title: DexaBEAM versus ICE salvage regimen prior to autologous transplantation for relapsed or refractory aggressive peripheral T cell lymphoma: a retrospective evaluation of parallel patient cohorts of one center.
abstract: High-dose chemotherapy (HDT) followed by autologous stem cell transplantation (ASCT) is considered standard in the treatment of patients with relapsed or refractory aggressive peripheral T cell lymphoma (PTCL). However, the optimal salvage regimen before ASCT has not yet been established. We retrospectively analyzed 31 patients with relapsed or refractory aggressive PTCL after anthracycline-based first-line chemotherapy who received either DexaBEAM (dexamethasone, carmustine, etoposide, cytarabine, and melphalan; n = 16) or ICE (ifosfamide, carboplatin, and etoposide; n = 15) regimen as first salvage chemotherapy followed by HDT/ASCT. The overall response rate (OR) was significantly higher for patients treated with DexaBEAM (69 %; 95 % confidence interval 46.0-91.5 %) as compared to the ICE group (20 %; 95 % confidence interval -0.2-40.2 %; P = 0.01), with higher complete response (CR; 38 %; 95 % confidence interval 13.8-61.2 %; vs. 7 %; 95 % confidence interval -6.0-19.6 %) as well as partial response (PR; 31 vs. 13 %) rate. Changing regimen due to failure of first salvage therapy, 12 patients initially receiving ICE still achieved an OR of 58 % (33 % CR, 25 % PR) with DexaBEAM as second salvage therapy, whereas in three patients receiving ICE after DexaBEAM failure, only one achieved an OR (1 PR). Median progression-free survival was significantly higher in the DexaBEAM group (6.4 vs. 2 months; P = 0.01). Major adverse event in both groups was myelosuppression with higher but tolerable treatment-related toxicity for patients in the DexaBEAM group. For all patients proceeding to HDT/ASCT, a 3-year overall survival was 50 %. Together, considering the limitations of the retrospective design of the evaluation and the small sample size, our data suggest that DexaBEAM salvage chemotherapy is superior to ICE for patients with relapsed or refractory aggressive PTCL for remission induction prior to autologous transplantation, with higher but manageable treatment-related toxicity.
authors.affiliation: Department of Medicine, Hematology and Oncology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Muenster, Germany.
authors.forename: Jan-Henrik
authors.initials: JH
authors.lastname: Mikesch
authors.forename: Mareike
authors.initials: M
authors.lastname: Kuhlmann
authors.forename: Angela
authors.initials: A
authors.lastname: Demant
authors.forename: Utz
authors.initials: U
authors.lastname: Krug
authors.forename: Gabriela B
authors.initials: GB
authors.lastname: Thoennissen
authors.forename: Eva
authors.initials: E
authors.lastname: Schmidt
authors.forename: Torsten
authors.initials: T
authors.lastname: Kessler
authors.forename: Christoph
authors.initials: C
authors.lastname: Schliemann
authors.forename: Michele
authors.initials: M
authors.lastname: Pohlen
authors.forename: Michael
authors.initials: M
authors.lastname: Mohr
authors.forename: Georg
authors.initials: G
authors.lastname: Evers
authors.forename: Gabriele
authors.initials: G
authors.lastname: Köhler
authors.forename: Johannes
authors.initials: J
authors.lastname: Wessling
authors.forename: Rolf
authors.initials: R
authors.lastname: Mesters
authors.forename: Carsten
authors.initials: C
authors.lastname: Müller-Tidow
authors.forename: Wolfgang E
authors.initials: WE
authors.lastname: Berdel
authors.forename: Nils H
authors.initials: NH
authors.lastname: Thoennissen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D002330:Carmustine / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D004341:Drug Evaluation; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006402:Hematologic Diseases / Q000139:chemically induced; D019650:Hematopoietic Stem Cell Mobilization; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D016411:Lymphoma, T-Cell, Peripheral / Q000188:drug therapy* / Q000601:surgery; D008297:Male; D008558:Melphalan / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D052016:Mucositis / Q000139:chemically induced; D036102:Peripheral Blood Stem Cell Transplantation; D011300:Preoperative Care; D012189:Retrospective Studies; D016879:Salvage Therapy; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003561:Cytarabine; D016179:Granulocyte Colony-Stimulating Factor; D005047:Etoposide; D003907:Dexamethasone; D016190:Carboplatin; D008558:Melphalan; D002330:Carmustine; D007069:Ifosfamide