Autologous stem-cell transplantation as consolidation of first-line chemotherapy in patients with peripheral T-cell lymphoma: a multicenter GELTAMO/FIL study

Abstract

Peripheral T-cell lymphomas (PTCLs) are a heterogeneous group of rare lymphoid malignancies that mostly have poor prognoses with currently available treatments. Upfront consolidation with autologous stem cell transplantation (ASCT) is frequently carried out, but its efficacy has never been investigated in randomized trials. We designed a multicenter, international, retrospective study with the main objective of comparing progression-free survival (PFS) and overall survival (OS) of patients with PTCL who underwent ASCT in complete remission (CR) after first-line chemotherapy with a control group who did not undergo ASCT. From the initial population of 286 registered patients, 174 patients with PTCL other than anaplastic large cell lymphoma, ALK-positive, deemed fit for ASCT at the time of diagnosis, and who were in CR or uncertain CR after induction therapy (CR1) were included in our analysis. 103 patients underwent ASCT, whereas 71 did not, in most cases (n=53) because the physician decided against it. With a median follow-up of 65.5 months, PFS was significantly better in the transplanted patients than in the non-transplanted group: 63% vs. 48% at 5 years (p=0.042). OS was significantly longer for ASCT patients in the subgroup with advanced stage at diagnosis (5-year OS: 70% vs. 50%, p=0.028). In the multivariate analysis, first-line ASCT was associated with significantly prolonged PFS (HR 0.57, 95% CI 0.35-0.93) and OS (HR 0.57, 95% CI 0.33-0.99). In conclusion, our study supports the use of ASCT as a consolidation strategy for patients with PTCL in CR1. These results should be confirmed in a prospective randomized study.

Characteristics and clinical outcomes of patients with ALK‐positive anaplastic large cell lymphoma: Report from the prospective international T‐cell lymphoma project

“…Regarding the consolidation of the first remission, recent data suggest that ASCT remains an option, mostly for high-risk patients. 20,21 In our analysis, 5 year OS and PFS for patients with advancedstage ALCL, ALK+ were 75% and 55%, respectively. However, interesting results were obtained after assessing the patients with IPI and PIT.…”

“…Regarding the consolidation of the first remission, recent data suggest that ASCT remains an option, mostly for high‐risk patients 20,21 …”

Mature T-cell neoplasms and stem cell transplant: the never-ending story

“…2-7 Let's break the suspense: the study published in this issue of Haematologica by Garcia-Sancho and colleagues does not definitely answer the questions, but it does add a significant brick to the wall. 8 Compared to historical and more recent series showing a poor median progression-free survival of approximately 10 to 12 months in PTCL, 9, 10 the results from a prospective trial by d'Amore et al published in 2012 convincingly demonstrated that six courses of CHOEP followed by ASCT in cases of partial or complete responses could yield progression-free survival of up to 44% at 5 years. 3 Since then, numerous retrospective studies have produced conflicting results.…”

“… 2-7 Let’s break the suspense: the study published in this issue of Haematologica by Garcia-Sancho and colleagues does not definitely answer the questions, but it does add a significant brick to the wall. 8 …”

A novel conditioning regimen of chidamide, cladribine, gemcitabine, and busulfan in the autologous stem cell transplantation of aggressive T-cell lymphoma

“…It is frequently used as standard-of-care for patients in first complete response (CR1), despite the advent of new drugs. Several retrospective and prospective studies have demonstrated that ASCT significantly prolongs the survival time of patients with aggressive T-cell lymphoma ( 3 , 4 ). However, the prognosis for patients with aggressive T-cell lymphoma remains unfavorable compared to other lymphomas.…”