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

• Published in: Leukemia Vol. 26; no. 3; pp. 520 - 526
• Main Authors: Dodero, A, Spina, F, Narni, F, Patriarca, F, Cavattoni, I, Benedetti, F, Ciceri, F, Baronciani, D, Scimè, R, Pogliani, E, Rambaldi, A, Bonifazi, F, Dalto, S, Bruno, B, Corradini, P
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-03-2012; Nature Publishing Group
• Subjects: Adolescent; Adult; Anaplastic large-cell lymphoma; Autografts; Biological and medical sciences; Bone marrow; Cancer; Cancer Research; Care and treatment; Chemotherapy; Conditioning; Critical Care Medicine; Cyclophosphamide; Donors; Female; Fludarabine; Graft vs Host Disease - etiology; Graft-versus-host reaction; Health risks; Hematologic and hematopoietic diseases; Hematology; Hematopoietic Stem Cell Transplantation; Humans; Immunotherapy, Adoptive; Intensive; Internal Medicine; Leukemia; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lymphocytes; Lymphocytes T; Lymphoma; Lymphoma, Large B-Cell, Diffuse - mortality; Lymphoma, Large B-Cell, Diffuse - therapy; Lymphoma, T-Cell, Peripheral - complications; Lymphoma, T-Cell, Peripheral - mortality; Lymphoma, T-Cell, Peripheral - therapy; Male; Medical prognosis; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Mortality; Oncology; original-article; Patients; Recurrence; Relapse; Remission (Medicine); Sibling Relations; Stem cell transplantation; Stem cells; Survival; Survival Analysis; T cell lymphoma; Tissue Donors; Transplantation; Transplantation Conditioning; Transplantation, Homologous; Young Adult; Italy; peripheral T-cell lymphomas; reduced-intensity conditioning regimen; allogeneic stem cell transplantation; Relapse; Graft versus tumor reaction; Stem cell; Hematopoietic cell; Homograft; Peripheral T cell lymphoma; Allogeneic hematopoietic stem cell transplantation; Lymphoproliferative syndrome; Immunotherapy; Graft; Remission; Adoptive immunization; Treatment resistance; Hematology; Donor lymphocyte infusion; Malignant hemopathy; Non myeloablative treatment; Non Hodgkin lymphoma; Long term; Treatment; Donor; Therapeutic protocol; Lymphocyte; Cancer
• ISSN: 0887-6924; 1476-5551
• DOI: 10.1038/leu.2011.240

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), angioimmunoblastic 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.