146525-156

The outcome of ALK positive and ALK negative anaplastic large cell lymphoma (ALCL) following DA-EPOCH.

Subcategory: 
Category: 
Lymphoma and Plasma Cell Disorders
Session Type and Session Title: 
Poster Session, Lymphoma and Plasma Cell Disorders
Abstract Number: 

8564

Poster Board Number: 
Board #382
Citation: 
J Clin Oncol 33, 2015 (suppl; abstr 8564)
Author(s): 
Catherine Lai, Stefania Pittaluga, Margaret Shovlin, Seth M. Steinberg, Mark J. Roschewski, Elaine S. Jaffe, Wyndham Hopkins Wilson, Kieron Dunleavy; Center for Cancer Research, National Cancer Institute, Bethesda, MD; Metabolism Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD; Biostatistics and Data Management Section, National Cancer Institute, National Institutes of Health, Bethesda, MD

Abstract Disclosures

Abstract: 

Background: Systemic anaplastic large cell lymphoma (ALCL) is a clinically and molecularly heterogeneous type of peripheral T-cell lymphoma (PTCL). It may be sub-divided into cases with or without translocation of the anaplastic lymphoma kinase gene (ALK), leading to overexpression of ALK. While the outcome for patients with ALK positive ALCL - particularly in pediatric patients - has been very favorable following doxorubicin-based therapy, ALK negative cases have fared more poorly. Approaches such as autologous transplantation have been studied in this group in an attempt to improve outcome (d’Amore et al. J Clin Oncol. 2012). Methods: 23 patients with newly diagnosed ALK positive (15) and ALK negative (8) ALCL underwent treatment with 6 to 8 cycles of dose-adjusted infusional etoposide, vincristine and doxorubicin with prednisone and cyclophosphamide (DA-EPOCH). Both groups had similar IPI characteristics (shown below). Results: 19/23 (83%) patients achieved CR or CRu; 3/23 (13%) a PR and 1 patients had PD. At the median potential follow-up time of 13 years, event free survival (EFS) in ALK positive and ALK negative ALCL was 72% and 62.5% (p = 0.50) and overall survival was 76% and 87.5% (p = 0.82), respectively. Toxicity was assessed on all 135 cycles. Neutropenic fever and thrombocytopenia < 25,000/mm3 occurred on 10% of cycles, respectively. Absolute neutrophil count (ANC) less than 500 cells/mm3 occurred on 35% of cycles. Conclusions: Following DA-EPOCH, the outcome of ALK negative ALCL is equivalent to ALK positive ALCL. The incorporation of etoposide, infusional scheduling and dose adjustment may play important roles in ALCL therapeutics. DA-EPOCH should be considered a reasonable front-line regimen in ALCL and especially in older patients where approaches such as transplantation may not be feasible. Clinical trial information: NCT00001337

CharacteristicsAll Patients
(N = 23)
ALK + ALCL
(N = 15)
ALK – ALCL
(N = 8)
Median age (range)38 (19-68)36 (19-68)43 (27-60)
Male sex16 (70%)9 (60%)7 (87%)
Stage III or IV17 (74%)12 (80%)5 (62%)
Elevated LDH12 (52%)8 (53%)4 (50%)
Extranodal sites
Bone/Bone marrow
Lung
Bowel
12 (52%)
5 (22%)
5 (22%)
3 (13%)
8 (53%)
3 (20%)
3 (20%)
2 (13%)
4 (50%)
2 (25%)
2 (25%)
1 (12%)
IPI ≥ 214 (61%)10 (67%)4 (50%)