Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone (CHOP) are used to treat peripheral T-cell lymphoma (PTCL) in patients of age less than 65. Although consolidation with autologous stem cell transplantation (ASCT) and the addition of etoposide (CHOEP) were favored in certain nations, randomized studies were limited. With the help of the Netherlands Cancer Registry, the population-based study conducted across the country evaluated the effects of etoposide and ASCT on overall survival (OS) in patients aged 18 to 64 with stage II to IV anaplastic large-cell lymphoma (ALCL), angioimmunoblastic T-cell lymphoma (AITL), or PTCL not otherwise specified (NOS) diagnosed between 1989 and 2018.

Patients were divided into 2 calendar periods, corresponding to the pre-and post-etoposide and ASCT eras, respectively. A total of 1,427 individuals were found(ALCL, 35%; AITL, 21%; and PTCL NOS, 44%). From 1989 to 2009, the percentage of OS grew from 39% to 49% (P<.01) in the period of 2009 to 2018. Patients treated with CHOEP compared to CHOP had better 5-year OS (64% vs. 44%; P<.01).

The risk of death was comparable between the 2 groups after adjusting for subtype, International Prognostic Index score, and ASCT, with the exception of patients with ALK+ ALCL, for whom the risk of mortality was 6.3 times greater when treated with CHOP versus CHOEP. Regardless of whether full remission was attained, participants receiving consolidation with ASCT had a better 5-year OS of 81% compared to 39% for patients not undergoing ASCT (P <.01). The use of ASCT consolidation, but not the addition of etoposide, was related with better OS in patients aged <65 years with advanced-stage ALK, ALCL, AITL, or PTCL.