The role of high-dose therapy and stem cell rescue in the management of T-cell malignant lymphomas: a BSBMT and ABMTRR study

Abstract

Peripheral T-cell lymphomas (PTCL) are a rare and heterogeneous subset of lymphomas with a poorer prognosis compared with B-cell lymphomas. We conducted a retrospective study of 82 patients who received high-dose therapy for PTCL (autologous SCT (ASCT) N ¼ 64; allogeneic SCT (Allo-SCT) N ¼ 18). With a median follow-up from ASCT of 37 months from transplant, 33 patients were alive; 20 died of progressive disease, 10 died from non-relapse mortality (NRM) with 1 unknown cause. Three-year overall survival (OS) and progression-free survival (PFS) were 53% (95% confidence interval (CI) 42, 67) and 50% (95% CI 39, 64), respectively. Factors significantly affecting OS and PFS on univariate analysis were histological subtype and chemotherapy sensitivity. In a multivariate analysis, the only factor with significant impact was chemotherapy sensitivity. After a median follow-up from Allo-SCT of 57 months, five patients were alive; five died of progressive disease and eight died from NRM. The 3-year OS and PFS were 39% (95% CI 22, 69) and 33% (95% CI 17, 64), respectively, and the 3-year relapse rate was 28% (95% CI 6, 50). These results demonstrate that high-dose chemotherapy with autologous stem cell rescue has a substantial role in the management of T-cell lymphoma. The use of full-intensity allogeneic transplantation is limited by high transplant-related mortality, and exploration of reduced intensity regimens is warranted.

Hematopoietic SCT for peripheral T-cell lymphoma

“…Although most information comes from retrospective studies, it seems that, in the salvage setting with this strategy, results are similar to those obtained in aggressive B-cell lymphomas, [10][11][12][13][14] ALK þ ALCL patients having better prognosis than the other PTCLs. 8 Table 3 shows the results from the main retrospective series.…”

Successful Treatment of Refractory Enteropathy-Associated T-Cell Lymphoma Using High-Dose Chemotherapy and Autologous Stem Cell Transplantation

“…These reports showed RIC followed by allo-SCT is feasible and effective for PTCL, and it has a low treatment-relapsed mortality (TRM). On the other hand, TRM of a myeloablative conditioning regimen followed by allo-SCT is higher than RIC (19). There is evidence that allo-SCT may produce a plateau in both the OS and PFS curves; if feasible, RIC followed by allo-SCT may be an effective strategy for PTCL.…”

Hematopoietic stem-cell transplantation following solid-organ transplantation in children

“…The role of allogeneic HSCT for stage IV T-cell lymphoma outside the context of PTLD shows encouraging results with an overall survival up to 40%, but a high risk non-relapse mortality of up to 39%. 24 For the patient younger than 3 years, we elected to use a conditioning regimen reported for transplant of children with acute lymphoblastic leukemia that showed similar results to a TBI approach, in an attempt to avoid TBI side effects. 25 For the second patient, we used the combination of cyclophosphamide and TBI.…”