Background <p>Despite the increased lymphoma burden in the Kingdom of Saudi Arabia (KSA) and poor prognostic factors in patients from KSA, limited data exist regarding the characteristics and outcomes of peripheral T-cell lymphoma (PTCL) patients. The present retrospective analysis evaluated the characteristics, treatment patterns, and survival outcomes of patients with PTCL in KSA.</p> Methods <p>The present retrospective chart review retrieved the data of patients with PTCL (aged ≥ 14 years) from two KSA centers. Data on clinical characteristics, treatment modalities, tumor response, and survival outcomes were obtained.</p> Results <p>Ninety-nine patients were enrolled, with a mean age of 50.68 ± 1.62. The two most prevalent histological subtypes were peripheral PTCL-not otherwise specified (NOS; 38.4%) and ALK-negative anaplastic large cell lymphoma (ALK-ALCL; 26.3%). The majority of individuals (60.6%) were diagnosed with Ann Arbor Stage IV disease. Approximately 54% of individuals had an IPI ≥ 3 at the time of diagnosis. Combination chemotherapy was used as the first-line treatment in 32.3% of cases. Only 14.1% and 13.1% of the patients underwent ASCT and radiation therapy as first-line treatments, respectively. The five-year progression-free survival (PFS) and overall survival (OS) rates were 23.6% and 44%, respectively. A significant difference was observed in the 5-year PFS (<i>p</i> = 0.048) and OS rates (<i>p</i> = 0.017) between treatment regimens. Older age (Hazard ratio [HR] = 1.03, 95% confidence interval 1.00-1.05, <i>p</i> = 0.01) was an independent predictor of PFS. Likewise, B-symptoms and extranodal involvement were independent predictors of OS.</p> Conclusion <p>Patients with PTCL in KSA tend to present at a younger age and at more advanced disease stages compared to patients from Western and other Asian countries. The survival of patients with PTCL remains poor in the Kingdom, highlighting the need for standardized protocols for early diagnosis, prompt referral, and treatment.</p>