(135) Impact of Early Relapse on Survival After First-line Therapy in Patients with Peripheral T-cell Lymphomas (Top Ten Poster)

Poster Abstract: The optimal front-line regimen for peripheral T-cell lymphomas (PTCL) remains unclear. CHOP is most commonly used. Addition of etoposide (e.g.,CHOEP) has shown benefit in patients < 60-65 years and low-risk disease. EPOCH has only been evaluated in small studies. In this study, overall survival was evaluated using a retrospective cohort of relapsed/refractory (R/R) PTCL from 15 centers globally.

Objective is to assess effect of time to progression after first-line CHOP, CHOEP, or EPOCH on overall survival (OS; time from diagnosis to death). A priori subgroups included histologic subtype and first-line autologous stem-cell transplant (autoHSCT) consolidation.

Data included adults with PTCL-not-otherwise-specified (PTCL-NOS), angioimmunoblastic (AITL), or anaplastic-large-cell (ALCL) lymphomas who received first-line CHOP, CHOEP, or EPOCH and at least second-line therapy from 2010-2021. Time to progression was defined by time-to-next-therapy (time from start of first-line to second-line therapy). Kaplan Meier method was used, and hazard ratios (HR) with 95% confidence intervals (95%CI) were calculated, adjusting for age, histology, and prognostic-index score for PTCL (PIT) using Cox Proportional Hazards.

Among 530 eligible patients, 265 (50%) with median age of 64 (range, 18-91) received CHOP; 227 (43%) with median age of 56 (range, 19-80) received CHOEP, and 38 (7%) with median age of 59 (range, 31-79) received EPOCH. In refractory patients, first-line CHOP (HR 0.35; 95%CI, 0.16-0.73; p=0.005) and CHOEP (HR 0.28; 95%CI, 0.13-0.60; p< 0.001) was associated with better survival versus EPOCH. In responding (versus refractory) patients independent of first-line treatment, relapse in 6-12 months (HR 0.64; 95%CI, 0.45-0.92; p=0.016) and >12 months (HR 0.46; 95%CI, 0.32-0.66; p< 0.001) was associated with better survival, however relapse within 6 months had similar survival (HR 0.75; 95%CI, 0.42-1.34; p=0.333). Within PTCL-NOS and ALCL, relapse >12 months was associated with better survival (PTCL-NOS: HR 0.34; 95%CI, 0.21-0.55; p< 0.001; ALCL: HR 0.07; 95%CI, 0.01-0.62; p=0.016), however, no difference was observed if relapse occurred within 6 months (PTCL-NOS: HR 0.75; 95%CI, 0.35-1.63; p=0.474; ALCL: HR 1.24; 95%CI, 0.13-12.28; p=0.856) or 6-12 months (PTCL-NOS: HR 0.68; 95%CI, 0.42-1.12; p=0.128; ALCL: HR 0.31; 95%CI, 0.08-1.20; p=0.090).

In this analysis of R/R PTCL, refractoriness to first-line EPOCH was associated with worse survival, highlighting potential efficacy differences between front-line regimens. Additionally independent of first-line treatment, being primary refractory has similar survival to relapse within 12 months in PTCL-NOS and ALCL, or any relapse in AITL, highlighting new high-risk groups. Further analyses are underway to directly compare survival with frontline treatment regimens stratified by response.

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