The results of combination chemotherapy for peripheral T cell lymphoma (PTCL) still showed poor, although alemtuzumab monotherapy has therapeutic activity in PTCL. We evaluated the safety and effectiveness of several combination chemotherapies with alemtuzumab for treating newly diagnosed PTCL including advanced stage cutaneous T-cell lymphoma. Nine patients with PTCL were included. The pathologic subtypes were as follows: cutaneous T cell lymphoma (CTCL) in 2 patients, peripheral T cell lymphoma unspecified (PTCLu) in 2 patients, extranodal NK/T cell lymphoma, nasal type in 3 patients, angioimmunoblastic T cell lymphoma (AITL) in 2 patient. Patients received a 30mg of alemtuzumab intravenously over about 8 hours on the first day of combination chemotherapy. The combination chemotherapy regimens included: CHOP (cyclophosphamide, adriamycin, vincristine and prednisolone) in 2 patients; EPOCH (etoposide, prednisolone, vincristine, cyclophosphamide and adriamycin) in 2 patients; IMVP16-PL (ifosfamide plus mesna, methotrexate, etoposide and prednisolone) in 5 patients. Complete remission was achieved in 2 patients, and partial remission was achieved in 5 patients, only one patient encountered treatment related mortality (septic shock). Nine patients received nineteen cycles of alemtuzumab plus combination chemotherapy. Alemtuzumab infusion related adverse events were reported in 10 of 19 cycles and were mainly mild to moderate in severity. The most common events were shivers and chills during the alemtuzumab infusion period, which occurred in 8 of 19 cycles. Six (32%) cycles had one or more episodes of new onset NCI-CTC grade 3 or 4 anemia. In addition, erythropoietin use was reported in 7 patients. All of the cycles had grade 3 or 4 neutropenia and 8 (42%) cycles had grade 3 or 4 thrombocytopenia. Grade 3 hyponatremia and grade 3 or 4 hypokalemia were observed in 1 and 4 cycles, respectively. Ten cycles (53%) with neutropenic fever occurred during the treatments. Six (32%) sepsis, 1 septic shock, 2 pneumonia, 2 fungal infection and 2 herpes zoster were observed. There was no cytomegalovirus reactivation during the treatment. Although alemtuzumab plus combination chemotherapy had significant hematologic and infection complications, we concluded that alemtuzumab plus combination chemotherapy was well tolerated and could be recommended for treating newly diagnosed PTCL. However, evaluation in more patients with long-term follow up is warranted.

Patients characteristics

SexAgeStageRegimenCyclesAdditional TxResponse
1Subcutaneous panniculitis T cell lymphom, 2Cutaneous gamma-delta T cell lymphoma, 3Extranodal T/NK cell lymphoma, nasal type, 4Radiotherapy, 5Treatment related mortality 
CTCL1 Female 22 IVA Alemtuaumab+EPOCH RTx4 + 2 IMVP16-PL Partial remission 
CTCL2 Female 48 IIIA Alemtuaumab+IMVP16-PL RTx4 Partial remission 
PTCLu Female 70 IIIA Alemtuaumab+CHOP 3 CHOP Complete remission 
PTCLu Female 50 IVB Alemtuaumab+IMVP16-PL No Partial remission 
NK/T3 Male 51 IVB Alemtuaumab+IMVP16-PL No Partial remission 
NK/T3 Male 46 IIEA Alemtuaumab+IMVP16-PL RTx4 + 1 IMVP16-PL Complete remission 
NK/T3 Male 74 IIEA Alemtuaumab+CHOP No TRM5(Sepsis) 
AITL Female 75 IIIB Alemtuaumab+EPOCH No Progression 
AITL Male 70 IVB Alemtuaumab+IMVP16-PL No Partial remission 
SexAgeStageRegimenCyclesAdditional TxResponse
1Subcutaneous panniculitis T cell lymphom, 2Cutaneous gamma-delta T cell lymphoma, 3Extranodal T/NK cell lymphoma, nasal type, 4Radiotherapy, 5Treatment related mortality 
CTCL1 Female 22 IVA Alemtuaumab+EPOCH RTx4 + 2 IMVP16-PL Partial remission 
CTCL2 Female 48 IIIA Alemtuaumab+IMVP16-PL RTx4 Partial remission 
PTCLu Female 70 IIIA Alemtuaumab+CHOP 3 CHOP Complete remission 
PTCLu Female 50 IVB Alemtuaumab+IMVP16-PL No Partial remission 
NK/T3 Male 51 IVB Alemtuaumab+IMVP16-PL No Partial remission 
NK/T3 Male 46 IIEA Alemtuaumab+IMVP16-PL RTx4 + 1 IMVP16-PL Complete remission 
NK/T3 Male 74 IIEA Alemtuaumab+CHOP No TRM5(Sepsis) 
AITL Female 75 IIIB Alemtuaumab+EPOCH No Progression 
AITL Male 70 IVB Alemtuaumab+IMVP16-PL No Partial remission 

Disclosure: No relevant conflicts of interest to declare.

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