International assessment of event-free survival at 24 months and subsequent survival in peripheral T-cell lymphoma

Matthew J. Maurer, Fredrik Ellin, Line Srour, Mats Jerkeman, Nabila Bennani, Joseph M. Connors, Graham W. Slack, Karin E. Smedby, Stephen Maxted Ansell, Brian K. Link, James R Cerhan, Thomas Relander, Kerry J. Savage, Andrew L Feldman

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Abstract

Purpose: Peripheral T-cell lymphomas (PTCLs) have aggressive clinical behavior. We have previously shown that event-free survival (EFS) at 24 months (EFS24) is a clinically useful end point in diffuse large B-cell lymphoma. Here, we assess EFS24 and subsequent overall survival (OS) in large, multinational PTCL cohorts. Patients and Methods: Patients with systemic PTCL newly diagnosed from 2000 to 2012 and treated with curative intent were included from the United States and Sweden (initial cohorts) and from Canada (replication cohort). EFS was defined as time from date of diagnosis to progression after primary treatment, retreatment, or death. Subsequent OS was measured after achieving EFS24 or from the time of progression if it occurred within 24 months. OS rates were compared with the age-, sex-, and country-matched general population. Results: Seven hundred seventy-five patients were included in the study (the median age at diagnosis was 64 years; 63% were men). Results were similar in the initial and replication cohorts, and a combined analysis was undertaken. Sixty-four percent of patients progressed within the first 24 months and had a median OS of only 4.9 months (5-year OS, 11%). In contrast, median OS after achieving EFS24 was not reached (5-year OS, 78%), although relapses within 5 years of achieving EFS24 occurred in 23% of patients. Superior outcomes after achieving EFS24 were observed in younger patients (≤ 60 years of age: 5-year OS, 91%). Conclusion: EFS24 stratifies subsequent outcome in PTCL. Patients with PTCL with primary refractory disease or early relapse have extremely poor survival. However, more than one third of patients with PTCL remain in remission 2 years after diagnosis with encouraging subsequent OS, especially in younger patients. These marked differences in outcome suggest that EFS24 has utility for patient counseling, study design, and risk stratification in PTCL.

Original languageEnglish (US)
Pages (from-to)4019-4026
Number of pages8
JournalJournal of Clinical Oncology
Volume35
Issue number36
DOIs
StatePublished - Dec 20 2017

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Peripheral T-Cell Lymphoma
Disease-Free Survival
Survival
Recurrence
Retreatment
Lymphoma, Large B-Cell, Diffuse
Sweden
Canada
Counseling
Survival Rate

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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International assessment of event-free survival at 24 months and subsequent survival in peripheral T-cell lymphoma. / Maurer, Matthew J.; Ellin, Fredrik; Srour, Line; Jerkeman, Mats; Bennani, Nabila; Connors, Joseph M.; Slack, Graham W.; Smedby, Karin E.; Ansell, Stephen Maxted; Link, Brian K.; Cerhan, James R; Relander, Thomas; Savage, Kerry J.; Feldman, Andrew L.

In: Journal of Clinical Oncology, Vol. 35, No. 36, 20.12.2017, p. 4019-4026.

Research output: Contribution to journalArticle

Maurer, MJ, Ellin, F, Srour, L, Jerkeman, M, Bennani, N, Connors, JM, Slack, GW, Smedby, KE, Ansell, SM, Link, BK, Cerhan, JR, Relander, T, Savage, KJ & Feldman, AL 2017, 'International assessment of event-free survival at 24 months and subsequent survival in peripheral T-cell lymphoma', Journal of Clinical Oncology, vol. 35, no. 36, pp. 4019-4026. https://doi.org/10.1200/JCO.2017.73.8195
Maurer, Matthew J. ; Ellin, Fredrik ; Srour, Line ; Jerkeman, Mats ; Bennani, Nabila ; Connors, Joseph M. ; Slack, Graham W. ; Smedby, Karin E. ; Ansell, Stephen Maxted ; Link, Brian K. ; Cerhan, James R ; Relander, Thomas ; Savage, Kerry J. ; Feldman, Andrew L. / International assessment of event-free survival at 24 months and subsequent survival in peripheral T-cell lymphoma. In: Journal of Clinical Oncology. 2017 ; Vol. 35, No. 36. pp. 4019-4026.
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abstract = "Purpose: Peripheral T-cell lymphomas (PTCLs) have aggressive clinical behavior. We have previously shown that event-free survival (EFS) at 24 months (EFS24) is a clinically useful end point in diffuse large B-cell lymphoma. Here, we assess EFS24 and subsequent overall survival (OS) in large, multinational PTCL cohorts. Patients and Methods: Patients with systemic PTCL newly diagnosed from 2000 to 2012 and treated with curative intent were included from the United States and Sweden (initial cohorts) and from Canada (replication cohort). EFS was defined as time from date of diagnosis to progression after primary treatment, retreatment, or death. Subsequent OS was measured after achieving EFS24 or from the time of progression if it occurred within 24 months. OS rates were compared with the age-, sex-, and country-matched general population. Results: Seven hundred seventy-five patients were included in the study (the median age at diagnosis was 64 years; 63{\%} were men). Results were similar in the initial and replication cohorts, and a combined analysis was undertaken. Sixty-four percent of patients progressed within the first 24 months and had a median OS of only 4.9 months (5-year OS, 11{\%}). In contrast, median OS after achieving EFS24 was not reached (5-year OS, 78{\%}), although relapses within 5 years of achieving EFS24 occurred in 23{\%} of patients. Superior outcomes after achieving EFS24 were observed in younger patients (≤ 60 years of age: 5-year OS, 91{\%}). Conclusion: EFS24 stratifies subsequent outcome in PTCL. Patients with PTCL with primary refractory disease or early relapse have extremely poor survival. However, more than one third of patients with PTCL remain in remission 2 years after diagnosis with encouraging subsequent OS, especially in younger patients. These marked differences in outcome suggest that EFS24 has utility for patient counseling, study design, and risk stratification in PTCL.",
author = "Maurer, {Matthew J.} and Fredrik Ellin and Line Srour and Mats Jerkeman and Nabila Bennani and Connors, {Joseph M.} and Slack, {Graham W.} and Smedby, {Karin E.} and Ansell, {Stephen Maxted} and Link, {Brian K.} and Cerhan, {James R} and Thomas Relander and Savage, {Kerry J.} and Feldman, {Andrew L}",
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T1 - International assessment of event-free survival at 24 months and subsequent survival in peripheral T-cell lymphoma

AU - Maurer, Matthew J.

AU - Ellin, Fredrik

AU - Srour, Line

AU - Jerkeman, Mats

AU - Bennani, Nabila

AU - Connors, Joseph M.

AU - Slack, Graham W.

AU - Smedby, Karin E.

AU - Ansell, Stephen Maxted

AU - Link, Brian K.

AU - Cerhan, James R

AU - Relander, Thomas

AU - Savage, Kerry J.

AU - Feldman, Andrew L

PY - 2017/12/20

Y1 - 2017/12/20

N2 - Purpose: Peripheral T-cell lymphomas (PTCLs) have aggressive clinical behavior. We have previously shown that event-free survival (EFS) at 24 months (EFS24) is a clinically useful end point in diffuse large B-cell lymphoma. Here, we assess EFS24 and subsequent overall survival (OS) in large, multinational PTCL cohorts. Patients and Methods: Patients with systemic PTCL newly diagnosed from 2000 to 2012 and treated with curative intent were included from the United States and Sweden (initial cohorts) and from Canada (replication cohort). EFS was defined as time from date of diagnosis to progression after primary treatment, retreatment, or death. Subsequent OS was measured after achieving EFS24 or from the time of progression if it occurred within 24 months. OS rates were compared with the age-, sex-, and country-matched general population. Results: Seven hundred seventy-five patients were included in the study (the median age at diagnosis was 64 years; 63% were men). Results were similar in the initial and replication cohorts, and a combined analysis was undertaken. Sixty-four percent of patients progressed within the first 24 months and had a median OS of only 4.9 months (5-year OS, 11%). In contrast, median OS after achieving EFS24 was not reached (5-year OS, 78%), although relapses within 5 years of achieving EFS24 occurred in 23% of patients. Superior outcomes after achieving EFS24 were observed in younger patients (≤ 60 years of age: 5-year OS, 91%). Conclusion: EFS24 stratifies subsequent outcome in PTCL. Patients with PTCL with primary refractory disease or early relapse have extremely poor survival. However, more than one third of patients with PTCL remain in remission 2 years after diagnosis with encouraging subsequent OS, especially in younger patients. These marked differences in outcome suggest that EFS24 has utility for patient counseling, study design, and risk stratification in PTCL.

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