Effect of autologous hematopoietic stem cell transplantation for patients with peripheral T-cell lymphoma in China: A propensity score-matched analysis

Abstract

BackgroundThe role of consolidation therapy with autologous stem cell transplantation (ASCT) in patients with peripheral T-cell lymphoma (PTCL) in first complete remission (CR1) or partial remission (PR1) remains controversial. The existing data from China are limited. Therefore, we aimed to investigate the effect of ASCT on the survival of Chinese patients with PTCL showing response to induction chemotherapy at our hospital.MethodsWe retrospectively reviewed the data of patients with PTCL (excluding Natural killer/T cell lymphoma) in CR1 or PR1 treated at Peking University Hospital &Institute from 1996 to 2020. Propensity score matching (PSM) was used to balance clinical characteristics between the ASCT and non-ASCT groups. The primary endpoints were event-free survival (EFS) and overall survival (OS).ResultsOf the 414 selected patients, 73 received ASCT consolidation and 341 did not. Over a median follow-up of 5.7 years, survival was significantly better in the ASCT group than in the non-ASCT group (median EFS, 8.1 years vs. 2.8 years, P = 0.002; median OS, 14.9 years vs. 10.2 years, P = 0.007). The 5-year EFS and OS rates were 68.4% and 77.0% in ASCT group, and 43.2% and 57.6% in non-ASCT group, respectively. The survival benefit was confirmed in the propensity score matched cohort (46 patients who received ASCT and 84 patients who did not receive ASCT): P = 0.007 for median EFS and P = 0.022 for the median OS. Cox regression analysis showed that ASCT was independently associated with better survival: hazard ratio (HR) for EFS, 0.46 (95% CI: 0.28-0.76); HR for OS, 0.50 (95% CI: 0.31-0.84). Subgroup analysis showed that ASCT was more likely to benefit higher-risk patients and those with advanced disease. Among the subtypes of PTCL, the benefit was significant in angioimmunoblastic T-cell lymphoma (HR = 0.26 [95% CI: 0.10-0.66] for EFS and 0.29 [95% CI: 0.12-0.74] for OS), but not in the other subtypes.ConclusionASCT may improve the long-term survival of patients with PTCL in first CR or PR, especially for patients with angioimmunoblastic T-cell lymphoma. The specific groups most likely to benefit from upfront ASCT need to be clearly identified.

Up‐front autologous stem cell transplant in peripheral T‐cell lymphoma patients achieving complete response after first‐line treatment: A multicentre real‐world analysis

“…Prior studies also reported this survival advantage for AITL patients receiving ASCT. 10,11 However, we observed a 28.2% relapse rate in AITL patients after ASCT. Epperla et al 19 reported that allo-HCT can offer durable disease control for AITL patients who relapse after ASCT.…”

“…suggested only AITL patients benefit from ASCT. However, most of these studies did not compare ASCT and non‐ASCT in the CR subgroup 11,16 . Here, we observed that among TCL patients achieving CR after first‐line treatment, non‐ALCL patients benefit from ASCT compared to chemotherapy, while outcomes remain comparable for the ALCL group.…”

“…However, most these studies did not compare ASCT and non-ASCT in the CR subgroup. 11,16 Here, we observed that among TCL patients achieving CR after first-line treatment, non-ALCL patients benefit from ASCT compared to chemotherapy, while outcomes remain comparable for the ALCL group. These findings are supported by the COMPLETE study, which also reported benefits only for AITL patients in the first CR.…”

“…For example, some studies found that ALCL 16 patients have better survival in the ASCT group, even with brentuximab vedotin available. 18 Conversely, Gao et al 11 suggested only AITL patients benefit from ASCT. However, most these studies did not compare ASCT and non-ASCT in the CR subgroup.…”

“…While Gao et al. 's 11 single‐centre study suggests potential long‐term survival benefits of ASCT for patients in first CR or partial response (PR) compared to those without ASCT, no subgroup analysis was performed for CR patients.…”