The adjusted International Prognostic Index and  -2-microglobulin predict the outcome after autologous stem cell transplantation in relapsing/refractory peripheral T-cell lymphoma

Rodríguez, José A.; Conde, Eulogio; Gutiérrez, Antonio; Lahuerta, Juan José; Arranz, Reyes; Sureda, Anna; Zuazu, J; Sevilla, Alberto Fernández de; Bendandi, Maurizio; Solano, Carlos; León, Ángel; Varela, María Rosario; Caballero, Marı́a Dolores

doi:10.3324/haematol.11173

Cited by 66 publications

(40 citation statements)

References 36 publications

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“…In the largest published series, reported by the Spanish Group for Lymphoma and ASCT (GEL/TAMO) from 2003 to 2007, 14,20 we presented similar results provided patients were chemosensitive to the salvage regimen. We also found that two prognostic adverse factors (adjustedinternational prognostic index (a-IPI) 2-3 and elevated b-2-microglobulin) may define a prognostic index, which is able to predict the outcome and survival of patients receiving ASCT in the salvage setting ( Figure 1).…”

Section: Retrospective Studies Of Asct For Ptclsupporting

confidence: 69%

“…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.…”

Section: Retrospective Studies Of Asct For Ptclmentioning

confidence: 62%

“…Chemoresistant patients are optimal candidates for these trials. Similarly, high-risk patients who do not benefit from frontline or salvage ASCT according to prognostic factors (that is, a-IPI 41 and elevated b-2-microglobin) 14 should also be considered for reduced intensity conditioning allo-HSCT trials. Figure 2 shows a standard treatment algorithm including all these considerations and Figure 3 shows a suggested experimental approach on the basis of a positron emission tomography-based response-adapted strategy (GEL/ TAMO approach).…”

Section: Conclusion and Future Considerationsmentioning

confidence: 99%

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Hematopoietic SCT for peripheral T-cell lymphoma

Gutiérrez

Caballero

Perez-Manga

et al. 2008

Bone Marrow Transplant

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Results of conventional chemotherapy for high-risk peripheral T-cell lymphoma (PTCL) are poor compared with those for their aggressive B-cell counterparts. We aim to review the current data on the use of hematopoietic SCT in these patients in both frontline and salvage settings. With respect to autologous SCT (ASCT), conclusions from retrospective studies are that ASCT in the salvage setting is as useful in PTCL as in aggressive B-cell lymphomas and also that consolidation in first complete response of high-risk patients has very good results when compared with conventional chemotherapy (with long-term PFS higher than 50%). From first frontline prospective clinical trials, it appears that ASCT is feasible and has a low TRM (o5%); consolidation in first complete response is associated with a very good outcome; around 25% of patients do not undergo ASCT due mainly to disease progression; new approaches aimed at increasing the number of chemosensitive patients should be found. Furthermore, 25-30% of patients deemed complete responders post transplant still relapse afterward. For all these mainly chemoresistant patients, there is preliminary evidence that allogeneic SCT (Allo-SCT) may produce a plateau in survival curves (with long-term PFS around 50%), which indicates a graft-versus-PTCL effect. For this reason, Allo-SCT procedures are the object of ongoing clinical trials.

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Section: Retrospective Studies Of Asct For Ptclsupporting

confidence: 69%

Section: Retrospective Studies Of Asct For Ptclmentioning

confidence: 62%

Section: Conclusion and Future Considerationsmentioning

confidence: 99%

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Hematopoietic SCT for peripheral T-cell lymphoma

Gutiérrez

Caballero

Perez-Manga

et al. 2008

Bone Marrow Transplant

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“…In addition, patients with an age-adjusted international prognostic index of more than 1 and/or high b2-microglobulin had a PFS of 24%. 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.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2011

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Rescue chemotherapy or autologous stem cell transplantation (autoSCT) gives disappointing results in relapsed peripheral T-cell lymphomas (PTCLs). We have retrospectively evaluated the long-term outcome of 52 patients receiving allogeneic SCT for relapsed disease. Histologies were PTCL-not-otherwise specified (n ¼ 23), anaplastic large-cell lymphoma (n ¼ 11), angioimmunoblastic T-cell lymphomas (n ¼ 9) and rare subtypes (n ¼ 9). Patients were allografted from related siblings (n ¼ 33, 64%) or alternative donors (n ¼ 13 (25%) from unrelated and 6 (11%) from haploidentical family donors), following reducedintensity conditioning (RIC) regimens including thiotepa, fludarabine and cyclophosphamide. Most of the patients had chemosensitive disease (n ¼ 39, 75%) and 27 (52%) failed a previous autoSCT. At a median follow-up of 67 months, 27 of 52 patients were found to be alive (52%) and 25 (48%) were dead (n ¼ 19 disease progression, n ¼ 6 non-relapse mortality (NRM)). The cumulative incidence (CI) of NRM was 12% at 5 years. Extensive chronic graft-versus-host disease increased the risk of NRM (33% versus 8%, P ¼ 0.04). The CI of relapse was 49% at 5 years, influenced by disease status at the time of allografting (P ¼ 0.0009) and treatment lines (P ¼ 0.007). Five-year overall survival and progression-free survival (PFS) were 50% (95% CI, 36 -63%) and 40% (95% CI, 27 -53%), respectively. The current PFS was 44% (95% CI, 30-57%). In all, 8 out of 12 patients (66%) who received donor-lymphocytes infusions for disease progression had a response. At multivariable analysis, refractory disease and age over 45 years were independent adverse prognostic factors. RIC allogeneic SCT is an effective salvage treatment with a better outcome for younger patients with chemosensitive disease.

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