Peripheral T-Cell Lymphoma: Navigating Diagnosis, Relapse, and Emerging Treatment Strategies

Episode Description:In this episode of HemeTalks, we are joined by Neha Mehta-Shah, MD, MSCI, Associate Professor of Medicine at Washington University in St. Louis, to discuss the evolving management of peripheral T-cell lymphomas (PTCL), with a focus on differences by histologic subtype. Through a case-based discussion, Dr. Mehta-Shah explores the diagnostic challenges of PTCL, including the role of repeat biopsies, expert pathology review, and molecular testing. She reviews frontline treatment approaches, including CHOP-, CHOEP-, and brentuximab vedotin-based regimens, and discusses the role of autologous transplantation in first remission. The conversation then turns to relapsed disease, highlighting emerging therapeutic strategies, genomic insights, and consideration of allogeneic transplantation. Listeners will gain practical guidance for managing one of the most challenging groups of hematologic malignancies. Clinical Perls Peripheral T-cell lymphomas frequently present diagnostic challenges and may require repeat biopsies, specialized hematopathology review, and integration of clinical, morphologic, and molecular findings to establish an accurate diagnosis. Frontline treatment involves an anthracycline backbone regardless of histologic subtype. BV-CHP is the standard of care for ALCL patients based on results of ECHELON-2 which enriched this patient population. Other histologic subtypes have less clear evidence for frontline BV regardless of CD30 status and CHOP or CHOEP are reasonable. The addition of etoposide is less clear and mainly benefits patients younger than 60 years old.  In the relapsed or refractory setting, histologic subtype can possibly guide treatment choice. Duvelisib and histone deacetylase (HDAC) inhibitors have shown efficacy for the T follicular helper phenotype which was previously referred to as angioimmunoblastic T cell lymphoma.  This podcast episode is supported by Secura Bio.