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Predictive model for treatment outcomes of peripheral T-cell lymphoma, not otherwise specified, in Taiwanese patients

Purpose: We aimed to explore the clinical outcomes and prognostic factors for PTCL-NOS patients in the real world.

Methods: Clinical data were retrospectively collected from adult patients with PTCL-NOS treated at a single center in Taiwan.

Results: 104 PTCL-NOS patients with a median age of 53.0 years were enrolled. Patients with the International Prognostic Index (IPI) or prognostic index for peripheral T-cell lymphoma (PIT) scores of zero had a longer overall survival (OS) and progression free survival (PFS), while patients with IPI or PIT scores ≥1 did poorly. For patients who are eligible for transplantation, the use of pralatrexate as salvage chemotherapy has shown better OS (2-year OS 83.3% vs. 24.4%, P = 0.011) compared to patients who did not. By multivariate analysis, age >60 years, male, B symptoms, ECOG >1, lung involvement, and thrombocytopenia were independent adverse factors for OS. Incorporating factors in multivariate analysis, we established a novel predictive index for PTCL-NOS which efficiently stratifies patients into low (0-1 factor), intermediate-1 (2 factors), intermediate-2 (3 factors), and high risk (4-6 factors) groups with 2-year OS rates of 81.5%, 32.9%, 8.8%, and 0%, respectively (P < 0.001).

Conclusion: PTCL-NOS patients have a dismal prognosis in Taiwan. Novel agents may improve the outcomes of PTCL-NOS patients. The usefulness of the novel prognostic index for PTCL-NOS needs further validation.

 

Comments:

Your study aimed to investigate the clinical outcomes and prognostic factors for patients with peripheral T-cell lymphoma-not otherwise specified (PTCL-NOS) in a real-world setting in Taiwan. Here's a breakdown of the key findings and conclusions from your study:

**Methods:**
- Retrospective collection of clinical data from adult PTCL-NOS patients treated at a single center in Taiwan.

**Results:**
- 104 PTCL-NOS patients with a median age of 53.0 years were enrolled.
- Patients with lower International Prognostic Index (IPI) or prognostic index for peripheral T-cell lymphoma (PIT) scores had longer overall survival (OS) and progression-free survival (PFS).
- Patients eligible for transplantation who received pralatrexate as salvage chemotherapy showed better OS compared to those who did not.
- Multivariate analysis identified several independent adverse factors for OS, including age >60 years, male gender, B symptoms, ECOG >1, lung involvement, and thrombocytopenia.

**Conclusion:**
- PTCL-NOS patients in Taiwan have a poor prognosis.
- The use of novel agents, such as pralatrexate, may improve outcomes for PTCL-NOS patients.
- The study established a novel predictive index for PTCL-NOS based on various factors, efficiently stratifying patients into low, intermediate-1, intermediate-2, and high-risk groups with corresponding 2-year OS rates.
- The usefulness of this novel prognostic index requires further validation.

**Implications:**
- The study emphasizes the need for improved treatment strategies for PTCL-NOS, particularly in the context of novel agents.
- The identified prognostic factors can assist clinicians in assessing the risk profile of PTCL-NOS patients and making informed treatment decisions.
- The novel predictive index could potentially aid in risk stratification and personalized treatment approaches for PTCL-NOS patients.

**Limitations:**
- The retrospective nature of the study may introduce biases and limitations inherent to such study designs.
- The findings may be specific to the patient population in Taiwan and may not be directly generalizable to other populations.
- The novel prognostic index requires external validation to confirm its utility in predicting outcomes for PTCL-NOS patients.

**Future Directions:**
- Further research is needed to validate the novel prognostic index in larger and more diverse patient cohorts.
- Prospective studies and clinical trials may be warranted to evaluate the efficacy of novel agents in improving outcomes for PTCL-NOS patients.
- Continuous monitoring and updating of treatment strategies based on evolving evidence and novel therapeutic options.

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S1497 Pralatrexate Pralatrexate is an antifolate, and structurally a folate analog. Its IC50 is < 300 nM in some cell lines. Pralatrexate induces tumor cell apoptosis.

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