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my personal edition > lymphomas > news
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DGDispatch
Clinicians Introduce Guidelines for Diagnosis and Treatment of Patients With Peripheral T-Cell Lymphoma (Unspecified): Presented at NCCN
By Jerry Ingram
HOLLYWOOD, FL -- March 21, 2007 -- For the first time, researchers and clinicians with the National Comprehensive Cancer Network (NCCN) have established guidelines for the diagnosis and treatment of individuals with peripheral T-cell lymphoma.
"We haven't had large clinical trials in these diseases. Though some of the guidelines are a bit anecdotal, they are a consensus of the guideline committee," explained Leo I. Gordon, MD, Abby and John Friend Professor of Cancer Research and Professor of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States.
Dr. Gordon discussed the findings here on March 17th at the 12th annual meeting on Clinical Practice Guidelines and Quality Cancer Care of the NCCN.
Though considered a "waste basket" category, peripheral T-cell lymphoma (unspecified) accounts for approximately 5% to 7% of all non-Hodgkin's lymphoma cases and between 60% and 70% of T-cell lymphomas.
For diagnosis of this disease, NCCN guidelines committee members point out that 90% of patients present with a clonally rearranged TCR gene, suggesting that adequate immunophenotyping is critical to establish the diagnosis. Clinicians may also find use of molecular genetic analysis to be essential in detection of antigen receptor gene rearrangements and variants of t2;5.
A full haematopathology review of all slides with at least 1 paraffin block representative of the tumour is essential in diagnosing this disease, Dr. Gordon noted.
Although data suggest that in limited stage disease, the overall survival rate is the same in B-cell and T-cell lymphomas, more patients present with stage IV disease (Savage, et. Al., ASH 2005, Abstract #2817), the committee reported.
Dr. Gordon and his associates also included in the new guidelines recommendations for first-line therapy in this patient population. Treatment options consist of having patients enter a clinical trial, as well as aggressive regimens of CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone), EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin) or HyperCVAD/MTX-AraC (fractionated cyclophosphamide, doxorubicin, vincristine 2 mg, dexamethasone with methotrexate and araC.
The researchers noted that intermediate and high-risk patients should be treated with consolidated high-dose therapy and stem cell support (either autologous or allogeneic).
The NCCN committee suggestions for second-line treatment (with intent for stem-cell rescue) include clinical trial, DHAP (dexamethasone, cisplatin, cytarabine), ESHAP (etoposide, methylprednisolone, cytarabine, cisplatin), ICE (ifosfamide, carbolated, etoposide), MiniBeam (carmustine, etoposide, cytarabine, and melphalan), and MINE (mesna, ifosfamide, mitoxantrone, etoposide).
For patients being treated with palliative intent, second-line therapy includes denileukin diftitox, gemcitabine, alemtuzumab, or GDP (gemcitabine, dexamethasone, and cisplatin).
[Presentation title: Presentation title: Update: Non-Hodgkin's Lymphoma Guidelines.]
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