The SALENTO prognostic model for limited-stage peripheral T-cell lymphoma from the International T-Cell Project Network

Abstract

The natural history of limited-stage peripheral T-cell lymphomas (PTCLs) remains poorly defined. We investigated outcomes and prognostic variables in patients registered in the T-Cell Project (TCP)(NCT01142674) to develop a model to predict overall survival (OS) for the common nodal PTCL subtypes (PTCL-NOS, AITL, ALCL). The model was validated in an independent data set from Australian and Brazilian registries. 211 patients registered in the TCP between 2006-2018 were studied. The median age was 59 years (range 18-88) and median follow-up was 49 months. 127 patients (78%) received anthracycline-based regimens, 5 patients (3%) radiotherapy alone (RT), 24 patients (15%) chemotherapy+RT. 5-year OS and PFS were 47% and 37%, respectively. Age >60y, elevated LDH and low serum albumin were independent prognostic factors. The model identified three groups with low- (26%, score 0), intermediate- (41%, score 1), and high-risk (33%, score 2-3) with 5-yr OS of 78% [95% CI 29-127], 46% [95% CI 24-68], and 25% [95% CI 20-30], respectively (P<0·001) and 5-yr PFS of 66% [95% CI 33-99], 37% [95% CI 9-65], and 17% [95% CI 9-25], respectively (P<0·001). The model demonstrated greater discriminatory power than established prognostic indices and an analogous distribution and outcomes in the three groups in the validation cohort of 103 patients. The SALENTO Model (Limited Stage Peripheral T Cell Lymphoma Prognostic Model) is an objective, simple and robust prognostic tool. The high-risk group has poor outcomes, comparable to advanced stage disease, and should be considered for innovative first-line approaches.