Long-term follow-up of patients with peripheral T-cell lymphomas treated up-front with high-dose chemotherapy followed by autologous stem cell transplantation.
We report the results of two prospective phase II studies investigating the role of high-dose sequential chemotherapy, followed by autologous stem cell transplantation (ASCT) in 62 patients with advanced stage peripheral T-cell lymphomas (PTCLs) at diagnosis. Conditioning regimen consisted of mitoxantrone (60 mg/m2) and melphalan (180 mg/m2) or carmustine, etoposide, Ara-C and melphalan followed by peripheral blood stem cell autografting. In an intent-to-treat analysis, 46 out of 62 patients (74%) completed the whole programme, whereas 16 patients did not undergo ASCT, mainly because of disease progression. At a median follow-up of 76 months, the estimated 12-year overall (OS), disease-free and event-free survival (EFS) were 34, 55 and 30%, respectively. OS and EFS were significantly better in patients with anaplastic lymphoma-kinase (ALK)-positive anaplastic large-cell lymphoma (ALCL), as compared with the remaining PTCL. Multivariate analysis showed that patients attaining complete remission (CR) before ASCT had a statistically significant benefit in terms of OS and EFS (P<0.0001). Overall treatment-related mortality rate was 4.8%. In conclusion, our findings indicate (1) up-front high-dose therapy and ASCT are feasible, but could induce a high rate of long-term CR only in patients with ALK-positive ALCL and (2) the achievement of CR before autografting is a strong predictor of better survival.
Corradini
P
P
Divisione di Ematologia, Istituto Nazionale per lo Studio e la Cura dei Tumori, Università di Milano, Milano, Italy. paolo.corradini@istitutotumori.mi.it
Tarella
C
C
Zallio
F
F
Dodero
A
A
Zanni
M
M
Valagussa
P
P
Gianni
A M
AM
Rambaldi
A
A
Barbui
T
T
Cortelazzo
S
S
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006801:Humans; D016399:Lymphoma, T-Cell / Q000188:drug therapy* / Q000601:surgery*; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D033581:Stem Cell Transplantation; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D016896:Treatment Outcome