Perspectives on the Mature T-Cell Lymphomas in the Middle East: A Comprehensive Review of the Present Status

Abstract

Highlights: The prevalence of TCLs in the ME is not well documented, as most of the research has been conducted in Western countries. While recent studies suggest that the prevalence of TCLs in the ME is comparable to that of Western countries, there is a suggestion that the prevalence of T-cell lymphomas may be increasing in the ME compared to the previous decade. Because of the limited data available on TCLs in the ME, its epidemiology is not well understood. However, there are some studies that demonstrated that the risk of TCLs is significantly higher in people who have a family history of lymphoma, those who have a history of autoimmune diseases such as rheumatoid arthritis and systemic lupus erythematosus, and those who have a history of exposure to ionizing radiation or certain chemicals such as benzene. Why are the main findings? Diagnosis of TCLs in the ME is often complicated and requires pathologists familiar with the complex classification, specialized techniques in immunohistochemistry and flow cytometry, and imaging, including PET scans. The use of molecular testing and profiling of TCLs in the region is limited. The treatment of TCLs in the ME, similar to other parts of the world, is often confusing and lacks consensus. Treatments may include combination chemotherapy, radiation therapy, immunotherapy, and autologous or allogeneic stem cell transplant. Chemotherapy is the most common treatment option for TCLs in the ME and is usually used in combination with other modalities, such as radiation therapy or immunotherapy. What is the Implications of main findings? The clinical outcomes of TCLs in the ME are not well understood, as there is limited data available on the outcomes of these cancers in the region. However, some studies have looked at the outcomes of T-cell lymphomas in the ME, suggesting that the 5-year survival rate for patients with TCLs is comparable to that of patients in Western countries. There is a dearth of real-world evidence and management consensus in the region, as well as a restricted number of clinical trials resulting from the ME pertaining to the management of TCLs. One of the main reasons for the limited evidence arising from the region is the lack of TCL registries. Background: T-cell lymphomas (TCLs) are rare and aggressive malignancies associated with poor outcomes, often because of the development of acquired drug resistance as well as intolerance to the established and often toxic chemotherapy regimens in elderly and frail patients. The many subtypes of TCL are well established to exhibit marked geographic variation. The epidemiology, clinical presentation, diagnosis, prognosis, and treatment of TCLs in the Middle East (ME) are yet to be explored; hence, limited data are available about these entities in this part of the world. Aim: Therefore, in this review article, we aim to discuss the available data regarding the T-cell neoplasms in the ME, including the incidence of specific subtypes of peripheral T-cell lymphoma (PTCL), as well as the trends in survival and treatment, all in an effort to understand the natural history of these complex entities across the ME.