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ICML 2021 | Advances in treating T-cell lymphoma

Franco Cavalli, MD, FRCP, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland, summarizes the latest developments in T-cell lymphoma management. Data from a Phase III trial (NCT02631239) comparing ESA (pegaspargase, etoposide and dexamethasone) with sandwiched radiotherapy to MESA (ESA plus methotrexate) in patients with natural killer/T-cell lymphoma was discussed, with ESA being more efficacious and less toxic. Standard allogenic transplantation was additionally found to be as effective as haploidentical transplantation, widening the indication for allogeneic transplantation. Alternative approaches to chemotherapy including the HDAC inhibitor romidepsin and PI3K inhibitor duvelisib were also discussed, potentially paving the way for new lines of treatment. This interview took place during the 2021 International Conference on Malignant Lymphoma (16-ICML).

Transcript (edited for clarity)

There were a few new data, T cells are still a big challenge because in the last two or three decades, while we have made a lot of progress in treating B cells, the progress in treating T cells has been rather scarce. We had a very interesting paper from China into treatment of NK T cells, which is a very frequent subtype of T cells in China, where they were comparing the usual treatment called MESA, which is methotrexate, etoposide, dexamethasone and PEG-asparaginase, to ESA, which means less or no methotrexate as compared to the standard treatment and also in a lower dosage, and that combined with radiotherapy in early stages of NK T cells, and they were able to hold that the less toxic and more easily applicable ESA is as efficacious as the more toxic, MESA, which for China, where they have thousands of these patients, is very important news...

There were a few new data, T cells are still a big challenge because in the last two or three decades, while we have made a lot of progress in treating B cells, the progress in treating T cells has been rather scarce. We had a very interesting paper from China into treatment of NK T cells, which is a very frequent subtype of T cells in China, where they were comparing the usual treatment called MESA, which is methotrexate, etoposide, dexamethasone and PEG-asparaginase, to ESA, which means less or no methotrexate as compared to the standard treatment and also in a lower dosage, and that combined with radiotherapy in early stages of NK T cells, and they were able to hold that the less toxic and more easily applicable ESA is as efficacious as the more toxic, MESA, which for China, where they have thousands of these patients, is very important news.

We had huge retrospective analysis carried out by ABMT with almost 2000 patients, where the standard allogeneic transplantation was compared to transplantation using haploidentical donors. In many cases, you are obliged to use haploidentical donors and the interesting point is that there was no difference between the matched donors and the haploidentical donors, which might enlarge the indication for a allergenic transplantation in T-cell lymphomas, which remain in many subtypes, the only possibility to cure the patients.

There were many abstracts about new drugs, but two very interesting in both there was the HDAC inhibitor romidepsin, which was combined in one of the trial with lenalidomide and the other trial with the PI3K inhibitor duvelisib, so two non-chemotherapy combinations, and they elicited both a very high response rate in phase two trials, both were abstracts presented by two different groups in New York. So an overall response rate in the order of 70 to 80% with a complete response rate higher than 30%. So for the first time non-chemotherapy agents, so biologic agents, are becoming a very important part in the treatment of T cell lymphomas and open new avenues for very much necessary improvement in the outcome of the treatment for T cell lymphomas.

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