Reduced-intensity allogeneic hematopoietic cell transplantation using fludarabine–melphalan conditioning for treatment of mature T-cell lymphomas

Abstract

Among non-Hodgkin lymphoma subtypes, T-cell phenotype confers a poor clinical prognosis. For more aggressive histologies, patients frequently present with advanced disease that is inherently chemoresistant. For cutaneous histologies, disease progresses less rapidly, but is debilitating and often incurable long term. Here we report the retrospective analysis of data from 27 patients with mature T-cell lymphoma treated with salvage allo-HCT at the City of Hope using a reduced-intensity fludarabine/melphalan conditioning regimen between the years 2001 and 2008. Eleven of the twenty-seven patients had cutaneous T-cell lymphoma (CTCL). The majority of patients had advanced disease at the time of transplant (17/27 or 63%). Median followup was 36 months. We observed 2-year overall survival (OS) of 55%, progression-free survival (PFS) of 47%, and cumulative incidence of relapse/progression and non-relapse mortality (NRM) of 30% and 22%, respectively. For CTCL, patients had a 2-yr PFS of 45% and NRM of 27% compared to patients with other histologies, who had PFS of 62% and NRM of 19%. Overall, our results suggest that meaningful long term survival rates and disease control can be achieved with acceptable non-relapse mortality in patients with mature T-cell lymphomas, including CTCL using reduced intensity conditioning with melphalan and fludarabine.

British Association of Dermatologists and U.K. Cutaneous Lymphoma Group guidelines for the management of primary cutaneous lymphomas 2018

“…A number of other case reports and small retrospective series have also described clinical responses and durable remissions of more than 3 years following myeloablative allo‐HSCT and reduced‐intensity conditioning allo‐HSCT . A single‐centre report described outcomes in 19 recipients of allo‐HSCT using an RIC regimen that included TSEB irradiation prior to transplant.…”

Allogeneic hematopoietic SCT for primary cutaneous T cell lymphomas

“…Delioukina et al also showed similarly encouraging results for RIC:SCT in 11 patients with CTCL, and observed no further relapses/deaths after the first 18 months after HSCT (ref. 15). …”

“…13, 14)(ref. 15). DLI has also been reported to be effective in producing a GVL effect but only when combined with several other modalities of therapy including chemotherapy (ref.…”

Treatment Options for Patients with Relapsing and Refractory Peripheral T-Cell Lymphoma

“…The retro spective data section of Table 2 summarizes the results of the eight published series with at least 28 patients enrolled [33,35,36,[39][40][41][42][43]. The cited series differ with respect to the intensity of conditioning regimen (myeloablative versus reduced intensity conditioning [RIC]), enrolled subtypes of PTCLs and prior treatment lines and therefore are difficult to compare.…”