OBJECTIVES

: PTCL, an aggressive lymphoid malignancy, accounts for 10-15% of non-Hodgkin lymphomas and has poor outcomes. Overall survival (OS) and progression-free survival (PFS) were assessed in patients treated outside clinical trials with first-line (1L) CHOP or EPOCH and by subsequent autologous stem cell transplantation (ASCT).

METHODS

: Patients with PTCL diagnosis between 2012–2018 were identified from a large, open-source, US payer claims database. Kaplan-Meier estimates of OS used ≥6 months clinical inactivity from last observed claim as proxy for mortality, and PFS used time to next treatment. Comparisons of treatment effect by 1L regimen and ASCT were made by log-rank tests. Adjusted hazard ratios (HR) for treatment effectiveness on death and progression were estimated by Cox proportional hazards models.

RESULTS

: Among 1,206 PTCL patients identified (median age, 63 years; 59% male) who initiated 1L (CHOP, n=884, EPOCH, n=322), 101 (8.4%) received ASCT during the study period. Patients treated with 1L CHOP had similar median OS and PFS versus (vs) 1L EPOCH (48.0 vs 38.4 months, p=0.68; 31.2 vs 32.4 months, p=0.56, respectively); OS and PFS from 2L were 19.2 vs 20.4 months (p=0.62) and 8.4 vs 7.2 months (p=0.92), respectively. Median OS and PFS from 2L among those with ASCT were significantly longer vs those without ASCT (not reached vs 15.6 months, p=0.002; 20.4 vs 10.5 months, p=0.02, respectively). Those receiving ASCT in 2L had reduced adjusted risks of death and progression vs those not receiving ASCT (HR=0.57, p=0.002; HR=0.62, p=0.007, respectively).

CONCLUSIONS

: The minority of PTCL patients undergo ASCT in the real world, but when performed, ASCT provides these patients with better OS and PFS vs those who do not. First-line treatment selection had no impact on outcomes. Research is warranted to understand barriers to ASCT in the real world. Novel therapies for PTCL remain needed given generally poor outcomes for these patients.