Effect of immune modulation in relapsed peripheral T-cell lymphomas after post-allogeneic stem cell transplantation: a study by the Société Française de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC)

Abstract

Peripheral T-cell lymphoma carries a poor prognosis. To document a possible graft-versus-lymphoma effect in this setting, we evaluated the impact of immunomodulation in 63 patients with peripheral T-cell lymphoma who relapsed after allogeneic transplant in 27 SFGM-TC centers. Relapse occurred after a median of 2.8 months. Patients were then treated with nonimmunologic strategies (chemotherapy, radiotherapy) and/or immune modulation (donor lymphocyte infusions (DLI) and/or discontinuation of immunosuppressive therapy). Median overall survival (OS) after relapse was 6.1 months (DLI group: 23.6 months, non-DLI group: 3.6 months). Among the 14 patients who received DLI, 9 responded and 2 had stable disease. Among the remaining 49 patients, a complete response accompanied by extensive chronic GvHD was achieved in two patients after tapering of immunosuppressive drugs. Thirty patients received radio-chemotherapy, with an overall response rate of 50%. In multivariate analysis, chronic GvHD (odds ratio: 11.25 (2.68-48.21), P = 0.0009) and skin relapse (odds ratio: 4.15 (1.04-16.50), P = 0.043) were associated with a better response to treatment at relapse. In a time-dependent analysis, the only factor predictive of OS was the time from transplantation to relapse (hazards ratio: 0.33 (0.17-0.640), P = 0.0009). This large series provides encouraging evidence of a true GvL effect in this disease.

Survival of Lymphoma Patients Experiencing Relapse or Progression after an Allogeneic Hematopoietic Cell Transplantation

“…Limited data suggest the utility of DLI in relapsed lymphoma patients after allo-HCT [6,[15][16][17][18][19][20]. More recently, French investigators showed excellent response rates with DLI in peripheral T cell lymphoma patients who relapsed after allo-HCT [21]. In our study there seemed to be a prolonged PR-OS (although not statistically significant) in patients who received DLIs compared with those who did not.…”

Allogeneic stem cell transplantation for peripheral T cell lymphomas: a retrospective study in 285 patients from the Société Francophone de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC)

“…Indeed, survival has been shown to plateau after alloSCT [15], even after RIC [16]. There is also a potential effect of donor lymphocyte infusion (DLI) in post-transplant relapse [17], and Kanakry et al reported a reduced incidence of relapse (17% compared to 66%, p = 0.04) in patients who developed GvHD [18]. However, because of high TRM, recommending alloSCT for PTCL remains a matter of debate, and current guidelines limit its use for relapsed or refractory patients [7,8].…”

Recurrent systemic anaplastic large cell lymphoma: Rapid onset and resolution of cutaneous metastases

“…10,11 A recent case series including 2 ALKpatients with recurrent ALCL to the skin reported that, when treated with DLI, 1 patient had complete response, and the other had partial response. 12 In addition, another patient with ALCL with relapse to the skin 10 months after chemotherapy and 7 months after allogeneic SCT was treated with DLI and palliative chemotherapy, which led to complete remission more than 3 years later. 13 Of note, both of these reports used DLI after the onset of skin lesions.…”