Safety considerations with the current treatments for peripheral T-cell lymphoma

ABSTRACT

Introduction

Peripheral T-Cell Lymphomas (PTCL) constitute a heterogeneous group of aggressive T – and natural killer (NK)-cell disorders and are associated with a poor prognosis. Frontline treatments often consist of anthracycline-based combination chemotherapy with the exception of NK-T cell lymphomas, where such combinations are ineffective due to the presence of P-glycoprotein which leads to multidrug resistance. Infectious and immune mediated side effects might be more pronounced in or unique to T-cell lymphomas due to the selection of agents which target multiple T-cell subtypes and also an immunocompromised state induced by the lymphomas themselves.

Areas covered

This review provides a comprehensive overview of safety considerations of treatment regimens used for peripheral T-cell lymphomas. We cover regimens used in both frontline and relapsed settings including combination chemotherapy, single agent chemotherapies and immunotherapies.

Expert opinion

Treatment of T-cell lymphomas often requires sequencing of several therapies due to lower efficacy of available treatment regimens in curing the disease compared to that seen in B-cell non-Hodgkin lymphomas. In addition, certain complications are more common in T-cell lymphomas due to their unique immunobiology. An understanding of these salient aspects is important for all providers who treat patients with this challenging disease group.

KEYWORDS:

• T-cell lymphoma
• PTCL
• immunotherapy
• therapeutic approach
• NHL
• safety
• toxicity

Article highlights

• Peripheral T-Cell Lymphomas (PTCL) constitute a heterogeneous group of aggressive T- and natural killer (NK)-cell disorders typically associated with a poor prognosis.

• Patient’s often go through multiple lines of therapy due to more limited efficacy of frontline regimens as compared with B-cell NHL.

• Considerations of autologous and allogeneic transplant consolidation in frontline or beyond depending on the nature of disease are important with regards to feasibility of stem cell collection and/or risk of increased graft vs. host disease after certain immunotherapies.

• Another consideration is unique side effects associated with T-cell immunobiology relating to risk of infections and immune mediated side effects.

• A knowledge of the specific side effects are key in determining the best sequence of comparable regimens based on expected tolerance for an individual patient.

Disclosure statement

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.