T-Cell Project: Prospective Collection of Data in Patients With Peripheral T-Cell Lymphoma

Peripheral T-cell lymphomas (PTCLs) comprise a heterogeneous group of neoplasms that are
derived from post-thymic lymphoid cells at different stages of differentiation with
different morphological patterns, phenotypes, and clinical presentations. PTCLs are highly
diverse, reflecting the diverse cells from which they can originate. Peripheral T-Cell
Lymphomas account for 5-10% of all lymphoproliferative disorders in the Western hemisphere,
with an overall incidence of 0.5-2 per 100,000 per year, and have a striking epidemiological
distribution, with higher incidence in Asia.

The clinical features of PTCLs are extremely heterogeneous. PTCLs express even more clinical
diversity than B-cell NHLs, and there is a close, though not absolute, relationship between
some unusual clinical features and certain histological subtypes. Despite efforts to
transferring to patients with T-cell lymphomas the most recent advances in the treatment of
other subtypes of B-cell lymphomas, the prognosis of patients with PTCL is still poor an,
unfortunately, the optimal therapy for PTCL is still unknown. The complete response rate is
rather low, ranging from 40% to 50% with a median Relapse Free Survival (RFS) of 2-3 years.
As a consequence of the aggressiveness of the disease and of the low efficacy of available
salvage treatments, Overall Survival (OS) is also short and the long-term survival rate is
lower than 10% in many series.

To better define the clinical outcome of PTCL-NOS, the Intergruppo Italiano Linfomi (IIL,
now Fondazione Italiana Linfomi, FIL) performed a large study on 385 patients diagnosed and
treated in the 1990s and defined a prognostic model specifically devised for patients with
this uncommon disease (Gallamini, A. et al Blood, 2004. 103(7): p. 2474-9). In addition to
defining a prognostic model specifically devised for PTCL-NOS, the FIL study confirms the
relevance of research on series of clearly defined cases in order to the development of
rationally designed and potentially more-efficacious treatment modalities. More recently,
the role of biological features of the disease is emerging as an important issue not only
for understanding its pathogenesis but also for prognosis and for addressing specific
biologic targets altered in the neoplasia. Significant progress in the prognosis of PTCL can
be expected from the novel, sophisticated, and powerful technologies of genomics and
proteomics, which will allow more reliable subtyping of PTCL into distinct clinical groups
characterized by different patterns of survival, as already demonstrated for some B-NHLs.

One common limitation of existing studies on prognosis of PTCL is their retrospective
nature. Currently available data are based on analysis performed on series collected over a
long period of time. This aspect is very important as it may introduce relevant biases in
the collected series. First classification systems have changed dramatically over time and
cases may have been defined in differently based on diagnosis year. Second some clinical or
laboratory data which now are considered as prognostic relevant may have not been determined
in older series of patients. Third in a retrospective analysis there is no guarantee that
collected series are based on real consecutive cases. These are the reasons why we thought
it would be useful to start a new study based on the prospective registration in a short
period of time of patients with diagnosis of Peripheral T-cell lymphoma for whom it would be
possible collect an exhaustive set of clinical data and biological information.

Inclusion Criteria:

1. Previously-untreated patients with de novo diagnosis of peripheral T-cell or
NK/T-cell lymphoma:

- Peripheral T-cell lymphoma unspecified;

- Peripheral T-cell lymphoma, lymphoepithelioid variant;

- Peripheral T-cell lymphoma, T-zone variant ;

- Peripheral T-cell lymphoma, parafollicular variant ;

- Angioimmunoblastic T-cell lymphoma;

- Nasal NK/T-cell lymphoma;

- NK/T-cell lymphoma, nasal time;

- Anaplastic large-cell lymphoma, T/null cell, ALK+, primary systemic type

- Anaplastic large-cell lymphoma, T/null cell, ALK-, primary systemic type

- Anaplastic large cell lymphoma, small cell variant, ALK+

- Anaplastic large cell lymphoma, lymphohistiocytic variant, ALK+

- Enteropathy- type T-cell lymphoma;

- Hepatosplenic T-cell lymphoma;

- Peripheral gamma-delta T-cell lymphoma;

- Subcutaneous panniculitis-like T-cell lymphoma;

- Unclassifiable peripheral T-cell Lymphoma

- Unclassifiable NK-cell lymphoma

2. Age over 18

3. Tissue biopsies adequate for diagnosis and classification and available for
centralized review

4. Clinical data including baseline information on disease localization and laboratory
parameters at staging, features of treatment adopted and assurance of follow-up
updating for at least 5 years are requested

5. Written informed consent

Exclusion Criteria:

1. Age < 18

2. Diagnosis of T-cell or NK-cell leukemia or proliferation and other than mature types
including:

- Adult T-cell leukemia/lymphoma;

- Blastic NK-cell leukemia/lymphoma;

- Aggressive NK-cell leukemia

- T-cell large granular lymphocytic leukemia

- T-cell large granular lymphocytic proliferation

- NK-cell large granular lymphocytic proliferation

- T-cell prolymphocytic leukemia

- Precursor T-cell lymphoblastic leukemia/lymphoma

- Mycosis fungoides;

- Sézary syndrome;

- Primary cutaneous ALCL