Long-Term Results Of Autologous Hematopoietic Cell Transplantation For Peripheral T Cell Lymphoma: The Stanford Experience

Abstract

The peripheral T cell lymphomas (PTCL) carry a worse prognosis compared to B cell non-Hodgkin lymphoma. There is no uniform standard therapy for PTCL, and autologous hematopoietic cell transplant (AHCT) is often offered as consolidation in first remission or at relapse because of the poor outcomes with conventional therapy. We conducted a retrospective review of patients who underwent AHCT for PTCL from 1989 to 2006. Fifty-three cases were identified consisting of systemic anaplastic large cell (n = 18), PTCL unspecified (n = 17), angioimmunoblastic (n = 9), nasal type extranodal NK/T (n = 7), hepatosplenic (n = 2), and adult T cell leukemia/lymphoma (n = 1). Fifteen patients were transplanted in first complete or partial response (CR1/PR1), 32 in second or beyond CR or PR (CR2/PR2+), and 11 with primary refractory disease (REF). With a median follow-up was 5 years (range: 1.0–11.5), the 5-year progression-free survival (PFS) and overall survival (OS) were 25% and 48%, respectively. Disease status at AHCT had a significant impact on PFS and OS. The 5-year PFS for patients in CR1/PR1, CR2/PR2+, and REF was 51%, 12%, and 0%, respectively, and the corresponding figures for OS were 76%, 40%, and 30%, respectively. The pretransplant factors that impacted survival were disease status and the number of prior regimens. Histology, age, sex, stage, B symptoms, bone marrow involvement, and duration of first response did not significantly affect PFS or OS. Based on these results, AHCT as consolidation therapy in first complete or partial response may offer a durable survival benefit. However, AHCT with conventional salvage chemotherapy has minimal durable benefit in patients with relapsed or refractory PTCL, and thus novel strategies and/or allogeneic HCT should be more aggressively explored in lieu of AHCT for relapsed/ refractory PTCL.

Autologous stem cell transplantation for enteropathy-associated T-cell lymphoma: a retrospective study by the EBMT

“…However, it can be concluded that patients with EATL who do manage to proceed to ASCT have treatment outcomes that are comparable with other types of PTCL. [10][11][12][13][14] It is difficult to estimate the proportion of all EATL patients amenable to intensive therapies, but at least one-half of the patients aged ,70 years may be considered for standard-dose chemotherapy. If they respond to therapy, their performance status may improve, thus allowing subsequent ASCT.…”

Long-term outcomes of autologous PBSCT for peripheral T-cell lymphoma: retrospective analysis of the experience of the Fukuoka BMT group

“…Our results are comparable with previous studies. For example, 5-year OS was reported to be 80% in patients transplanted in CR1 and 45% in other status by the GEL-TAMO group; 19 5-year OS was reported to be 76 and 30% in patients with CR1/PR1 and refractory disease by Stanford group; 14 and 5-year OS was 80% in CR1 by EBMT group. 20 Therefore, these data strongly indicate that HDCT with auto-SCT can be one of the treatment choices for patients with PTCL as consolidation after achieving initial response, or as salvage after sensitive relapse.…”

“…Despite high and good initial response rates, most patients with PTCL fare poorly and develop progression early during or shortly after sequential conventional chemotherapy. 14 The 5-year survival reported is o30% with CHOP regimen or more intensive regimens, such as those used in LNH programs and Hyper CVAD regimen. [15][16][17] Recent studies have shown the superiority of HDCT with auto-SCT to conventional sequential chemotherapy and salvage chemotherapy for patients with aggressive NHL.…”

Allogeneic transplantation following a reduced-intensity conditioning regimen in relapsed/refractory peripheral T-cell lymphomas: long-term remissions and response to donor lymphocyte infusions support the role of a graft-versus-lymphoma effect

“…5 The administration of uncontaminated stem cells using purged autograft did not improve the outcome of patients with relapsed or refractory disease with a PFSo15%. 6 In recent years, alloSCT has been investigated in patients suffering from aggressive lymphomas who failed autoSCT or who were unable to receive it. In a large retrospective analysis on 111 aggressive lymphomas with 51 PTCL patients, the authors reported a 2-year OS of 42% following a myeloablative conditioning.…”

“…Patients receiving autoSCT in second remission or with refractory disease have a poor outcome with a progression-free survival (PFS) ranging from 15-20% to 0%, respectively. 5,6 We firstly reported the activity of allogeneic stem cell transplantation (alloSCT), which now is increasingly used, supporting the evidence for a graft-versus-PTCL effect. [7][8][9] In a retrospective analysis, Kim et al 7 reported a 2-year OS of 42% in a large population of patients with aggressive non-Hodgkin's lymphomas receiving myeloablative alloSCT, with an especially good outcome for those with nodal PTCL.…”