How the International T-Cell Project can improve the understanding of T-cell lymphomas

Over 60 international experts in T-cell lymphoma met in Montevideo, Uruguay, on 12–13 April 2018 to discuss the launch of the new T-cell Project 2.0. This project will be a global collaboration to consolidate data on T-cell lymphoma to provide a better understanding of the baseline disease characteristics, improve prognosis and therefore patient outcomes.

The initial International T-cell Project 1.0 (ITCP) was launched in 2006 by Massimo Federico, Professor of Medical Oncology at the University of Modena and Reggio Emilia, Italy and the International T-Cell Lymphoma Study Group. The project aimed to collect data on T-cell lymphoma patients through registries to better define prognosis, especially of the most common subtypes (PTCL, NOS and AITL) and to improve knowledge on clinical and biological characteristics and outcomes of the more uncommon subtypes. The rationale for this being that PTCL has very poor outcomes, demonstrating an unmet medical need for this disease.

Due to changes in the WHO classification for T-cell lymphomas in 2016, Prof Federico stated in the meeting report “it is necessary to update the current project, which adapts to the changes made in diagnosis, staging and response evaluation. The new WHO classification for lymphoid neoplasms recognizes more than 20 biologically distinct subtypes of mature T and NK neoplasms, making the diagnosis and treatment of these lymphomas even more challenging. Additionally, the purpose of the new 2.0 project is to better assess the clinical relevance of the 2016 WHO classification and the role of the 2014 Lugano Classification staging and response assessment. Including the prognosis of different entities, the genomic landscape of different subtypes, and to investigate the most adequate treatment strategies for these neoplasms in the real-world population.”

Meeting Discussions

Astrid Pavlovsky, Medical Director of the Pavlovsky Center and staff member in the Hematology Department of FUNDALEU, Buenos Aires, provided an overview of the meeting outcomes and also the Latin American perspective in an interview with the Lymphoma Hub. She described a key objective of the meeting was to increase awareness of the importance of T-cell registries and to invite more countries to join in this effort. She said that much was learned about the unmet medical need in T-cell lymphoma highlighting that “most patients progress and die of the disease” and “the overall survival of three years is very low.”

Dr Pavlovsky explained that the ITCP 2.0 aimed to provide data on T-cell lymphoma patient outcomes including progression-free survival and overall survival at 3 years, event-free survival at 24 months and complete response rate at 30 months. The short endpoints will provide quicker initial results that can then lead to new prognostic factors in order to “learn more about what is going on in T-cell lymphoma all over the world.”

Dr Pavlovsky said that the meeting provided “interesting discussion among different experts to learn how to integrate national T-cell registries from around the world.” An electronic case report form (ECRF) was developed by Massimo Federico that aims to “gather information on baseline information on treatment, follow-up and outcomes. The main inclusion criterion is a confirmed diagnosis of T-cell lymphoma.” A website is available to sign an agreement form in order to register with the project with more countries being encouraged to join the collaboration. Dr Pavlovsky explained that “in Latin America we think that the project is a great opportunity. Not only will we collaborate with the international knowledge, we will also have more data as there is currently not a lot of published data on the epidemiology of different lymphomas in Latin America.” She added, “even though data will be collected internationally, it will be possible to do sub-analyses from local registries too.”

Dr Pavlovsky has helped to translate the ECRF, including documents such as the protocol and informed consent, so that it will be easier for other Spanish-speaking countries and other regions of Latin American to have their own registry. She said “we already have 24 centers that have signed the agreement form and have started to register and now this will be available for any other Spanish-speaking sites in Latin American.”

She said “we hope that this will eventually have an impact on clinical practice because there is a lot we have to learn from T-cell lymphoma and today, this is a lymphoma with a very bad prognosis and most people will die of disease progression. There is no doubt that the aim of the project is to understand and change the future with the information that we gather and analyze and this may change every day clinical practice.” She added, “in the short-while I don’t think this will have a direct impact on clinical practice as it is only registering data at this point and not suggesting different types of treatment or indication. I think that today’s effort will mean a better future for T-cell lymphoma.”

Meeting Conclusions

Finally, Prof Federico described in his meeting report that, “as of March 20, 2018, 77 centers from 15 different countries of 5 different geographic areas including Europe, North America, South America, Middle/Far East and Oceania registered 1,611 cases making this the largest series of PTCL or NK/T-cell lymphoma ever collected.”

“Given the relevance of this project and the benefits that patients all over the world can receive from such a large and qualified International Consortium, the undersigned representatives of respective institutions approve the project and express their strong commitment in supporting the study in their own institutions and countries.”

About the ITCP Committee

Julie Vose, Professor of Internal Medicine at the University of Nebraska Medical Center, US and also Chair of the ITCP, started one of the first T-cell registries in the US. Raul Gabus, Head of the Hematology and Bone Marrow Transplant, Maciel Hospital, Montevideo, was the chair of the ITCP organizing committee for the Montevideo meeting. The Montevideo meeting organizing committee included; Pierluigi Porcu, Director of the Division of Medical Oncology and Hematopoietic Stem Cell Transplantation, Jefferson University Hospitals Philadelphia, Andrei Shustov, Associate Professor at the Division of Hematology, University of Washington, Seattle, Steven Horwitz, Medical Oncologist at the Memorial Sloan Kettering Cancer Center, New York and Stefano Luminari, Assistant Professor of Oncology at the University of Modena and Reggio Emilia, Italy.