Strategies for relapsed peripheral T-cell lymphoma: the tail that wags the curve

J Clin Oncol. 2013 Jun 1;31(16):1922-7. doi: 10.1200/JCO.2012.48.3883. Epub 2013 Apr 29.

Abstract

A 69-year-old woman was referred for further evaluation and management of relapsed angioimmunoblastic T-cell lymphoma. At diagnosis, she received six cycles of dose-adjusted EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin) and achieved a complete response (CR). Her first surveillance computed tomography scan 3 months later demonstrated enlarging cervical lymphadenopathy. A lymph node excision confirmed relapsed angioimmunoblastic T-cell lymphoma with atypical lymphocytes expressing CD3, CD4, CD10, PD-1, and EBER, with loss of CD5 (Fig 1). A clonal T-cell receptor beta and gamma rearrangement by polymerase chain reaction was identical to that in her initial diagnostic biopsy. At our initial consultation, options for standard as well as investigational therapies were discussed, and HLA typing was initiated. The patient was enrolled onto an investigational phase II study; however, she developed progressive disease after two cycles. She was then treated with romidepsin 14 mg/m(2) administered intravenously for 3 consecutive weeks with 1 week off. After two cycles, she achieved a partial response, and after four additional cycles, she maintained her response without further improvement. We discussed additional treatment options.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Antibiotics, Antineoplastic / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Cyclophosphamide / administration & dosage
  • Depsipeptides / administration & dosage
  • Doxorubicin / administration & dosage
  • Etoposide / administration & dosage
  • Female
  • Graft vs Host Disease / immunology
  • Humans
  • Induction Chemotherapy / methods*
  • Lymphoma, T-Cell, Peripheral / diagnosis*
  • Lymphoma, T-Cell, Peripheral / diagnostic imaging
  • Lymphoma, T-Cell, Peripheral / drug therapy
  • Lymphoma, T-Cell, Peripheral / pathology
  • Lymphoma, T-Cell, Peripheral / surgery
  • Lymphoma, T-Cell, Peripheral / therapy*
  • Multimodal Imaging
  • Patient Selection*
  • Positron-Emission Tomography
  • Prednisone / administration & dosage
  • Recurrence
  • Severity of Illness Index
  • Stem Cell Transplantation*
  • Tomography, X-Ray Computed
  • Transplantation, Homologous
  • Vincristine / administration & dosage

Substances

  • Antibiotics, Antineoplastic
  • Depsipeptides
  • Vincristine
  • Etoposide
  • Doxorubicin
  • Cyclophosphamide
  • romidepsin
  • Prednisone

Supplementary concepts

  • EPOCH protocol