denileukin diftitox (Ontak), and single-agent chemotherapy. Combination therapies can be used when single agents fail or when patients have advanced or progressive disease.

Evidence for stem cell transplantation, both autologous and allogeneic is on the level of case reports. Experts agree that more investigation is needed.

In 2012, the Cochrane team attempted to review available evidence to compose a guideline. They found 2077 citations but none were relevant randomised controlled trials. All 41 studies that were thought to be potentially suitable were excluded after full text screening for being non-randomised, not including CTCL or being review articles.They say in the conclusion section: “We planned to report evidence from genetically or non-genetically randomised controlled trials comparing conventional therapy and allogeneic stem cell transplantation. However, no randomised trials addressing this question were identified. Nevertheless, prospective genetically randomised controlled trials need to be initiated to evaluate the precise role of alloSCT in advanced CTCL.”

The NCCN on p. MFSS-7 does say” “Consider non-ablative allogeneic transplant as appropriate”. A note “aa” says: ” The role of allogeneic transplant is controversial. See discussion for further details”. This discussion is found on page MS – 130. It says that allogenic SCT has been reported in case reports and small series in patients with advanced MF and SS. It references a a a meta-analysis that compares allogeneic and autologous transplant and concludes that additional study in high-risk patients with advanced diseases is warranted. The rationale for lukewarmly recommending non-ablative approach is probably to reduce toxicity.

Allogeneic stem cell transplantation versus conventional therapy for advanced primary cutaneous T-cell lymphoma. Cochrane Database Syst Rev. 2012 Jan 18

Y. Oyama, J. Guitart, T. Kuzel, R. Burt, S. RosenHigh-dose therapy and bone marrow transplantation in cutaneous T-cell lymphoma. Hematology/Oncology Clinics of North America, Volume 17, Issue 6, Pages 1475-1483, 2003. Whittaker SJ, Marsden JR, Spittle M, Russell Jones R. Joint British Association of Dermatologists and U.K. Cutaneous Lymphoma Group guidelines for the management of primary cutaneous T-cell lymphomas. Br J Dermatol 2003 Dec;149(6):1095-107. [67 references

Read the Layperson version here.

Stem cell transplantation for T-cell lymphoma – pro

M Levin, MD — Thu, 21 Jun 2012 17:22:40 +0000

Stem Cell transplantation is in the infant stages for this disease; however it is promising. Reports on allo-SCT in T-cell lymphoma have been encouraging. The largest series by Corradini et al. reported on 17 patients with a median age of 14 years, of whom 8 patients had failed an autograft. The estimated 3-year OS and PFS rates were 81% and 64%, respectively. TRM at 2 years was 6% and DLI induced a response in 2 patients progressing after allografting. Wulf et al. reported on 10 patients with relapsed or primary progressive T-cell lymphoma. Patients received salvage therapy consisting of alemtuzumab with or without chemotherapy and received RIC (fludarabine, busulfan, cyclophosphamide) followed by allo-SCT. With a median follow-up of seven months 7 patients remained alive, 6 in complete remission. Surprisingly good results were also reported by Kim et al. and Kusumi et al. All these are retrospective series. Nevertheless, NCCN lists stem cell transplantation as an option.

http://clinicalstudies.info.nih.gov/detail/A_2003-C-0304.html

Norbert Schmitz, Peter Dreger, Bertram Glass, Anna Sureda Allogeneic transplantation in lymphoma: current status Haematologica, Vol 92, Issue 11, 1533-1548

Au WY, Lie AKW, Liang R, et al: Autologous stem cell transplantation for nasal NK/T-cell lymphoma: A progress report on its value. Ann Oncol 14:1673-1679, 2003

NCCN.ORG, NHL. T-CELL 3. 2012

Kimiharu Uozumi Treatment of Adult T-cell Leukemia J Clin Exp Hematopathol Vol. 50, No. 1, May 2010

http://www.bcshguidelines.com/documents/T-cell_guideline_final_bcsh.pdf , 2012