☆ 4.7 Article

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

LEUKEMIA (2012)

Journal

LEUKEMIA

Volume 26, Issue 3, Pages 520-526

Publisher

NATURE PUBLISHING GROUP

DOI: 10.1038/leu.2011.240

Keywords

allogeneic stem cell transplantation; peripheral T-cell lymphomas; reduced-intensity conditioning regimen

Funding

Associazione Italiana Ricerca sul Cancro (AIRC)
MIUR

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Abstract

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 = 23), anaplastic large-cell lymphoma (n = 11), angio-immunoblastic T-cell lymphomas (n = 9) and rare subtypes (n = 9). Patients were allografted from related siblings (n = 33, 64%) or alternative donors (n = 13 (25%) from unrelated and 6 (11%) from haploidentical family donors), following reduced-intensity conditioning (RIC) regimens including thiotepa, fludarabine and cyclophosphamide. Most of the patients had chemosensitive disease (n = 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 = 19 disease progression, n = 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 = 0.04). The CI of relapse was 49% at 5 years, influenced by disease status at the time of allografting (P = 0.0009) and treatment lines (P = 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. Leukemia (2012) 26, 520-526; doi:10.1038/leu.2011.240; published online 9 September 2011

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Impact of conditioning regimen intensity on the outcomes of peripheral T-cell lymphoma, anaplastic large cell lymphoma and angioimmunoblastic T-cell lymphoma patients undergoing allogeneic transplant

Malvi Savani, Kwang W. Ahn, Yue Chen, Sairah Ahmed, Amanda F. Cashen, Mazyar Shadman, Dipenkumar Modi, Farhad Khimani, Corey S. Cutler, Jasmine Zain, Jonathan E. Brammer, Andrew R. Rezvani, Timothy S. Fenske, Craig S. Sauter, Mohamed A. Kharfan-Dabaja, Alex F. Herrera, Mehdi Hamadani

Summary: This study compared the outcomes of reduced-intensity/non-myeloablative conditioning (RIC/NMA) and myeloablative conditioning (MAC) regimens in T-cell non-Hodgkin lymphoma (T-NHL) patients undergoing allogeneic transplant (allo-HCT). The results showed no significant differences in overall survival, non-relapse mortality, risk of progression/relapse, and therapy failure between the two regimens.

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