Peripheral T-cell lymphomas (PTCLs) are a rare, heterogeneous subset of non-Hodgkin lymphomas (NHL) that are biologically and clinically distinct from B-cell lymphomas. They are typically resistant to chemotherapy and associated with poor outcomes compared to most B-cell malignancies. Despite this, CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) or CHOP-like regimens remain the standard frontline therapy-even though pivotal studies establishing CHOP in NHL included only B-cell patients, with no evidence for PTCL. For decades, efforts to improve outcomes have focused on "CHOP-plus" strategies, adding novel agents to the backbone. Outside of anaplastic large cell lymphoma (ALCL), where brentuximab vedotin has improved survival, this approach has generally failed; in most PTCL subtypes, 5-drug regimens add toxicity without clear benefit. After two decades of disappointing results, this review critically examines the evidence, the limitations of current strategies, and opportunities to rethink future approaches.
Saleh et al. (Wed,) studied this question.