CME-Certified 2012 Hematology Tumor Board Series: Practical Solutions to Current Clinical Challenges in T- Cell Lymphoma Moderator James O. Armitage, MD Joe Shapiro Distinguished Chair of Oncology Professor of Internal Medicine Division of Hematology/Oncology Department of Internal Medicine University of Nebraska Medical Center
CME-Certified 2012 Hematology Tumor Board Series: Practical Solutions to Current Clinical Challenges in T-Cell Lymphoma. Moderator James O. Armitage, MD Joe Shapiro Distinguished Chair of Oncology Professor of Internal Medicine Division of Hematology/Oncology - PowerPoint PPT Presentation
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CME-Certified 2012 Hematology Tumor Board Series: Practical Solutions to Current Clinical Challenges in T-Cell Lymphoma
CME-Certified 2012 Hematology Tumor Board Series: Practical Solutions to Current Clinical Challenges in T-Cell Lymphoma
ModeratorJames O. Armitage, MDJoe Shapiro Distinguished Chair of Oncology Professor of Internal MedicineDivision of Hematology/OncologyDepartment of Internal MedicineUniversity of Nebraska Medical CenterOmaha, Nebraska
PanelistsJulie M. Vose, MD, MBA Neumann M. and Mildred E. Harris Professorial ChairChief and Professor of Internal Medicine Division of Hematology/OncologyDepartment of Internal MedicineUniversity of Nebraska Medical CenterOmaha, Nebraska
Bertrand Coiffier, MD, PhDProfessor of HematologyHead, Department of HematologyHospices Civils de LyonUniversité Claude BernardLyon, France
Owen O’Connor, MD, PhD Professor of Medicine and Developmental TherapeuticsColumbia University College of Physicians and SurgeonsDirector of the Center for Lymphoid MalignanciesNew York-Presbyterian HospitalColumbia University Medical CenterNew York, New York
Program Goals
• Identify prognostic and clinical factors that should be considered in selecting treatment for patients with T-cell lymphoma.
• Consider patient- and disease-specific factors when selecting frontline and relapse/refractory treatment options for patients with T-cell lymphoma.
• Assess how emerging therapies or regimens for patients with T-cell lymphoma may impact current treatment practices.
T-Cell LymphomaOverview
• Relatively rare− ~10% of lymphomas in the United States
• PTCL− Arises from mature T-cell counterparts− Geographic variation in distribution− Has 3 major aggressive subtypes
AITL = angioimmunoblastic T-cell lymphoma; ALCL = anaplastic large cell lymphoma; ALK = anaplastic lymphoma kinase; NOS = not otherwise specified; PTCL = peripheral T-cell lymphoma. Vose J, et al. J Clin Oncol. 2008;26:4124-4130.
PTCL-NOSClinicopathologic Features
• Clinically aggressive, typically occurs in adults aged 50 to 70 years
− Usual patient presentation: high-stage disease, generalized lymphadenopathy, B symptoms, and peripheral blood eosinophilia
• Highly variable pathology − Most likely represents more than 1 subtype
• Broad differential diagnosis due to the heterogeneous appearance
− Other lymphoma subtypes− Reactive hyperplasias due to viral or drug reaction
AITLClinicopathologic Features
• Clinically aggressive, typically occurs in middle-aged or elderly adults− Dismal outcome with current therapies− Usual patient presentation: generalized lymphadenopathy,
Relapsed and Refractory PTCLPhase 2 Study of Romidepsin
Subtype CR/CRu, % ORR, %
PTCL-NOS (n = 69) 14 29
AITL (n = 27) 19 30
ALCL, ALK− (n = 21) 19 24
Case 3Initial Treatment Considerations
• Patients like this—older and not very well—often respond early on to steroids.− Start with a steroid-containing combination to try to get her
symptoms under control and improve her performance status.
• Avoid anthracycline-based therapy.• Single-agent gemcitabine may help manage disease
without excess myelosuppression.• Look for the possible presence of an associated B-cell
clone; if found, use a rituximab combination.• This is one of the more difficult patient types.• If possible, enroll the patient in clinical trial!
AITLRole of Transplant
AITLRole of Transplant
Concluding Remarks
• The key to getting a better understanding of these rare lymphoma subtypes and to improving patient outcomes lies in a collaborative effort and efficient enrollment of patients into clinical trials.
• We also need more biologic studies to discern and understand clinicopathologic features of various PTCL subtypes better.