High dose chemotherapy and autologous stem cell transplantation in patients with peripheral T-cell lymphoma not achieving complete response after induction chemotherapy. The GEL-TAMO experience.
OBJECTIVE
Patients with aggressive non-Hodgkin's lymphomas (NHL) who do not obtain a complete response (CR) after induction chemotherapy have a poor prognosis. However, provided they are sensitive to the first regimen of chemotherapy, 25-40% of them with a B-cell phenotype may achieve long-term survival when treated with high dose chemotherapy and autologous stem cell transplantation (HDC/ASCT). The aim of this study was to analyze the efficacy of this therapy in the corresponding patients with peripheral T-cell lymphoma (PTCL).


METHODS
We retrospectively evaluated the efficacy of ASCT in 35 patients with PTCL from the GEL-TAMO registry, who did not achieve a CR to standard induction chemotherapy regimens for aggressive NHL. Thirty-one patients underwent transplantation after achieving a partial response (PR) and 4 patients were non-responders.


RESULTS
Following HDC/ASCT, 23 (66%) of the patients achieved a CR, 4 (11%) a PR and in 7 (20%) cases the transplant failed. One patient was not evaluated because of early toxic death. With a median follow-up of the survivors of 37.5 months, 18 patients (51%) are alive and 15 patients (43%) are free of disease. Transplant-related mortality rate at 100 days was 11% and at 5 years the probabilities of survival, freedom from progression and disease-free survival for complete responders were 37%, 36% and 55% respectively. Pre-transplant lactate-dehydrogenase level, age-adjusted International Prognostic Index (aa-IPI) and tumor score correlated with survival.


CONCLUSIONS
One third of the patients with PTCL who fail to achieve CR to the first chemotherapeutic regimen can be rescued with HDC/ASCT. Pre-transplant values of IPI and tumor score risk systems for aggressive lymphomas were useful to predict subsequent survival.
Rodriguez
José
J
Servicio de Hematología, Hospital Universitario Son Dureta, Av/Andrea Doria 55, Palma de Mallorca 07014, Spain. jrodriguez@hsd.es
Caballero
Maria Dolores
MD
Gutierrez
Antonio
A
Gandarillas
Marco
M
Sierra
Jorge
J
Lopez-Guillermo
Armando
A
Sureda
Anna
A
Zuazu
Javier
J
Marin
Jesus
J
Arranz
Reyes
R
Carreras
Enric
E
Leon
Angel
A
De Sevilla
Alberto Fernández
AF
San Miguel
Jesus F
JF
Conde
Eulogio
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015993:Life Tables; D016411:Lymphoma, T-Cell, Peripheral / Q000188:drug therapy* / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation; D011379:Prognosis; D012042:Registries; D012074:Remission Induction; D012189:Retrospective Studies; D016879:Salvage Therapy; D012720:Severity of Illness Index; D013030:Spain; D016019:Survival Analysis; D014182:Transplantation, Autologous; D016896:Treatment Outcome