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The Peripheral T‐Cell Lymphomas

The Peripheral T‐Cell Lymphomas

American Cancer Society Research Professor

Professor of Medicine

Department of Medicine

Division of Hematology and Oncology

Program for T‐Cell Lymphoma Research

Department of Microbiology, Immunology, and Cancer Research

University of Virginia Cancer Center, Charlottesville, VA, USA

Won Seog Kim

Sungkyunkwan University School of Medicine Seoul, Korea

Pier Luigi Zinzani, M.D., Ph.D.

Professor of Hematology

Department of Medicine

Program for Lymphomas and Chronic Lymphocytic Leukemia

University of Bologna, Bologna Italy

This edition first published 2021 © 2021 John Wiley & Sons Ltd

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions.

The right of Owen A. O’Connor, Won Seog Kim, and Pier Luigi Zinzani to be identified as the authors of the editorial material in this work has been asserted in accordance with law.

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Library of Congress Cataloging‐in‐Publication Data

Names: O’Connor, Owen A., editor. | Kim, Won Seog, editor. | Zinzani, Luigi, editor.

Title: The peripheral T-cell lymphomas / edited by Owen A. O’Connor, Won Seog Kim, Pier Luigi Zinzani.

Description: Hoboken, NJ : Wiley-Blackwell, 2021. | Includes bibliographical references and index.

Identifiers: LCCN 2020028451 (print) | LCCN 2020028452 (ebook) | ISBN 9781119671312 (hardback) | ISBN 9781119671329 (adobe pdf) | ISBN 9781119671367 (epub)

Subjects: MESH: Lymphoma, T-Cell, Peripheral

Classification: LCC RC280.L9 (print) | LCC RC280.L9 (ebook) | NLM WH 525 | DDC 616.99/446–dc23

LC record available at https://lccn.loc.gov/2020028451

LC ebook record available at https://lccn.loc.gov/2020028452

Cover Design: NA

Cover Images: Excellent backgrounds/Shutterstock

Set in 9.5/12.5pt STIXTwoText by SPi Global, Pondicherry, India

Contents

Contributors xix

About the Companion Website xxiii

Part I Biological Basis of the Peripheral T-cell Lymphomas 1

1 The Fundamentals of T-cell Lymphocyte Biology 3

Claudio Tripodo and Stefano A. Pileri

Introduction  3­

General View of the Differentiation and Function of T Lymphocytes  3

The T-cell System as a Frame for Peripheral T-cell Lymphoma: Taking Plasticity into Account  5

Must Reads  7

References  7

2 Mechanisms of T-cell Lymphomagenesis 9

François Lemonnier, Philippe Gaulard and Laurence de Leval

Introduction  9

Oncogenic Events in the Transformation of T or Natural Killer Cells  9

Genetic Lesions  9

Deregulated Pathways in Peripheral T-cell Lymphoma Oncogenesis (Figure 2.1, Table 2.1)  10

Signaling Pathways  13

Cell-cycle Control  14

Immune Surveillance  14

Role of the Microenvironment in Peripheral T-cell Lymphoma  15

The Model of Angio-immunoblastic T-cell Lymphoma and T Follicular Helper-derived Peripheral T-cell Lymphoma  15

Specific Microenvironment Components Present in Other Primary Cutaneous T-cell Lymphoma Entities  16

Underlying Factors Favoring the Tumor Transformation  18

Viruses  18

Chronic Antigenic Stimulation  19

Other Factors  19

Cell of Origin (Table 2.1)  20

Conclusion  22

Must Reads  22

References  22

3 Epigenetics of T-cell Lymphoma 27

H. Miles Prince, Jasmine Zain, Anas Younes, Sean Whittaker, Owen A. O’Connor and Sean Harrop

Introduction  27

Epigenetic Pathways Altered in T-cell Lymphoma  27

Epigenetic Changes Within Specific T-cell Lymphoma Subtypes  31

Peripheral T-cell Lymphoma Not Otherwise Specified  32

Angioimmunoblastic T-cell Lymphoma and Peripheral T-cell Lymphoma with T Follicular Helper Phenotype  32

Anaplastic Large-cell Lymphoma  33

Adult T-cell Leukemia/Lymphoma  33

Intestinal T-cell Lymphoma  34

Hepatosplenic T-cell Lymphomas  34

Extranodal Natural Killer/T-cell Lymphoma  34

Mycosis Fungoides and Sézary Syndrome  35

Established and Emerging Drugs Targeting the T-cell Lymphoma Epigenome  35

DNA Methyltransferase Inhibitors  35

Isocitrate Dehydrogenase Inhibitors  36

EZH2 Inhibitors  37

BET Inhibitors  38

Protein Arginine Methyltransferases Inhibitors  38

Combination Therapies Involving Epigenetic Targeting Agents  38

Future Directions  38

Must Reads  39

References  39

4 Animal Models of T-cell Lymphoma 47

Keiichiro Hattori, Raksha Shrestha, Tatsuhiro Sakamoto, Manabu Kusakabe and Mamiko Sakata-Yanagimoto

Introduction  47

Angioimmunoblastic T-cell Lymphoma  50

The ROQUIN Mouse Model  50

The Mouse Models Recapitulating Human Angioimmunoblastic T-cell Lymphoma Genomic Features  50

Tet2 Gene Trap Mice  50

G17V RHOA Mouse Model  50

PDX Models of Angioimmunoblastic T-cell Lymphoma  51

Anaplastic Large T-cell Lymphoma  51

Viral and Chimeric Models  51

Transgenic Models  51

CRISPR-Based Models  52

PDX Models of Anaplastic Large-Cell Lymphomas  52

Human T-cell Lymphotropic Virus Type 1 Adult T-cell Leukemia/Lymphoma  52

Mice Expressing HTLV-1 Viral Proteins  52

PDX Models of Adult T-cell Leukemia/Lymphoma  52

Cutaneous T-cell Lymphoma  53

Enteropathy-associated T-cell Lymphoma  53

Conclusion  53

Must Reads  53

References  54

Part II Epidemiology and Classification of the PTCL 57

5 Geographic Distribution of the Peripheral T-cell Lymphomas 59

Global Epidemiology

Amulya Yellala, Avyakta Kallam and James O. Armitage

Historical Perspective  59

Epidemiology  60

Peripheral T-cell Lymphoma, Not Otherwise Specified  60

Angioimmunoblastic T-cell Lymphoma  61

Anaplastic Large-cell Lymphoma  61

Adult T-cell Lymphoma/Leukemia (HTLV Associated)  62

Extranodal NK/T-cell Lymphomas  62

T-cell Prolymphocytic Leukemia  62

Large Granular Lymphocytic Leukemia  62

Primary Cutaneous Gamma/Delta PTCL  63

Enteropathy Associated T-cell Lymphomas and Monomorphic Epitheliotropic Intestinal T-cell lymphoma  63

Hepatosplenic T-cell Lymphoma  63

The Cutaneous T-cell Lymphomas  63

Conclusion  63

Must Reads  64

References  64

6 Classification of the Peripheral T-cell Lymphomas 69

Neval Ozkaya and Elaine S. Jaffe

Introduction  69

Angioimmunoblastic T-cell Lymphoma and Other Nodal Lymphomas of T follicular Helper Cell Origin  69

Angioimmunoblastic T-cell Lymphoma  70

Follicular T-cell Lymphoma  71

Nodal Peripheral T-cell Lymphoma with T-follicular Helper Phenotype  71

Peripheral T-cell Lymphoma Not Otherwise Specified  71

Anaplastic Large-cell Lymphomas  72

Anaplastic Large-cell Lymphoma, ALK-Positive  72

Anaplastic Large-cell Lymphoma, ALK-Negative  72

Breast Implant-associated Anaplastic Large-cell Lymphoma (Provisional)  73

Adult T-cell Leukemia/Lymphoma  74

Intestinal T-cell Lymphomas  74

Enteropathy-associated T-Cell Lymphoma  75

Monomorphic Epitheliotropic Intestinal T-cell Lymphoma  76

Intestinal T-cell ymphoma, Not Otherwise Specified  76

Indolent T-cell Lymphoproliferative Disorder of the Gastrointestinal Tract (Provisional)  77

NK-Cell Enteropathy  78

Hepatosplenic T-cell Lymphoma  78

Mycosis Fungoides  78

Sézary Syndrome  79

Primary Cutaneous CD30-positive T-cell Lymphoproliferative Disorders  79

Lymphomatoid Papulosis  79

Primary Cutaneous Anaplastic Large-cell Lymphoma  80

Subcutaneous Panniculitis-like T-cell Lymphoma  80

Primary Cutaneous Gamma–Delta T-cell Lymphoma  80

Primary Cutaneous CD8+ Aggressive Epidermotropic Cytotoxic T-cell Lymphoma (Provisional)  81

Primary Cutaneous CD4+ Small/Medium T-Cell Lymphoproliferative Disorder (Provisional)  81

Primary Cutaneous Acral CD8+ T-cell Lymphoma (Provisional)  82

Large Granular Lymphocytic Leukemia  82

T-cell Large Granular Lymphocytic Leukemia  82

Chronic Lymphoproliferative Disorder of NK Cells (Provisional)  82

T-cell Prolymphocytic Leukemia  82

NK-cell Lymphomas  83

Extranodal NK/T-cell Lymphoma, Nasal Type  83

Aggressive NK-cell Leukemia  83

EBV-positive T-cell and NK-cell Lymphoproliferative Diseases of Childhood  83

Must Reads  84

References  84

7 Molecular Classification of the Peripheral T-cell Lymphomas 91

Tyler A. Herek and Javeed Iqbal

Introduction  91

T-cell Development and Activation: An Overview  92

T-cell Receptor Signaling  92

Derivation of Diagnostic Signatures for Molecular Classification of Peripheral T-cell Lymphomas  95

Angioimmunoblastic T-cell Lymphoma and Other T Follicular Helper-derived Malignancies  95

Recurrent Genetic Features  96

Anaplastic Large-cell Lymphomas  96

Recurrent Genetic Features  96

Adult T-cell Leukemia/Lymphoma  97

Recurrent Genetic Features  97

Peripheral T-cell Lymphoma Not Otherwise Specified  97

Recurrent Genetic Features in Two Novel Subgroups  98

Hepatosplenic T-cell Lymphoma  98

Recurrent Genetic Features  98

Extranodal natural killer/T-cell Lymphoma  98

Recurrent Genetic Features  99

Cutaneous T-cell Lymphomas  99

Conclusion  99

Must Reads  99

References  99

Part III Discrete Clinical Subtypes of PTCL (Unique Epidemiology, Therapy and Management) 105

8 Peripheral T-cell Lymphoma Not Otherwise Specified 107

N. Nora Bennani and Stephen M. Ansell

Introduction  107

Epidemiology, Risk Factors, and Clinical Characteristics  107

Basic Principles of Disease Biology  108

Prognostic Tools  109

Frontline Therapy  110

Management of Relapsed or Refractory Disease  111

Future Directions  112

Must Reads  112

References  112

9 Angioimmunoblastic T-cell Lymphoma 115

Jehan Dupuis and Franck Morschhauser

Introduction  115

Clinical and Biological Presentation  115

Epidemiology and Risk Factors, Disease Incidence and Prevalence  117

Basic Principles of Disease Biology  118

TET2 Mutations  119

IDH2 Mutations  120

DNMT3A Mutations  120

Rho A Mutations  121

CD28 Alterations  121

Other Mutations Affecting the T-cell Lymphoma Pathway  121

Management of Disease in the Front Line  122

Management of Relapsed or Refractory Disease  122

Conventional Chemotherapy Agents  123

Bendamustine  123

Pralatrexate  123

Romidepsin  124

Belinostat  124

Newer Targeted Therapy Approaches  125

Future Directions  125

Must Reads  126

References  126

10 The Spectrum of Anaplastic Large-cell Lymphoma 129

Jianping Kong and Andrew L. Feldman

Introduction 129

Epidemiology and Risk Factors  129

Disease Incidence and Prevalence  131

Basic Principles of Disease Biology  133

Management of Disease in the Front Line  134

Management of the Relapsed or Refractory Patient  137

Future Directions  138

Acknowledgement  140

Must Reads  140

References  140

11 Human T-cell Lymphotropic Virus Type 1 Positive Adult T-cell Leukemia/Lymphoma 145

Wataru Munakata and Kensei Tobinai

Epidemiology and Disease Incidence  145

Basic Principles of Disease Biology  145

CCR4 and Adult T-cell Leukemia/Lymphoma  146

Clinical Features of Adult T-cell Leukemia/Lymphoma  146

Prognosis and Prognostic Index of ATLL  147

Front-line Management of Aggressive Adult T-cell Leukemia/Lymphoma  149

Chemotherapy and Hematopoietic Stem-cell Transplantation  149

Mogamulizumab with Dose-intensified Chemotherapy  150

Interferon alpha and Antiretroviral Agents  151

Chemotherapy in Transplant-ineligible Patients with Aggressive Adult T-cell Leukemia/Lymphoma  151

Front-line Management of Indolent ATLL  152

Management of Relapsed or Refractory Patients  152

Mogamulizumab Monotherapy  152

Lenalidomide Monotherapy  153

Other Treatments for Relapsed or Refractory Adult T-cell Leukemia/Lymphoma  153

Future Directions  154

Must Reads  154

References  154

12 Natural Killer/T-cell Lymphomas 159

Seok Jin Kim, Ritsuro Suzuki, Arnaud Jaccard, Soon Thye Lim and Wong Seog Kim

Introduction  159

Epidemiology and Risk Factors  161

Disease Incidence and Prevalence  161

Basic Principles of Disease Biology  161

Genetic Susceptibility to NK/T-Cell Lymphoma  161

Molecular Pathogenesis  162

JAK–STAT and Associated Pathways  162

Nuclear Factor Kappa B and Other Deregulated Pathways  163

The Programmed Cell Death 1/Programmed Death Ligand 1 Pathway  163

Management of Newly Diagnosed Treatment-naïve Patients  163

Diagnosis and Initial Assessment  164

Monitoring the Response  165

Treatment Strategies  165

Localized Disease  165

Disseminated Disease  167

Consolidation Treatment with Hematopoietic Stem-cell Transplantation  167

Management of Relapsed or Refractory Disease  167

Treatment of Localized Nasal Relapse  167

Treatment of a Systemic Relapse  167

Novel Agents for Relapsed or Refractory ENKTL  168

Future Directions  168 Must Reads  168

References  169

13 T-Prolymphocytic Leukemia 175

Dima El-Sharkawi and Claire Dearden

Introduction  175

Incidence  175

Clinical Features  175

Laboratory Findings  175

Treatment  176

Stem-cell Transplantation  178

Treatment for Relapsed/Refractory Disease  178

Future Directions  178 Must Reads  179

References  179

14 Large Granular Lymphocyte Leukemia 183

Karolina H. Dziewulska, Katharine B. Moosic, HeeJin Cheon, Kristine C. Olson, David J. Feith and Thomas P. Loughran, Jr

Introduction  183

Epidemiology and Risk Factors  183

Prevalence of Concomitant Disorders  184

Autoimmune Diseases  184

Hematological Disorders  184

Basic Principles of Disease Biology  185

Biology  185

STAT3 Dysregulation  185

STAT3 and Common Cytopenias  186

JAK–STAT Pathway  187

Other Mutated and Dysregulated Pathways  187

Chronic Activation and Large Granular Lymphocyte Clonal Malignancy  188

STAT3 and Clonality  188

Antigenic Stimulation  188

Immune System Dysregulation  189

Cytotoxic Killer Cells and Autoimmunity  189

Humoral Abnormalities  189

Abnormal Bone Marrow  190

Neutropenia and Rheumatoid Arthritis  190

Spleen Pathology  191

Management of Disease in the Front Line  191

Diagnosis  191

Prognosis  191

Current Treatments  192

Indications for Treatment  192

Evaluation of Treatment Response  192

Therapeutic Approach  192

Canonical Immunosuppressive Treatments  192

Non-canonical Immunosuppressive Treatments  193

Supportive Therapy  194

Summary of Therapeutic Recommendations  194

Management of Relapsed or Refractory Disease  194

Future Directions  194

JAK–STAT Pathway Targeting  194

Natural Compounds  196

Other Candidate Agents  196

Funding  196

Disclosures  197

Must Reads  197

References  197

15 Gamma–Delta T-cell Lymphomas 203

Francine Foss, Aadil Ahmed and Mina Xu

Introduction  203

Epidemiology and Risk Factors  203

Biology of Primary Cutaneous Gamma–Delta T-cell Lymphoma  204

Management of Disease in the Front Line  206

Management of Relapsed/Refractory Disease  208

Must Reads  209

References  209

16 Enteropathy-Associated and Monomorphic

Epitheliotropic Intestinal T-cell Lymphomas 211

Craig R. Soderquist, Jennifer Shingleton, Sandeep Dave and Govind Bhagat

Introduction  211

Enteropathy-associated T-cell Lymphoma  211

Epidemiology and Risk Factors  211

Disease Incidence and Prevalence  212

Basic Principles of Disease Biology  212

Morphology and Immunophenotype  212

Molecular and Genetic Alterations  212

Management of Patients in the Front Line  213

Management of the Relapsed or Refractory Patient  214

Future Directions  214

Refractory Celiac Disease  214

Disease Definition, Risk Factors, Incidence, and Prevalence  214

Basic Principles of Disease Biology  214

Morphology and Immunophenotype  214

Molecular and Genetic Alterations  215

Management of Patients in the Front-Line  216

Management of the Relapsed or Refractory Patient  216

Future Directions  216

Monomorphic Epitheliotropic Intestinal T-Cell Lymphoma  216

Disease Risk Factors, Incidence, and Prevalence  216

Basic Principles of Disease Biology  216

Morphology and Immunophenotype  216

Molecular and Genetic Alterations  218

Management of Disease in the Front Line  218

Management of Relapsed or Refractory Disease  218

Future Directions  218

Must Reads  218

References  219

17 Hepatosplenic T-cell Lymphomas 225

Robert N. Stuver, Mwanasha Merrill and Salvia Jain

Epidemiology and Disease Incidence  225

Basic Principles of Disease Biology  227

Clinical Features  227

Management of Disease in the Front Line  228

Management of the Relapsed or Refractory Disease  229

Splenectomy  230

Future Directions  230

Funding  231

Must Reads  231

References  231

18 Cutaneous T-cell Lymphoma 235

Alejandro A. Gru, Bethanie Rooke, Kevin Molloy and Julia Scarisbrick

Introduction  235

Epidemiology and Risk Factors  236

Basic Principles of Disease Biology  237

Clinical, Pathologic, and Immunophenotypic Findings  240

Management of Front-Line Mycosis Fungoides/Sézary Syndrome  247

Early-stage Disease (Stages IA–IIA)  248

Late-stage Disease (Stage IIB–IVA2)  250

Stage IIB (Tumor-stage Disease)  250

Stage III–IVA1 Disease (Erythrodermic Disease and Sézary)  250

Stage IVA2–IVB Disease  250

Management of Relapsed or Refractory Disease with Mycosis Fungoides/Sézary Syndrome  250

Early-stage Disease (Stage IA–IIA)  250

Late-stage Disease (IIB–IVA2)  251

Stage IIB (Tumor-stage Disease)  251

Stage III–IVA1 (Erythrodermic Disease)  251

Stage IVA2–IVB Disease  252

Front-Line Management of Non-mycosis Fungoides Cutaneous T-cell Lymphomas  252

Management of Relapsed or Refractory Non-mycosis Fungoides Cutaneous T-cell Lymphomas  252

Future Directions  252

Must Reads  253

References  253

19 Other Rare Subtypes of Peripheral T-cell Lymphoma 259

Pier Paolo Piccaluga

Introduction  259

Chronic Lymphoproliferative Disorders of Natural Killer Cells  259

Epidemiology and Risk Factors  259

Disease Incidence and Prevalence  259

Basic Principles of Disease Biology  260

Management of Front-line Disease  260

Epstein–Barr Virus-associated T-cell and NK-cell Lymphoproliferative Disorders of Childhood  260

Systemic Epstein–Barr Virus-positive T-cell Lymphoma of Childhood  260

Epidemiology and Risk Factors  260

Basic Principles of Disease Biology  260

Management of Front-Line Disease  261

Chronic Active Epstein–Barr Virus Infection of T- and NK-cell Type, Systemic Form  261

Epidemiology and Risk Factors  261

Basic Principles of Disease Biology  261

Management of Front-Line Disease  262

Chronic Active Epstein–Barr Virus Infection of T- and NK-cell Type, Cutaneous Form  264

Hydroa Vacciniforme-like Lymphoproliferative Disorder  264

Basic Principles of Disease Biology  264

Management of Disease in the Front Line  264

Severe Mosquito Bite Allergy  265

Epidemiology and Risk Factors  265

Basic Principles of Disease Biology  265

Management of Disease in the Front-Line  265

Future Directions  265

Must Reads  265

References  266

Part

IV Treatment of the PTCL 269

20 Standard Front-line Therapies 271

Raphael Koch and Lorenz Truempe

Introduction  271

Initial Workup and Risk Stratification  271

Front-line Therapy  274

Front-line Treatment Approaches for Common Subtypes  274

Systemic Anaplastic Large-cell Lymphomas  276

Breast Implant-associated Anaplastic Large-cell Lymphomas  277

Enteropathy-associated T-cell Lymphoma and Monomorphic Epitheliotropic Intestinal T-cell Lymphoma  277

Hepatosplenic T-cell Lymphoma  278

Extranodal natural killer/T-cell Lymphoma, Nasal Type  279

T-cell Prolymphocytic Leukemia  280

Adult T-Cell Leukemia/Lymphoma  280

Must Reads  281

References  281

21 Approved Agents in the Relapsed or Refractory Setting, Excluding Brentuximab Vedotin 287

Helen Ma and Owen A. O’Connor

Introduction  287­

Challenges in Developing New Drugs in Peripheral T-cell Lymphomas  288

Drugs Approved by the US Food and Drug Administration with an Indication in Relapsed/Refractory Peripheral T-cell Lymphoma  288

Pralatrexate  289

Pharmacology  289

Early-phase Data  289

Pivotal Data  289

Recent Developments  291

Histone Deacetylase Inhibitors (Including Romidepsin and Belinostat)  291

Pharmacology  291

Early Phase Data  292

Pivotal Data  292

Recent Developments  293

Drugs Approved by the US Food and Drug Administration But Without An Indication in Relapsed/Refractory

Peripheral T-cell Lymphoma  294

Etoposide  294

Pharmacology  294

Clinical Experiences in Peripheral T-cell Lymphoma  294

Summary  294

Bortezomib  294

Pharmacology  294

Clinical Experiences in Peripheral T-cell Lymphoma  296

Recent Developments  296

Bendamustine  296

Pharmacology  296

Clinical Experience in Peripheral T-cell Lymphoma  296

Recent Developments  296

Gemcitabine  296

Pharmacology  296

Clinical Data  297

Recent Developments  297

Drugs Approved by International Regulatory Agencies, Not Including the United States, that Carry an Indication in Relapsed/Refractory Peripheral T-cell Lymphoma  297

Chidamide  297

Pharmacology  297

Early Phase Data  297

Pivotal Data  297

Recent Developments  297

Forodesine  297

Pharmacology  297

Early Phase Data  297

Pivotal Data  298

Recent Developments  298

Considerations in the Selection of Therapy  298

Treatment Goals  298

Aggressive Versus Indolent Disease  299

Transplant Eligible or Ineligible  299

Suitability for Chemotherapy  299

Conclusion  299

Must Reads  299

References  300

22 The Role of Autologous Stem-cell Transplantation in Peripheral T-cell Lymphomas 305

Juan Alejandro Ospina-Idárraga, Rolando Humberto Martinez-Cordero, Leonardo José Enciso-Olivera and Henry Idrobo-Quintero

Introduction  305

Autologous Stem-cell Transplantation in First Complete Remission  306

Autologous Stem-cell Transplantation in Relapsed/Refractory Disease  307

Interpretation of Available Literature  307

Identifying the Most Relevant Determinants for Survival among Patients with Peripheral T-cell Lymphoma Undergoing Autologous Stem-cell Transplantation  308

Status of Response Prior to Autologous Stem-cell Transplantation  309

Risk of Stage  310

Number of Prior Therapies and Refractory Disease  311

Autologous Stem-cell Transplantation on Specific Subtypes of Peripheral T-cell Lymphoma  311

Peripheral T-cell Lymphomas Not Otherwise Specified  311

Angioimmunoblastic T Cell Lymphoma  312

Anaplastic T Large-cell Lymphoma  312

Extranodal Natural Killer/T-cell Lymphoma, Nasal Type  313

The Role of Autologous Stem-cell Transplantation in Cutaneous T-cell Lymphomas  314

Must Reads  314

References  315

23 Allogeneic Stem-cell Transplantation 319

Anna Dodero and Paolo Corradini

Introduction  319

Allogeneic Stem-cell Transplantation for Relapsed and Refractory Disease (Focus on Nodal Hystotypes)  320

Allogeneic Stem-cell Transplantation as Consolidation of First Remission  322

Allogeneic Stem-cell Transplantation in Specific Subtypes  322

Cutaneous T-cell Lymphomas  322

Hepatosplenic T-cell Lymphomas  324

Extranodal Natural Killer/T-cell Lymphomas, Nasal Type  324

Adult T-cell Leukemia/Lymphoma  324

Future Directions  325

Must Reads  325

References  325

24 Emerging Immunotherapy Approaches in Peripheral T-cell Lymphomas 329

Barbara Pro and Andrei Shustov

Introduction  329

Monoclonal Antibody Therapy  329

Alemtuzumab  330

Mogamulizumab  330

Immunoconjugate-Based Therapy for Peripheral T-Cell Lymphoma  331

Brentuximab Vedotin  332

Cell-Mediated or Cellular Immunotherapy in Peripheral T-Cell Lymphoma  333

PD1–PD-L1 Checkpoint Inhibition  334

AFM13 – Targeted Natural Killer Cell Immunotherapy Facilitator  335

TTI-621 – Targeted Macrophage Immunotherapy Facilitator  335

4-1BB – Enabled Adoptive Therapy of Epstein–Barr Virus-Positive Malignancies  335

IPH4102 (Anti-KIR3DL2 Monoclonal Antibody)  336

Chimeric Antigen Receptor T-cell Therapy for Peripheral T-cell Lymphoma  336

Challenges and Future Directions  336

Must Reads  337

References  338

25 Emerging New Small Molecules in Peripheral T-cell Lymphomas 343

Alessandro Broccoli and Pier Luigi Zinzani

Introduction  343

Demethylating Agents  344

Janus-associated Kinase–Signal Transducers and Activators of Transcription and Spleen Tyrosine Kinase Inhibitors  345

Phosphatidylinositol 3-Kinase Inhibitors  345

Miscellaneous  347

Pro-apoptotic Small Molecules  347

Farnesyltransferase Inhibitors  347

Aurora Kinase Inhibitors  347

Conclusion  348

Must Reads  348

References  348

Part V Future Directions 351

26 The Value and Relevance of T-cell Lymphoma Registries 353

Tetiana Skrypets, Martina Manni, Monica Civallero, Iryna Kriachok and Massimo Federico

Introduction  353

Population-based Cancer Registries  353

Retrospective Studies  355

T-cell Lymphoma Registries  360

T-cell Project 1.0  360

COMPLETE  363

T-cell Project 2.0  363

Future Directions  364

Disclosures  364

Must Reads  364

References  365

27 Innovative Chemotherapy-free Approaches for the Treatment of Peripheral T-Cell Lymphoma 367

Enrica Marchi, Ahmed Sawas, Helen Ma, Luigi Scotto and Francesca Montanari

Introduction  367

Targeting the Peripheral T-cell Lymphoma Epigenome  369

Romidepsin Plus Pralatrexate  370

Preclinical Rationale  370

Clinical Experience  370

Romidepsin Plus 5-Azacytidine  371

Preclinical Rationale  371

Clinical Experience  371

Romidepsin Plus Duvelisib  372

Preclinical Rationale  372

Clinical Experience  372

Romidepsin Plus Lenalidomide  373

Preclinical Rationale  373

Clinical Experience  373

Panobinostat and Bortezomib  373

Preclinical Rationale  373

Clinical Experience  374

A Glance at the Future: Building on the Active Doublets  374

Must Reads  375

References  375

28 Global Collaborations 379

Dejan Radjeski, Eliza Hawke, Owen A. O’Connor, Pier Luigi Zinzani, Won Seog Kim and Enrica Marchi

Introduction  379

The Global T-cell Lymphoma Consortium  380

The Mission  380

Structure  380

Organizational Features  380

Submission of Trial Concepts  381

Budget Negotiations  382

Institutional Review Board  383

Publications  383

Conclusion  384

Index 385

Contributors

Aadil Ahmed

Department of Hematology, Yale University School of Medicine, New Haven, CT, USA

Stephen M. Ansell

Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA

James O. Armitage

Division of Oncology-Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA

N. Nora Bennani

Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA

Govind Bhagat

Division of Hematopathology, Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA

Alessandro Broccoli

IRCCS Azienda Ospedaliero-Universitaria di Bologna

Istituto di Ematologia “Seràgnoli”, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università degli Studi, Bologna, Italia

HeeJin Cheon

Department of Medicine & Biochemistry and Molecular Genetics, Division of Hematology and Oncology, University of Virginia Cancer Center, Charlottesville, VA, USA

Monica Civallero

Department of Surgical, Medical and Dental Sciences

Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Reggio Emilia, Italy

Paolo Corradini

Fondazione IRCCS istituto Nazionale dei Tumori, Milano, Italy; and University of Milano, Italy

Sandeep Dave

Duke Cancer Institute, Center for Genomic and Computational Biology, Duke University, Durham, NC, USA

Laurence de Leval

Institut de Pathologie, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Lausanne, Switzerland

Claire Dearden

Department of Haematology, The Royal Marsden NHS Foundation Trust, Sutton, UK

Anna Dodero

Fondazione IRCCS istituto Nazionale dei Tumori, Milano, Italy; and University of Milano, Italy

Jehan Dupuis

Lymphoid Malignancies Unit, Henri Mondor University Hospital, Créteil, France

Karolina H. Dziewulska

Department of Medicine and Department of Pathology, Division of Hematology and Oncology, University of Virginia Cancer Center, Charlottesville, VA, USA

Dima El-Sharkawi

Department of Haematology, The Royal Marsden NHS Foundation Trust, Sutton, UK

Leonardo José Enciso-Olivera

Programa de Investigación e Innovación en Leucemias Agudas y Crónicas (PILAC) Instituto Nacional de Cancerología, Bogotá, Colombia

Massimo Federico

Department of Surgical, Medical and Dental Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Reggio Emilia, Italy

David J. Feith

Department of Medicine, Division of Hematology and Oncology, University of Virginia Cancer Center, Charlottesville, VA, USA

Andrew L. Feldman

Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA

Francine Foss

Department of Hematology, Yale University School of Medicine, New Haven, CT, USA

Philippe Gaulard

Assistance Publique des Hôpitaux de Paris, Paris, France; Institut Mondor de Recherche Biomédicale, INSERMU955, Université Paris Est Créteil, Créteil, France; and Département de Pathologie, Hôpitaux Universitaires Henri Mondor, Créteil, France

Alejandro A. Gru

Department of Pathology and Dermatology, University of Virginia, Charlottesville, VA, USA

Sean Harrop

Epworth Healthcare and Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

Keiichiro Hattori

Department of Hematology, Faculty of Medicine, University of Tsukuba Hospital, Tsukuba, Japan

Eliza Hawke

Department of Oncology and Clinical Haematology, Austin Health, Heidelberg, Victoria, Australia

Tyler A. Herek

Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA

Henry Idrobo-Quintero

Grupo Latinoamericano de estudio de Linfoproliferativos (GELL) Hospital Universitario del Valle, Grupo Ospedale, Universidad del Valle, Universidad Libre, Cali, Colombia.

Javeed Iqbal

Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA

Arnaud Jaccard

Service d’Hématologie et de Thérapie Cellulaire, Hôpital Dupuytren, CHU de Limoges, Limoges, France

Elaine S. Jaffe

Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, NCI, Bethesda, MD, USA

Salvia Jain

Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA, and Harvard Medical School, Boston, MA, USA

Avyakta Kallam

Division of Oncology-Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA

Seok Jin Kim

Division of Hematology and Oncology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea

Won Seog Kim

Division of Hematology and Oncology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea

Raphael Koch

Department of Hematology and Medical Oncology, University Medical Center Goettingen, Goettingen, Germany

Jianping Kong

Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA

Iryna Kriachok

Oncohematology Department, National Cancer Institute, Kyiv, Ukraine

Manabu Kusakabe

Department of Hematology, Faculty of Medicine, University of Tsukuba Hospital, Tsukuba, Japan, and Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan

François Lemonnier

Unité hémopathies Lymphoïdes, Hôpitaux Universitaires Henri Mondor, Créteil, France; Assistance Publique des Hôpitaux de Paris, Paris, France; and Institut Mondor de Recherche Biomédicale, INSERMU955, Université Paris Est Créteil, Créteil, France

Soon Thye Lim

Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore

Thomas P. Loughran, Jr

Department of Medicine, Division of Hematology and Oncology, University of Virginia Cancer Center, Charlottesville, VA, USA

Helen Ma

Department of Medicine, Division of Hematology and Oncology, Center for Lymphoid Malignancies, Columbia University Medical Center, New York, NY, USA

Martina Manni

Department of Surgical, Medical and Dental Sciences

Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Reggio Emilia, Italy

Enrica Marchi

University of Virginia Cancer Center, Charlottesville, VA, USA

Rolando Humberto Martinez-Cordero

Instituto Nacional de Cancerología, Universidad El Bosque, Bogotá, Colombia

Mwanasha Merrill

Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA

Kevin Molloy

Department of Dermatology, University Hospital, Birmingham, UK

Francesca Montanari

Center for Lymphoid Malignancies, Columbia University Medical Center, New York, NY, USA

Katharine B. Moosic

Department of Medicine and Department of Pathology, Division of Hematology and Oncology, University of Virginia Cancer Center, Charlottesville, VA, USA

Franck Morschhauser

Department of Hematology, Lille University Hospital, Lille, France

Wataru Munakata

Department of Hematology, National Cancer Center Hospital, Tokyo, Japan

Owen A. O’Connor

Department of Medicine, Division of Hematology and Oncology, University of Virginia Cancer Center, Charlottesville, VA, USA, and Program for T-Cell Lymphoma Research, Department of Microbiology, Immunology and Cancer Research University of Virginia Cancer Center, Charlottesville, VA, USA

Kristine C. Olson

Department of Medicine, Division of Hematology and Oncology, University of Virginia Cancer Center, Charlottesville, VA, USA

Juan Alejandro Ospina-Idárraga

Los Cobos Medical Center, Instituto Nacional de Cancerología, Universidad El Bosque, Bogotá, Colombia

Neval Ozkaya

Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, NCI, Bethesda, MD, USA

Pier Paolo Piccaluga

Department of Experimental, Diagnostic, and Specialty Medicine, Bologna University School of Medicine, Bologna, Italy

Stefano A. Pileri

Hematopathology Division, European Institute of Oncology, IRCCS, Milan, Italy

H. Miles Prince

Epworth Healthcare and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia

Barbara Pro

Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA, and Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA

Dejan Radjeski

Sir Charles Gardner Hospital, Perth, Western Australia, Australia

Bethanie Rooke

Department of Dermatology, University Hospital, Birmingham, UK

Tatsuhiro Sakamoto

Department of Hematology, Faculty of Medicine, University of Tsukuba Hospital, Tsukuba, Japan, and Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan

Mamiko Sakata-Yanagimoto

Department of Hematology, Faculty of Medicine, University of Tsukuba Hospital, Tsukuba, Japan, and Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan

Ahmed Sawas

Center for Lymphoid Malignancies, Columbia University Medical Center, New York, NY, USA

Julia Scarisbrick

Department of Dermatology, University Hospital, Birmingham, UK

Luigi Scotto

Center for Lymphoid Malignancies, Columbia University Medical Center, New York, NY, USA

Jennifer Shingleton

Duke Cancer Institute, Center for Genomic and Computational Biology, Duke University, Durham, NC, USA

Raksha Shrestha

Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan

Andrei Shustov

Division of Hematology, Department of Medicine, University of Washington, Seattle, WA, USA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; and Seattle Cancer Care Alliance, Seattle, WA, USA

Tetiana Skrypets

Department of Surgical, Medical and Dental Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Reggio Emilia, Italy

Craig R. Soderquist

Division of Hematopathology, Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA

Robert N. Stuver

Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA

Ritsuro Suzuki

Department of Oncology and Hematology, Shimane University Hospital, Izumo, Japan

Kensei Tobinai

Department of Hematology, National Cancer Center Hospital, Tokyo, Japan

Claudio Tripodo

Tumor Immunology Unit, Department of Health Sciences, University of Palermo, Palermo, Italy, and Histopathology Unit, FIRC Institute of Molecular Oncology, Milan, Italy

Lorenz Truempe

Department of Hematology and Medical Oncology, University Medical Center Goettingen, Goettingen, Germany

Sean Whittaker

Guy’s and St Thomas’ National Health Service Foundation Trust, London, UK

Mina Xu

Department Pathology, Yale University School of Medicine, New Haven, CT, USA

Amulya Yellala

Division of Oncology-Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA

Anas Younes

Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

Jasmine Zain

Department of Hematology/Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA

Pier Luigi Zinzani

IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia “Seràgnoli”, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università degli Studi, Bologna, Italia

About the Companion Website

Don’t forget to visit the companion web site for this book:

www.wiley.com/go/OConnor/Peripheral_T-cell_Lymphomas

There you will find valuable materials, including:

● Figures and Tables from within the book

Scan this QR code to visit the companion website:

Part I

Biological Basis of the Peripheral T-cell Lymphomas

The Fundamentals of T-cell Lymphocyte Biology

1 Tumor Immunology Unit, Department of Health Sciences, University of Palermo, Palermo, Italy

2 Histopathology Unit, FIRC Institute of Molecular Oncology, Milan, Italy

3 Hematopathology Division, European Institute of Oncology, IRCCS, Milan, Italy

TAKE HOME MESSAGES

● The natural diversity of T cells in normal immune system functions contributes – in part – to the diversity of T-cell malignancies.

● CD4-positive T lymphocytes, also called T helper (Th) cells, are divided into a diverse repertoire of T lymphocytes (e.g. Th1, Th2, and Th17), in part defined by the cytokine profile they elaborate.

Introduction

The T-cell system is conventionally regarded as an enabler of diverse compartments, which correspond to different steps of differentiation and functional subsets of mature cells taking part in the immune response in the peripheral lymphoid and non-lymphoid tissues.

In this chapter, we give a overview of the T-cell system, more functionally than anatomically oriented, to reflect its extreme plasticity. This plasticity is thought to lie at the heart of the diversity of T-cell malignancies now recognized by the World Health Organization.

General View of the Differentiation and Function

of T Lymphocytes

The immune system can be classified into two basic component: (i) the innate immune system, and (ii) the acquired immune system. The innate immune system is considered to be relatively agnostic to any specific antigen, and is often described as invariant. The innate immune response is the first line of defense, and typically exhibits limited specificity. Examples of innate immune response may include

● Th1 and Th2 lymphocytes can also be classified based on the expression of the transcription factors T-bet and GATA3. These factors can be prognostic in peripheral T-cell non-Hodgkin lymphomas derived from these cells (with GATA3 being associated with a poor prognosis).

phagocytosis by macrophages, barriers to infection provided by the skin and tears, natural killer and mast cells, and complement-mediated cytolysis. In contrast, the adaptive (or sometimes called acquired) immune response develops in response to specific antigen, being “custom” designed for the antigen in question. It usually occurs later in the immune response, and has the ability to recall the response to past infections. Components of a functioning acquired immune response might involve antigen-presenting cells presenting antigen or T cells, the activation of specific T cells which would signal to B cells enlisting their engagement in the response and the production of highly specific antibody capable of binding specific antigen. T and B lymphocytes are the major types of lymphocytes found in the human body, where they can constitute 20–40% of all white blood cells, with only about 2–3% being found in the peripheral circulation, the remainder being localized to various lymphoid organs (lymph nodes, spleen, submucosal tissue). Remarkably, the total mass of lymphocytes in the body can approximate the mass of the brain and liver.

As shown in Figure 1.1 [1], T lymphocytes arise from a bone marrow precursor, which undergoes maturation and

The Peripheral T-Cell Lymphomas, First Edition. Edited by Owen A. O’Connor, Won Seog Kim and Pier Luigi Zinzani. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. Companion website: www.wiley.com/go/OConnor/Peripheral_T-cell_Lymphomas

functional orientation in the thymus. Antigen-specific T cells mature in the thymic cortex, where the elements recognizing self-peptides and major histocompatibility antigens expressed by cortical epithelial cells and thymic nurse cells are eliminated via apoptosis. Failure to eliminate those T cells recognizing self-peptides is thought to give rise to a host of autoimmune disorders.

Cortical thymocytes exhibit an immature T-cell phenotype and express a characteristic repertoire of proteins including TdT, CD1a, CD3, CD5, and CD7. CD3 is expressed in the cytoplasm until completion of T-cell receptor (TCR) gene rearrangement and is then exported to the cell membrane. Cortical thymocytes are initially CD4/CD8 double negative.

Medullary thymocytes exhibit a phenotype similar to that of mature T cells of the peripheral lymphoid organs with segregation of CD4 and CD8 antigens. Based on the structure of the variable portion of the TCR, T cells have been divided into two classes, including alpha/beta and gamma/delta T cells. They are both associated with the CD3 complex, which contains gamma, delta, and epsilon chains. Gamma and delta T cells usually lack expression of CD4, CD8, and CD5, although a subpopulation can expresses CD8. They represent less than 5% of normal T lymphocytes and are primarily located in the splenic red pulp, intestinal epithelium, and other epithelial sites. They also have a restricted range of antigen recognition and take part in the innate immune reaction, serving as a first line of defense against bacterial peptides. They are often involved in responses to mycobacterial infections and in mucosal

immunity. T lymphocytes of the adaptive immune system, which are heterogeneous and functionally complex, include naïve, effector (regulatory and cytotoxic), and memory T cells.

CD4+ T cells are primarily regulatory in nature. Based on their cytokine secretion profiles, they are divided into two major types: T helper (Th) 1 cells and Th2 cells. Th1 cells secrete interleukin (IL) 2 and interferon gamma, while Th2 cells secrete IL4, IL5, IL6, and IL10. Th1 cells provide help mainly to other T cells and macrophages, whereas Th2 cells provide help mainly to B cells in antibody production. CD4+ T cells can both help and suppress immune responses and consist of multiple subpopulations. Recent studies have shown overexpression of the transcription factors TBX21 (also known as T-bet) and GATA3 in Th1 and Th2 lymphocytes, respectively.

T regulatory (Treg) cells suppress immune responses to cancer and limit inflammatory responses in tissues. These CD4-positive cells, which are thought to play an important role in preventing autoimmunity, express a high density CD25 and the transcription factor FOXP3. Th17 lymphocytes correspond to a subset of CD4+ effector T cells, characterized by expression of the IL17 family of cytokines, and play a role in immune-mediated inflammatory diseases and other conditions. Recently, there has been a rapidly evolving literature around a unique CD4+ T-cell subset that takes part in the natural functions of normal germinal centers. These cells, called T follicular helper (Tfh) cells, support B cells in the context of the germinal center reaction. They reveal a distinctive phenotype with expression

Cortical thymocyte
Medullary
Figure 1.1 Schematic overview of T-cell ontogeny and differentiative trajectories. Source: Claudio Tripodo, Stefano Pilleri.

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