Long-Term Outcome of Patients With Peripheral T-Cell Lymphoma Treated With First-Line Intensive Chemotherapy Followed by Autologous Stem Cell Transplantation

Abstract

Background. Peripheral T-cell lymphomas (PTCL) are infrequent subtypes of non-Hodgkin's lymphomas. The clinical course is aggressive and the median survival is about 2-3 years. An optimal first-line chemotherapy protocol has not been established and the role of high-dose therapy with autologous stem cell transplantation (ASCT) is still unclear.Aim. To analyze the long-term outcome of unselected PTCL patients treated with intensive first-line chemotherapy with high-dose therapy and ASCT.Method. Here we report our experience with 29 patients with PTCL. The histological subtypes were as follows: peripheral T-cell lymphoma, not otherwise specified n=13; anaplastic large cell lymphoma (ALCL) ALK-negative n=5; ALCL ALK-positive n=3; ALCL with an unknown ALK status n=3; angioimmunoblastic lymphoma n=1; hepatosplenic lymphoma n=1; Sézary syndrome n=1; and enteropathy-associated T-cell lymphoma n=2. The median age at diagnosis was 48 years (29-64), most patients had advanced Ann Arbor stages (22 patients, 77%), IPI score ≥3 was found in 13 (45%) and PIT score ≥2 in 17 (59%) of the 29 patients. Eighteen patients received first-line high-dose therapy and autologous SCT consolidation; two patients were consolidated with allogeneic SCT in the 1st complete remission and one patient in the 1st relapse. Ten patients with FDG-avid lymphoma were examined with integrated Positron emission tomography/ Computed tomography (PET/CT) at the time of diagnosis and after first-line therapy, two other patients were assessed with Positron emission tomography/ Computed tomography (PET/CT) only at time of restaging.Results. Nineteen (66%) patients achieved complete remission, 3 (10%) partial remission and 7 (24%) patients failed the treatment. The overall response rate was 76%. PET negativity (complete metabolic response) after therapy was achieved in 8/12 (75%) individuals. After a median follow-up of 55.1 months, 14 (48.3%) patients relapsed or progressed and nine patients died (lymphoma progression). Eleven patients (50% of chemosensitive patients) survived more than 50 months. Three of the long-term survivors were treated with allogeneic SCT. The 2-year event-free survival (EFS) was 52% (95% confidence interval [CI], 0.33-0.71); the 2-year overall survival (OS) rate reached 65% (95%CI, 0.47-0.84). PET negativity was associated with a lower probability of relapse (chi-square p=0.09).Conclusion. Our data show that intensive first-line therapy with etoposide-doxorubicine-based regimens and ASCT consolidation may lead to long-term disease control in about a half of patients with chemosensitive PTCL. Achievement PET negativity is probably an essential prerequisite for long-term complete remission.

Evaluation of clinical trial eligibility and prognostic indices in a population‐based cohort of systemic peripheral T‐cell lymphomas from the Danish Lymphoma Registry

“…A number of retrospective [11][12][13][14][15][16][17][18]29] and prospective [8][9][10]22,30,31] studies have reported an apparent outcome advantage from the use of upfront HDT/ASCT in PTCL patients with chemosensitive disease. In the present study, less than half of PTCL patients were considered eligible for inclusion in CTs with multiagent chemotherapy followed by SCT.…”

“…Recently, large phase II trials testing upfront high-dose chemotherapy (HDT) and autologous SCT (ASCT) have shown good feasibility and a possible beneficial effect on clinical outcome [8][9][10]. With the obvious caveat of patient selection, retrospective studies also seem to support this impression, particularly in patients exhibiting chemosensitive disease [11][12][13][14][15][16][17][18]. National guidelines, such as those from the National Comprehensive Cancer Network, include HDT/ASCT as a recommended option for consolidation after first remission in patients with histologies other than anaplastic lymphoma kinase (ALK)-positive anaplastic large cell lymphoma (ALCL) [19].…”

Autologous Stem Cell Transplantation as the First-Line Treatment for Peripheral T Cell Lymphoma: Results of a Comprehensive Meta-Analysis

“…Among the patients treated with HDT/ASCT, analysis of OS in terms of the International Prognostic Index (IPI) at diagnosis was reported in 9 studies [23,25,28,30,36,37,38,39,45]. Six studies, including 347 patients, were enrolled in this meta-analysis [23,28,36,38,39,45].…”

“…Six studies, including 347 patients, were enrolled in this meta-analysis [23,28,36,38,39,45]. The summary-estimated HR for OS was 0.36 (95% CI 0.22-0.60, I 2 49%), as determined with the fixed-effect model, suggesting a significant survival advantage after transplantation for patients with low IPI risk compared to patients with high IPI risk (p < 0.0001; fig.…”

“…In recent years, several retrospective and prospective trials have been published evaluating the role of ASCT as part of the first-line therapy in PTCL patients. However, these studies were limited by small sample sizes and case composition with various histologies [22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39]. Therefore, it is difficult to draw definitive conclusions regarding the efficacy of ASCT.…”