This analysis explored factors influencing survival of patients with primary refractory and relapsed peripheral T-cell lymphomas enrolled in the prospective International T-cell project. We analyzed data from 1,020 patients with newly diagnosed disease, enrolled between September 2006 and December 2015. Out of 937 patients who received first line treatment, 436 (47%) were identified as refractory and 197 (21%) as relapsed. Median time from the end of treatment to relapse was 8 months (range, 2-73). Overall, 75 patients (8%) were consolidated with bone marrow transplantation, including 12 refractory and 22 relapsed patients. After a median follow-up of 38 months (range, 1-96) from documentation of refractory/relapse disease, 440 patients had died. The median overall survival was 5.8 months, and the rates of 3-yr overall survival were 21% and 28% for refractory and relapsed patients, respectively (p<0.001). Patients receiving or not salvage bone marrow transplantation had a 3-yr survival rates of 48% and 18%, respectively, (p<0.001). In a univariate Cox regression analysis, refractory disease was associated with a higher risk of death (HR=1.43, p=0.001), whereas late relapse (>12 months, HR 0.57, p=0.001) and salvage therapy with transplantation (HR=0.36, p<0.001) were associated with a better OS. No difference was found in OS with respect to histology. This study accurately reflects outcomes for patients treated according to standards of care world-wide. Results confirm that peripheral T-cell lymphomas patients had dismal outcome after relapse or progression. Patients with chemotherapy sensitive disease who relapsed > 12 months might benefit from consolidative bone marrow transplantation.