Panel discussion on T-cell lymphoma: current status of therapy and progress

John Gribben, MD, DSc, FRCPath, FMed Sci of Barts Cancer Institute, London, UK introduces the panel discussion on T-cell lymphoma at the 2016 International Workshop on Non-Hodgkin Lymphoma (iwNHL) meeting held in San Diego, CA. Prof. Gribben is joined by Laurence de Leval, MD, PhD of University Medical Center (CHUV), Lausanne, Switzerland, Francine Foss, MD of Yale School of Medicine, New Haven, CT and Elaine Jaffe, MD of the National Cancer Institute, Bethesda, MD. Dr Jaffe starts by summarizing the changes in the classification of T-cell lymphomas based on advances in molecular understanding. She further outlines how the changes affect nodal and extra-nodal lymphoma and discusses the relative importance of morphological and molecular changes for the classification of T-cell lymphoma. Prof. Gribben points out that molecular alterations will be the focus of new drugs targeting those pathways and asks which pathways we should focus on. Dr de Leval explains that we do not have a full understanding of these pathways and highlights the ones of interest. Prof. Foss then talks about identifying patients who could benefit from targeted therapies; she believes that we need wider combinational approaches with an exploratory look at who responds. There is evidence that the expression of epigenetic mutations in angioimmunoblastic T-cell lymphoma (AITL) mirrors the clinical effect of HDAC inhibitors. In terms of CD30 expression and trials of brentuximab vedotin, it is clear that a minimal level of expression is needed but it is not clear how much. Therefore, the best approach is to keep these trials broad and as a secondary analysis, try to figure out if there is a biomarker that correlates with clinical outcome. In terms of using biomarkers for prognosis, Prof. Foss explains that we are not very far in terms of identifying who will benefit from a transplant; we only have clinical observations and clinical prognostic factors. She believes that we need to stratify patients in future trials. An example is DUSP22 in anaplastic large cell lymphoma. Dr de Leval talks about the use of the markers in clinical practice and explains that the best biomarker for now is a good diagnosis. Dr Jaffe discusses the idea of regional diagnostic laboratories in the US and standardizing molecular markers. She believes that the field will move to, for example, next-generation sequencing (NGS) panels. Prof. Foss then discusses the poor prognosis group of patients with AITLs and the role of allogeneic transplant. Prof. Foss explains that when she sees a patient who has poor prognostic markers or a poor histological subtype, she tries to identify a donor right away. She further discusses the use of mogamulizumab and the issue of graft-versus-host-disease (GvHD).

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