Real world outcome of nodal T cell non-Hodgkin lymphoma from hematology cancer consortium registry in India

Abstract

Abstract Introduction Here we present the real-world outcome of nodal T-NHL data from a prospectively maintained lymphoma registry in India established by the Haematology Cancer Consortium (HCC) between January 2020 and May 2023, with 10 participating centres. Methods Prospective data of patients (more than or equal to 18 years) diagnosed between January 2020 and May 2023 were entered into an independent centralized online data capture system and analysed for presenting characteristics, staging parameters, treatment parameters and survival outcomes. Evaluation and treatment protocols were based on individual centre preferences. Results: Baseline Characteristics: We identified 294 patients with nodal T-NHL, of which 117 patients (40%) were diagnosed with Peripheral T cell Not otherwise specified (PTCL-NOS), 66 patients (23%) were diagnosed with ALK positive Anaplastic Large Cell Lymphoma (ALK +ve ALCL), 63 patients (21%) were diagnosed with ALK negative Anaplastic Large Cell Lymphoma (ALK-ve ALCL), and 48 patients (16%) were diagnosed with Angioimmunoblastic T cell Lymphoma (AITL). The median age was 51 years(Range 18 to 77), with a male-to-female ratio of 1.74:1.Staging information was available in 272(93%) of patients (PET/CT in 74%, CT in 18%, bone marrow in 18%, and ultrasound and X-ray in 11%) of which 197 patients(74%)had stage III/IV disease, extra nodal involvement was seen in 150 patients(51%),more than 1 extra nodal site involvement in 47 patients (31%). Ninety-four patients (36%, n=259) had poor ECOG performance status >1, 144 patients (49%) presented with B symptoms, elevated LDH in 178 patients (73%,n=244). An International Prognostic Index (IPI) score of >2 was seen in 97 patients (33%). Treatment Outcome: Two thirty-seven patients underwent treatment (217: only chemotherapy,15: chemotherapy and radiotherapy,4: only radiotherapy;1: wait and watch). Chemotherapy protocols used were CHOEP (n=112; 47%), CHOP (n=76; 32%), CVP-like regimen (n=14; 6%), and GMALL NHL protocol (n=13; 5%). Azacytidine with CHP was used in 2 patients, and Brentuximab with CHP was used in 1 patient. In PTCL NOS treated with chemotherapy (n=88), 56% of patients received CHOEP, and 35% received the CHOP regimen. In ALK+ALCL treated with chemotherapy (n=62), 55% received CHOEP, 24% received CHOP, and 16% received GMAL NHL-type protocol. In ALK-ve ALCL treated with chemotherapy (n=49), 41% received CHOEP and 31% received CHOP. In AITL treated with chemotherapy (n=33), 27% received CHOEP and 46% received CHOP. Major toxicity to the initial regimen was febrile neutropenia (35%). End of first-line therapy assessment was performed in 158 patients (67%). Complete Response (CR) to first line therapy was present in 68%; 14% obtained partial response (PR), 14% had progressive disease (PD), and 4% had stable disease. Stem cell transplant as consolidation to first complete remission was done in 10 patients. Autologous stem cell transplant (SCT) in 9 patients and allogenic SCT in one patient. After a median follow-up of 21 months (reverse KM method), 61 patients(26%) died,57 patients (24%) relapsed after first line treatment,100 patients (42%) were lost to follow-up(Among these, 60 patients were either not in CR or were receiving palliative treatment, and disease response status was unavailable for an additional 14 patients at the time of the last data capture). Median EFS for the cohort was 29 months. The two-year EFS was 34% for PTCL NOS, 70% for ALK+ve ALCL, 59% for ALK-ve ALCL, and 37% for AITL. There was no statistically significant EFS difference between patients less than 60 years old and older patients or patients treated with CHOEP when compared with the CHOP protocol. In univariate analysis, advanced stage, high LDH, poor ECOG performance status (>1), and ALK-negative status were predicting poor EFS. On Multivariate analysis advanced stage, high LDH predicted poor EFS. Conclusion: Our data reflects the poor outcome of nodal T-NHL with current available therapy. Modes of staging, choice of initial protocol, and consolidation with SCT differed from centre to centre based on practical issues like finance and patient/physician preference. Data loss due to lost follow-up (42%) and short median follow-up duration are the major drawbacks in this registry analysis.