What are the treatment options for Anaplastic Large Cell Lymphoma (ALCL)?

From the Guidelines

The treatment for anaplastic large cell lymphoma (ALCL) typically involves chemotherapy with a regimen called CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone), often given every 21 days for 6-8 cycles, with brentuximab vedotin 1 CHP being a preferred first-line therapy option for patients with ALCL, as per the most recent guidelines 1.

Key Considerations

• For ALK-positive ALCL, which generally has a better prognosis, CHOP alone may be sufficient, but brentuximab vedotin 1 CHP is also a preferred option 1.
• For ALK-negative ALCL, which tends to be more aggressive, more intensive approaches may be needed, such as adding etoposide to the CHOP regimen (CHOEP) or considering consolidation with autologous stem cell transplantation after achieving remission 1.
• For relapsed or refractory ALCL, targeted therapies like brentuximab vedotin (an antibody-drug conjugate targeting CD30) at 1.8 mg/kg IV every 3 weeks for up to 16 cycles has shown significant efficacy 1.

Treatment Options

• Multiagent chemotherapy (6 cycles with or without involved-site radiation therapy [ISRT] or for 3 to 4 cycles with ISRT) is recommended for patients with stage I–II ALCL, ALK-positive 1.
• Multiagent chemotherapy alone for 6 cycles is recommended for patients with stage III–IV ALCL, ALK-positive 1.
• Participation in clinical trials is the preferred management approach for patients with other subtypes (PTCL-NOS, ALCL, ALK-negative, AITL, EATL, MEITL, nodal PTCL, TFH, and follicular T-cell lymphoma) 1.

Important Considerations

• The choice of therapy depends on the specific ALK status, disease stage, patient's age, and overall health status 1.
• Early diagnosis and treatment are crucial for improving outcomes in this aggressive form of lymphoma 1.

From the FDA Drug Label

1.5 Previously Untreated Systemic Anaplastic Large Cell Lymphoma (sALCL) or Other CD30-Expressing Peripheral T-cell Lymphomas (PTCL), in Combination with Chemotherapy ADCETRIS is indicated for the treatment of adult patients with previously untreated sALCL or other CD30-expressing PTCL, including angioimmunoblastic T-cell lymphoma and PTCL not otherwise specified (NOS), in combination with cyclophosphamide, doxorubicin, and prednisone. 1.6 Relapsed Systemic Anaplastic Large Cell Lymphoma (sALCL) ADCETRIS is indicated for the treatment of adult patients with sALCL after failure of at least one prior multi-agent chemotherapy regimen.

The treatment options for Anaplastic Large Cell Lymphoma (ALCL) include:

• Brentuximab vedotin (ADCETRIS) in combination with chemotherapy for previously untreated systemic ALCL
• Brentuximab vedotin (ADCETRIS) as a single agent for relapsed systemic ALCL after failure of at least one prior multi-agent chemotherapy regimen 2

From the Research

Treatment Options for Anaplastic Large Cell Lymphoma (ALCL)

• The standard first-line treatment for ALK-positive ALCL consists of doxorubicin-containing polychemotherapy, which is associated with an overall response rate of ∼90%, a 5-year relapse-free survival of ∼60%, and a 5-year overall survival of 70% 3.
• Anthracycline-based chemotherapy regimens, including CHOP, CHOEP, or MACOP-B, have been reported to have excellent results in treating ALK-positive ALCL 3.
• Consolidative high-dose chemotherapy and autologous stem cell transplantation (HDC/ASCT) has also been evaluated in patients in first remission with favorable results, although its superiority to standard chemotherapy is unproven and this approach remains investigational 3.
• For relapsed or refractory ALK-positive ALCL, HDC/ASCT can effectively salvage a proportion of patients 3.
• Targeted therapies, such as an anti-CD30 monoclonal antibody linked to a synthetic antimitotic agent (brentuximab vedotin) and ALK inhibitors (crizotinib, alectinib, and ceritinib), are being used in clinical settings 4.
• Emerging therapies, including anaplastic lymphoma kinase inhibitors, brentuximab vedotin, mTOR inhibitors, programmed cell death protein 1/programmed death ligand 1 inhibitors, and chimeric antigen receptor-T cell therapy, seem to provide new opportunities for certain patients with ALCL 5.
• Combination therapy with brentuximab vedotin and cisplatin/cytarabine has been reported to be effective in a patient with primarily refractory ALK-positive ALCL 6.
• Naked antibodies, "enhanced antibodies", antibody drug-toxin conjugates, radioimmunoconjugates, CD30-ligand-toxin conjugates, bispecific antibodies, and T cell-based immune therapies are different approaches to targeting CD30 in ALCL 7.