Lymphoma, T-Cell, Peripheral Clinical Trial
Official title:
Prospective Collection of Data in Pts With Peripheral T-Cell Lymphoma: PTCL,NOS;AITL; Extranodal NK/T-cell;Enteropathy-type; Hepatosplenic γ-δ; Subcutaneous Panniculitis-like; ALCL,Primary Systemic Type. By the Intl. T-Cell Lymphoma Project
The designed study follows up the retrospective previous one by the International T-cell
Non-Hodgkin's Lymphoma Study Group (International Peripheral T-Cell Lymphoma Project).
It is designed as a prospective collection of information potentially useful to predict the
prognosis of newly diagnosed patients with the more frequent subtypes of Peripheral T-cell
lymphoma (Peripheral T-cell lymphoma unspecified and Angioimmunoblastic T-cell lymphoma) and
to better define clinical characteristics and outcome of the more uncommon subtypes
Peripheral T-cell lymphomas (PTCLs) comprise a heterogeneous group of neoplasms that are
derived from post-thymic lymphoid cells at different stages of differentiation with different
morphological patterns, phenotypes, and clinical presentations. PTCLs are highly diverse,
reflecting the diverse cells from which they can originate. Peripheral T-Cell Lymphomas
account for 5-10% of all lymphoproliferative disorders in the Western hemisphere, with an
overall incidence of 0.5-2 per 100,000 per year, and have a striking epidemiological
distribution, with higher incidence in Asia.
The clinical features of PTCLs are extremely heterogeneous. PTCLs express even more clinical
diversity than B-cell NHLs, and there is a close, though not absolute, relationship between
some unusual clinical features and certain histological subtypes. Despite efforts to
transferring to patients with T-cell lymphomas the most recent advances in the treatment of
other subtypes of B-cell lymphomas, the prognosis of patients with PTCL is still poor an,
unfortunately, the optimal therapy for PTCL is still unknown. The complete response rate is
rather low, ranging from 40% to 50% with a median Relapse Free Survival (RFS) of 2-3 years.
As a consequence of the aggressiveness of the disease and of the low efficacy of available
salvage treatments, Overall Survival (OS) is also short and the long-term survival rate is
lower than 10% in many series.
To better define the clinical outcome of PTCL-NOS, the Intergruppo Italiano Linfomi (IIL, now
Fondazione Italiana Linfomi, FIL) performed a large study on 385 patients diagnosed and
treated in the 1990s and defined a prognostic model specifically devised for patients with
this uncommon disease (Gallamini, A. et al Blood, 2004. 103(7): p. 2474-9). In addition to
defining a prognostic model specifically devised for PTCL-NOS, the FIL study confirms the
relevance of research on series of clearly defined cases in order to the development of
rationally designed and potentially more-efficacious treatment modalities. More recently, the
role of biological features of the disease is emerging as an important issue not only for
understanding its pathogenesis but also for prognosis and for addressing specific biologic
targets altered in the neoplasia. Significant progress in the prognosis of PTCL can be
expected from the novel, sophisticated, and powerful technologies of genomics and proteomics,
which will allow more reliable subtyping of PTCL into distinct clinical groups characterized
by different patterns of survival, as already demonstrated for some B-NHLs.
One common limitation of existing studies on prognosis of PTCL is their retrospective nature.
Currently available data are based on analysis performed on series collected over a long
period of time. This aspect is very important as it may introduce relevant biases in the
collected series. First classification systems have changed dramatically over time and cases
may have been defined in differently based on diagnosis year. Second some clinical or
laboratory data which now are considered as prognostic relevant may have not been determined
in older series of patients. Third in a retrospective analysis there is no guarantee that
collected series are based on real consecutive cases. These are the reasons why we thought it
would be useful to start a new study based on the prospective registration in a short period
of time of patients with diagnosis of Peripheral T-cell lymphoma for whom it would be
possible collect an exhaustive set of clinical data and biological information.
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