Current treatment approaches in patients with newly diagnosed peripheral T-cell lymphoma and novel therapies-focusing on brentuximab vedotin

Czech version

Authors: D. Belada
Authors‘ workplace: IV. interní hematologická klinika, FN a LF UK v Hradci Králové
Published in: Transfuze Hematol. dnes,26, 2020, No. 3, p. 177-185.
Category: Review/Educational Papers

Overview

Peripheral T-cell lymphoma (PTCL) is a rare disease with unfavourable prognosis except for low-risk patients with ALK (anaplastic lymphoma kinase)-positive anaplastic large T-cell lymphoma (ALCL). CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) was for many years the standard first line regimen. Addition of etoposide to the CHOP (CHOEP) resulted in better progression-free survival (PFS) but did not confer any overall survival (OS) benefit. The role of autologous stem cell transplantation as consolidation therapy of first line treatment remains unclear in the absence of randomised phase 3 studies. Prognosis of patients failing first line therapy is extremely poor. Apart from a small cohort of young patients who can benefit from salvage therapy with allogeneic stem cell transplantation, there is no standard therapy showing adequate results in the relapse/refractory setting. A recently published phase 3, randomised, double-blind, double dummy study (ECHELON-2) for newly diagnosed CD30-positive patients with PTCL has shown remarkable benefit of brentuximab vedotin (BV, chimeric anti-CD30 antibody with monomethyl auristatin E) when added to CHP chemotherapy in terms of significantly improved PFS as well as OS compared to standard therapy with CHOP, especially in ALCL patients. In other histological subtypes, benefit of BV was difficult to assess given the small numbers of patients and will have to be studied further. Combination of BV and CHP is considered to be a very potent therapy for CD30 positive treatment-naïve PTCL patients. Brentuximab vedotin is newly reimbursed from 01-AUG-2020 in Czech Republic for newly diagnosed patients with CD30-positive T-cell lymphoma, in combination with cyclophosphamid, doxorubicin and prednison.

Keywords:

T-cell lymphoma – Prognosis – brentuximab vedotin – Transplantation

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