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Vol. 46. Núm. S4.
HEMO 2024
Páginas S256-S258 (outubro 2024)
Vol. 46. Núm. S4.
HEMO 2024
Páginas S256-S258 (outubro 2024)
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THE NUMBER OF EXTRANODAL SITES IN NODAL PTCL: A PROPOSAL FOR A FEASIBLE PROGNOSTIC MARKER FOR OUTCOMES IN LOW-INCOME COUNTRIES. A COLLABORATIVE STUDY GRUPO DE ESTUDIO LATINO-AMERICANO DE LINFOPROLIFERATIVO (GELL) & T-CELL BRAZIL PROJECT (TCBP)
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T Fischera, E Mirandab, J Pereirac, G Dufflesb, JV Tavaresd, NS Castroe, RSA Silvaf, DLC Fariasg, SAB Brasilh, CCG Macedoi, C Colaçoi, RLR Baptistaj, KZ Cecynk, D Bortucchil, GFS Barrosm, S Nabhann, PPG Radtkeo, R Schaffelp, N Zingq, FL Nogueirar..., AD Cunha-Juniors, DV Clét, JTDS Filhou, VLP Figueiredov, MD Pontw, R Gaiollax, N Hamerschlaky, EFO Ribeiroz, A Hallack-NetoA, MA DiasB, Y GonzagaC, YS RabeloD, L TeixeiraE, G PeriniF, MALHM ConhalatoG, P CuryH, H IdroboI, D CastroJ, B BeltranJ, D EnriquezK, J VasquezK, C RocheL, D ArtilesL, F ValvertM, L VillelaM, C OliverN, L KorinO, C PenaP, M RoaP, MAT VieraQ, AV GasenappR, A QuirozR, CS FigariS, R RiosT, S ParedesJ, EE SaulU, C BermackU, K MezaV, B ValcarcelW, CA Souzab, L MalpicaT, CS Chiattoneh,XVer más
a AC Camargo Câncer Center, São Paulo, Brazil
b Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
c Universidade de São Paulo (USP), São Paulo, Brazil
d Hospital Ophir Loyola (HOL), Belém, Brazil
e Hospital de Amor de Barretos, Barretos, Brazil
f HemoMed, Instituto de Ensino e Pesquisa (IEP), São Paulo, Brazil
g A Beneficência Portuguesa de São Paulo (BP), São Paulo, Brazil
h Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP), São Paulo, Brazil
i Instituto de Ensino, Pesquisa e Inovação, Liga Contra o Câncer (CECAN), Natal, Brazil
j Universidade do Estado do Rio de Janeiro (UERJ) & Oncologia D'Or, Rio de Janeiro, Brazil
k Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
l Faculdade de Medicina do ABC (FMABC), Santo André, Brazil
m Hospital Aldenora Bello, São Luís, Brazil
n Universidade Federal do Paraná (UFPR), Curitiba, Brazil
o Hospital Santa Marcelina, São Paulo, Brazil
p Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
q Prevent Senior de São Paulo, São Paulo, Brazil
r Hospital Luxemburgo (HL), Belo Horizonte, Brazil
s Hospital do Câncer de Cascavel, Cascavel, Brazil
t Universidade de São Paulo (USP), Ribeirão Preto, Brazil
u Faculdade de Medicina de Campos (FMC), Campos dos Goytacazes, Brazil
v Hospital do Servidor Público do Estado de São Paulo (HSPE), Instituto de Assistência Médica ao Servidor Público Estadual (IAMSPE), São Paulo, Brazil
w Centro de Pesquisas Oncológicas de Santa Catarina (CEPON), Florianópolis, Brazil
x Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Botucatu, Brazil
y Hospital Israelita Albert Einstein (HIAE), São Paulo, Brazil
z Grupo Santa Lúcia, Brasília, Brazil
A Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, Brazil
B Universidade Federal da Bahia (UFBA), Salvador, Brazil
C Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
D Universidade Federal de Goiás (UFG), Goiânia, Brazil
E Hospital Municipal Vila Santa Catarina, São Paulo, Brazil
F Hospital Paulistano, Oncologia Américas, São Paulo, Brazil
G Santa Casa de Belo Horizonte, Belo Horizonte, Brazil
H Clínica São Germano, São Paulo, Brazil
I Universidad del Valle del Cauca, Cali, Colombia
J Hospital Edgardo Rebagliati Martins, Lima, Peru
K Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
L Hospital Arnaldo Milián Castro, Villa Clara, Cuba
M INCAN, Ciudad de Mexico, Mexico
N Hospital Britanico de Montevideo, Montevideo, Uruguai
O CABA - Alexander Fleming Institute, Olivos, Argentina
P Hospital Del Salvador, Santiago, Chile
Q Clínica Santa Sofia, Caracas, Venezuela
R Hospital Central Instituto de Previsión Social, Asunción, Paraguai
S Oncosalud, AUNA, Lima, Peru
T Hospital Clinico Quirúrgico Hermanos Amejeiras, La Habana, Cuba
U University of Texas, MD Anderson Cancer Center, Houston, United States
V Baylor College of Medicine, Houston, United States
W University of George Washington, Washington DC, United States
X Hospital Samaritano, São Paulo, SP, Brazil
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Vol. 46. Núm S4

HEMO 2024

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Introduction

PTCL accounts for 10-15% of all NHL. As previously demonstrated, Latin America has its own epidemiological distribution, with a high frequency of ATLL and ENKT, likely influenced by distinct genetic profiles and viral epidemiology. 3-year OS is about 40%. Treatment advances have also been limited, except for BV-CHP in some countries. The IPI, which includes extranodal (EN) site as a variable, has been validated for PTCL. However, the specific impact of EN involvement on nodal PTCL (such as PTCL-NOS, AIT, ALCL ALK+/ALK-) and its biological implications remain unclear. Simplification could improve the reproducibility and applicability of these models, especially in low-income countries.

Objective

To evaluate number of EN sites in nodal PTCL lymphomas as a risk factors or surrogate for outcomes, as OS and PFS in Latin America cohort.

Methodology

Patients (pts) aged ≥18 years with newly diagnosed nodal PTCL-NOS, AITL and ALCL ALK+/ALK-) from GELL (n = 339, 2000-2023, retrospective), TCBP (n = 427, 2015-2022, ambispective). Treatment outcome was determined by OS and PFS. REDcap Platform (by Vanderbilt) was used to collect and store data, whereas statistical analysis the IBM-SPSS v.24. This trial is registered at Clinical trials (NCT03207789).

Results

766 pts [427pts - TCBP and 339 - GELL] diagnosed with nodal PTCL were grouped according to the number of EN: no EN involvement (No EN - 383); one EN involvement (EN1 -168); and 32 (EN2 - 215). Considering all, 61% male; median age 56 y/o; 74% were staged III/IV; 69% IPI 32; 60% was PTCL-NOS, 19% ALCL ALK- and 12% AITL. 61% had B symptoms and 55% elevated LDH. CHOEP was used in 47% and 34% CHOP, and 47% achieved CR after first line; 16% used transplant as consolidation. No EN, EN1 and EN2 were similar regarding clinical characteristics, except, for stage III/IV (58% vs. 79% vs 96%; p < .0001); IPI 32 (58% vs. 59% vs. 99%; p < .0001); ECOG>1 (58% vs. 92% vs. 99%; p < .0001); BMO involvement (16% vs. 24% vs. 63%%; p <.0001), elevated LDH (54% vs. 47% vs. 61%; p =.03) and Hypoalbuminemia (33% vs. 38% vs. 58%; p <.0001). NHL-T subtypes showed better OS and ALCL ALK+ better PFS. Among No EN, EN1 and EN2 the response CR after 1st line had a statistically difference (54% vs 46% vs 37%, p = 0.002), 60-month OS (45% vs. 44% vs. 27%, p <.0001) and PFS (31% vs. 34% vs. 18%; p <.0001).

Conclusion

EN2 presented more advanced disease, with possible distinct biology, hence, the number of EN involvements can be useful as a practical and informative surrogates for outcomes, suggesting number of EN sites involvement assessed by CT and PET-CT as feasible clinical surrogate for outcomes in this population. New biomarkers are essential to better stratify patients with PTCL. Still, in practice, it is also necessary to have ways to stratify these patients using clinical data, mainly in regions with low-income resources. These indicators reflect distinct biological characteristics that merit further molecular investigation, potentially enhancing tailored therapies. Registries are essential given the rarity and poor prognosis associated with these diseases as well as generate hypotheses.

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Hematology, Transfusion and Cell Therapy
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