Lack of Correlation between CD 52 Expression and Treatment Outcome in PTCL Patients Treated with CHOP Chemotherapy Plus Campath-1h (CHOP-C) as First Line Treatment.

Prognosis for PTCL patients is poor; the 5-year overall survival rate ranges from 25 to 40%. Despite variable CD52 expression in T-cell malignancies, promising results have been demonstrated with alemtuzumab (Campath ®). We report preliminary results of standard CHOP therapy plus alemtuzumab (CHOP-C) in a cohort of untreated PTCL patients (pts). Beginning Jan 03, 25 consecutive PTCL pts were treated with 8 courses of CHOP. In the first cohort, 4 pts received alemtuzumab 30 mg. sc 1 day prior to the first 4 courses of CHOP, whereas in cohort 2 (N=21) alemtuzumab 30 mg was given one day prior to all 8 CHOP courses administered. The histopathology was centrally reviewed and included 16 patients with PTCL-U, 6 patients with AILD-T, and 3 patients with ALCL Alk. CD52 expression was checked by immunohistochemisty on paraffin-embedded material. Median age of patients was 51.2 years (range: 28–69), 22 (88%) were stage III–IV, 3 (12%) had bulky disease, 11 (44%) had bone marrow involvement, and 13 (52%) had high LDH values. The age-adjusted IPI values were 0 in 5 pts, 1 in 8 pts, 2 in 9 pts, and 3 in 3 pts. All 25 pts completed therapy. Results: at a mean follow-up of 436 days (range:105–1124) 14/25 pts. are still alive and 11/25 have died, mostly of progressive disease (10/11). 17/25 pts achieved CR, 1 PR and 1 minimal response (MR); 6 pts. progressed. Of these 6 pts, 1 pt achieved a PR, and 1 pt in MR and 2 pts in CR died despite salvage treatment; one patient died +198 d. in CR due to pneumonia. Three pts relapsed +62, +119 and +145 days after achieving a CR. The mean duration of response was 273 days. The 2-year OS and FFS (Failure Free Survival) were 45% and 50% days, respectively (Figure). CD52 expression was available for 16 of 25 pts. Of 11 pts who progressed on, or relapsed after therapy, CD52 was positive in 5, negative in 2 and not available for 4 pts. Among the 14 responding pts, 7 were positive, 2 negative, and not available in 5. Conclusions: CHOP-C seems to be a feasible chemoimmunotherapy regimen: the efficacy of this therapy seems fairly good with a CR rate of 68%; however 6/25 pts showed disease progression during therapy, most frequently after the third C-CHOP course. Although most pts were positive for CD52 expression (12/16), no relationship between CD52 expression and treatment outcome was identified. Failure free survival (25 pts.) Failure free survival (25 pts.)