title: Graft-versus-lymphoma effect in relapsed peripheral T-cell non-Hodgkin's lymphomas after reduced-intensity conditioning followed by allogeneic transplantation of hematopoietic cells.
abstract: OBJECTIVE
  Peripheral T-cell lymphomas (PTCLs) are a heterogeneous group of malignancies characterized by a poor prognosis. We performed a pilot study to investigate the role of reduced-intensity conditioning (RIC) followed by allogeneic stem-cell transplantation in relapsed or refractory PTCLs.
  
  
  METHODS
  We have conducted a phase II trial on 17 patients receiving salvage chemotherapy followed by RIC and allogeneic transplantation of hematopoietic cells. The RIC regimen consisted of thiotepa, fludarabine, and cyclophosphamide. The acute graft-versus-host disease prophylaxis consisted of cyslosporine and short course methotrexate.
  
  
  RESULTS
  Patients had a median age of 41 years (range, 23 to 60 years). Two patients were primary chemorefractory, and 15 had relapsed disease; eight patients (47%) had a disease relapse after an autologous transplantation. After a median follow-up of 28 months from the day of study entry (range, 3 to 57 months), 14 of 17 patients were alive (12 in complete remission, one in partial remission, and one with stable disease), two died as a result of progressive disease, and one died as a result of sepsis concomitant to acute graft-versus-host disease. The estimated 3-year overall and progression-free survival rates were 81% (95% CI, 62% to 100%) and 64% (95% CI, 39% to 89%), respectively. The estimated probability of nonrelapse mortality at 2 years was 6% (95% CI, 1% to 17%). Donor lymphocyte infusions induced a response in two patients progressing after allografting.
  
  
  CONCLUSIONS
  RIC followed by allogeneic stem-cell transplantation is feasible, has a low treatment-related mortality, and seems to be a promising salvage treatment for relapsed PTCL. These findings suggest that the existence of a graft-versus-T-cell lymphoma effect.
authors.affiliation: Division of Hematology-Bone Marrow Transplantation, Istituto Nazionale per lo Studio e la Cura dei Tumori, Via Venezian, 1, 20133 Milano, Italy. paolo.corradini@unimi.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Corradini
authors.forename: Anna
authors.initials: A
authors.lastname: Dodero
authors.forename: Francesco
authors.initials: F
authors.lastname: Zallio
authors.forename: Daniele
authors.initials: D
authors.lastname: Caracciolo
authors.forename: Marco
authors.initials: M
authors.lastname: Casini
authors.forename: Marco
authors.initials: M
authors.lastname: Bregni
authors.forename: Franco
authors.initials: F
authors.lastname: Narni
authors.forename: Francesca
authors.initials: F
authors.lastname: Patriarca
authors.forename: Mario
authors.initials: M
authors.lastname: Boccadoro
authors.forename: Fabio
authors.initials: F
authors.lastname: Benedetti
authors.forename: A
authors.initials: A
authors.lastname: Rambaldi
authors.forename: Alessandro M
authors.initials: AM
authors.lastname: Gianni
authors.forename: Corrado
authors.initials: C
authors.lastname: Tarella
mesh_terms: D000328:Adult; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality; D006801:Humans; D016411:Lymphoma, T-Cell, Peripheral / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D016879:Salvage Therapy / Q000379:methods*; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*