‘The HemOnc Pulse’ Live: Unanswered Questions in T-Cell Lymphoma

In our continued podcast coverage of the “HemOnc Pulse” Live meeting in Chicago, an expert panel explores unanswered questions in T-cell lymphoma management. The panelists were Mehdi Hamadani, MD, a Professor of Internal Medicine at the Medical College of Wisconsin, Andrew Evens, DO, MBA, MSc, Deputy Director for Clinical Services at Rutgers Cancer Center, and Barbara Pro, MD, a Professor of Medicine at Columbia University Vagelos College of Physicians and Surgeons.

To begin, Dr. Evens remarked in the management of T-cell lymphoma, “besides BV-CHP or ALK PTCL, everything’s unanswered.” There was a consensus in the panel that stem cell transplantation helps patients and Dr. Hamadani commented “[he finds] it sad that in 2024 we are still debating the role of transplant versus no transplant in upfront remission.”

However, the entire panel agreed that uncertainty about when to perform stem cell transplant is a major issue. It then touched on the factors which cause this uncertainty, such as the inability to predict relapse in patients, variance in disease response to transplant, and a lack of study data. However, Dr. Evens mentioned that most clinicians do perform transplant at the first complete remission.

The discussion moved to when to use BV-CHP to treat CD30-positive patients.

Dr. Pro said that she will use the therapy if no clinical trial is available but added that more data on BV-CHP is needed. The panel agreed it is unknown at what percentage of CD30- positivity should BV-CHP be used, and it entered a spirited debate with the audience about disease identification from histochemistry. An audience member questioned how studies have determined disease, and said that in practice, speaking on behalf of pathologists, “[w]e cannot tell the difference between a B-immunoblast versus a T-cell lymphoma in the core…We can’t tell what’s [a] tumor.” The audience member also emphasized a need for clinical trials whose designs are informed by molecular analysis.

Dr. Pro responded that such work is underway but noted in the discussion that “it’s not easy to do T-cell molecular analysis.”

Another audience member asked the panel if it expects the role of Janus kinase (JAK) inhibitors in the management of T-cell lymphoma to increase. Dr. Pro replied that for the newer agents more data is needed but research investment from companies is hard to come by. Dr. Hamadani said that JAK inhibitors’ efficacy against T-cell lymphomas is limited and widely varies by disease type. He added that this situation is similar to that seen with checkpoint inhibitor use in T-cell lymphoma.

At the panel’s close, the experts commented on the difficulty of obtaining funding from pharmaceutical sponsors to conduct studies on actionable mutations in T-cell lymphoma.

Regarding new findings in T-cell lymphoma to be presented at the upcoming American Society of Hematology Annual Meeting and Exposition and the European Hematology Association Congress, the panel is excited by studies in CAR-T cell therapies.