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

• Published in: Bone marrow transplantation (Basingstoke) Vol. 40; no. 5; pp. 443 - 450
• Main Authors: FEYLER, S, PRINCE, H. M, COOK, G, PEARCE, R, TOWLSON, K, NIVISON-SMITH, I, SCHEY, S, GIBSON, J, PATTON, N, BRADSTOCK, K, MARKS, D. I
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01-09-2007
• Subjects: Adolescent; Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antineoplastic Agents - administration & dosage; Autografts; B-cell lymphoma; Biological and medical sciences; Bone marrow; Bone marrow, stem cells transplantation. Graft versus host reaction; Cancer; Care and treatment; Chemotherapy; Child; Confidence intervals; Disease Management; Dosage; Fatalities; Female; Follow-Up Studies; Health aspects; Hematopoietic Stem Cell Transplantation - methods; Hematopoietic Stem Cell Transplantation - mortality; Humans; Lymphocytes B; Lymphocytes T; Lymphoma; Lymphoma, T-Cell - therapy; Lymphoma, T-Cell, Peripheral - mortality; Lymphoma, T-Cell, Peripheral - therapy; Male; Medical prognosis; Medical sciences; Methods; Middle Aged; Mortality; Multivariate analysis; Recurrence; Retrospective Studies; Sensitivity analysis; Stem cell transplantation; Stem cells; Survival; Survival Analysis; T cell lymphoma; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation, Autologous; Transplants & implants; Australia; United Kingdom; Cell therapy; Hematology; T lymphoma; Stem cell; autologous stem cell transplantation; Hematopoietic cell; Homograft; Malignant tumor; Autograft; Clinical management; Treatment; allogeneic stem cell transplantation; Graft; High dose; T-cell lymphoma
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1705752

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=64; allogeneic SCT (Allo-SCT) N=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.