Upfront allogeneic stem-cell transplantation for patients with nonlocalized untreated peripheral T-cell lymphoma: an intention-to-treat analysis from a single center.
BACKGROUND
Peripheral T-cell lymphomas (PTCLs) are rare and heterogeneous diseases with dismal outcome when treated with chemotherapy alone. Because allogeneic stem-cell transplantation (allo-SCT) can cure relapse/refractory patients, we hypothesized that upfront allo-SCT may provide a better outcome. Therefore, all patients that presented with advanced PTCL in our institution at diagnosis were scheduled to undergo upfront allo-SCT after induction chemotherapy.


METHODS
The aim of the present work was to assess the feasibility and toxicity of upfront allo-SCT. From 2004 to 2012, 49 newly diagnosed PTCL patients were scheduled to receive upfront allo-SCT. A human leukocyte antigen-matched donor was found for 42 patients: related to the patient in 15 cases, unrelated in 20 cases, and suitable cord blood units were used in 7 cases.


RESULTS
After induction chemotherapy, 17 patients reached complete remission and 29 (60%) proceeded to upfront allo-SCT. For all patients, the 1 and 2-year overall survival (OS) rates were 59% [95% confidence interval (CI) 47-75] and 55% (95% CI 43-71), respectively. The most frequent reason we did not proceed to allo-SCT was disease progression or insufficient response after induction. For transplanted patients, the 1- and 2-year OS were 76% (95% CI 62-93) and 72.5% (95% CI 58-91), respectively. Toxicity-related mortality (TRM) 1 year after allo-SCT was only 8.2% (95% CI 0-18.5). The 2-year progression-free survival (PFS) rate of patients who did not proceed to allo-SCT (n = 20) was below 30%. The disease status at the time of transplantation was a strong predictive marker for both PFS and OS in transplant patients.


CONCLUSIONS
Upfront allo-SCT in PTCLs is feasible with low TRM, and it provides long-term disease control. However, one-third of patients remain chemo-refractory and, thus, new therapeutic approaches are warranted. The role of upfront allo-SCT compared with other therapeutic approaches in PTCLs requires investigation in randomized studies.
Department of Hematology.
M
M
Loirat
Department of Hematology.
P
P
Chevallier
Department of Epidemiology.
C
C
Leux
Department of Pathology, University Hospital of Nantes, Nantes.
A
A
Moreau
Department of Pathology, University Hospital of Nantes, Nantes.
C
C
Bossard
Department of Hematology.
T
T
Guillaume
Department of Hematology.
T
T
Gastinne
Department of Hematology.
J
J
Delaunay
Department of Hematology.
N
N
Blin
Department of Hematology.
B
B
Mahé
Department of Hematology.
V
V
Dubruille
Department of Hematology.
K
K
Augeul-Meunier
Department of Hematology.
P
P
Peterlin
Department of Hematology, CHD de la Roche-Sur-Yon.
H
H
Maisonneuve
Department of Hematology, CH de Lorient, La Roche-Sur-Yon.
P
P
Moreau
Department of Hematology, Centre Catherine de Sienne, Rezé
N
N
Juge-Morineau
Department of Hematology, CH de Vannes, Vannes.
H
H
Jardel
Department of Hematology, Saint-antoine, APHP, Paris.
M
M
Mohty
Department of Hematology.
P
P
Moreau
Department of Hematology INSERM, UMR892, Equipe 10, Nantes INSERM, CIC 004, Nantes University Hospital, Nantes, France steven.legouill@chu-nantes.fr.
S
S
Le Gouill
D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D057194:Intention to Treat Analysis; D053208:Kaplan-Meier Estimate; D016411:Lymphoma, T-Cell, Peripheral / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D014184:Transplantation, Homologous
allogeneic stem-cell transplantation; peripheral T-cell lymphoma