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Bone Marrow Transplantation for Peripheral T-Cell Non-Hodgkins’ Lymphoma in First Remission

  • Lymphoma (JW Sweetenham, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion Statement

Peripheral T-cell lymphomas (PTCLs) are rare and heterogeneous diseases that carry, with the exception of anaplastic lymphoma kinase-positive (ALK+) anaplastic large cell lymphoma, a poor prognosis when treated with conventional chemotherapy. Historically, PTCL was treated like aggressive B-cell lymphomas, and to date cyclophosphamide, prednisone, vincristine, and doxorubicin (CHOP) remains the most commonly used regimen, despite disappointing results. Given the poor outcomes of PTCL patients, a number of studies have investigated the role of high-dose chemotherapy and autologous stem cell transplantation (HDT/ASCT) in the upfront setting, with different results. However, there are no prospective randomized trials, and the clinical benefit appears to be restricted to patients who achieve an objective response after induction chemotherapy. Nevertheless, with the exception of low-risk ALK+ anaplastic large cell lymphoma, in light of the available data, HDT/ASCT for consolidation should be recommended for patients deemed eligible. The results of phase II trials showed that allogeneic stem cell transplantation can cure some relapsed/refractory patients, and few studies have evaluated this strategy in the frontline setting. With the availability of recently approved new drugs as well as new targeted agents under investigation, a number of ongoing studies are testing novel combinations aiming to improve rate and durability of responses to induction chemotherapy.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance•• Of major importance

  1. Campo E et al. The 2008 WHO classification of lymphoid neoplasms and beyond: evolving concepts and practical applications. Blood. 2011;117(19):5019–32.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Morton LM et al. Lymphoma incidence patterns by WHO subtype in the United States, 1992–2001. Blood. 2006;107(1):265–76.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Reddy NM, Savani BN. Management of T-cell lymphomas: overcoming challenges and choosing the best treatment. Semin Hematol. 2014;51(1):1–4.

    Article  PubMed  Google Scholar 

  4. Savage KJ et al. Characterization of peripheral T-cell lymphomas in a single North American institution by the WHO classification. Ann Oncol. 2004;15(10):1467–75.

    Article  CAS  PubMed  Google Scholar 

  5. Vose J et al. International peripheral T-cell and natural killer/T-cell lymphoma study: pathology findings and clinical outcomes. J Clin Oncol. 2008;26(25):4124–30.

    Article  PubMed  Google Scholar 

  6. Schmitz N et al. Treatment and prognosis of mature T-cell and NK-cell lymphoma: an analysis of patients with T-cell lymphoma treated in studies of the German High-Grade Non-Hodgkin Lymphoma Study Group. Blood. 2010;116(18):3418–25.

    Article  CAS  PubMed  Google Scholar 

  7. Escalon MP et al. Prognostic factors and treatment of patients with T-cell non-Hodgkin lymphoma: the M.D. Anderson Cancer Center experience. Cancer. 2005;103(10):2091–8.

    Article  PubMed  Google Scholar 

  8. Sonnen R et al. The International Prognostic Index determines the outcome of patients with nodal mature T-cell lymphomas. Br J Haematol. 2005;129(3):366–72.

    Article  PubMed  Google Scholar 

  9. Cuttica A et al. Patients with high-risk aggressive lymphoma treated with frontline intensive chemotherapy and autografting: evidence of marked differences in outcome between patients with age-adjusted International Prognostic Index scores 2 and 3. Cancer. 2003;98(5):983–92.

    Article  CAS  PubMed  Google Scholar 

  10. Savage KJ et al. ALK- anaplastic large-cell lymphoma is clinically and immunophenotypically different from both ALK+ ALCL and peripheral T-cell lymphoma, not otherwise specified: report from the International Peripheral T-Cell Lymphoma Project. Blood. 2008;111(12):5496–504.

    Article  CAS  PubMed  Google Scholar 

  11. Gaulard P, de Leval L. Pathology of peripheral T-cell lymphomas: where do we stand? Semin Hematol. 2014;51(1):5–16.

    Article  CAS  PubMed  Google Scholar 

  12. Sibon D et al. Long-term outcome of adults with systemic anaplastic large-cell lymphoma treated within the Groupe d’Etude des Lymphomes de l’Adulte trials. J Clin Oncol. 2012;30(32):3939–46.

    Article  PubMed  Google Scholar 

  13. Reddy NM, Evens AM. Chemotherapeutic advancements in peripheral T-cell lymphoma. Semin Hematol. 2014;51(1):17–24.

    Article  CAS  PubMed  Google Scholar 

  14. d’Amore F et al. Up-front autologous stem-cell transplantation in peripheral T-cell lymphoma: NLG-T-01. J Clin Oncol. 2012;30(25):3093–9. The largest prospective study to date which included 160 patients with PTCL of which 115 patients underwent an autologous stem cell transplant. The treatment related mortality was 1.7% and with a median follow-up of 60.5 months the OS was 70%, 52% and 47% for ALCL, AILT and PTCL-NOS, respectively.

    Article  PubMed  Google Scholar 

  15. Pfreundschuh M et al. Two-weekly or 3-weekly CHOP chemotherapy with or without etoposide for the treatment of elderly patients with aggressive lymphomas: results of the NHL-B2 trial of the DSHNHL. Blood. 2004;104(3):634–41.

    Article  CAS  PubMed  Google Scholar 

  16. Gallamini A et al. Alemtuzumab (Campath-1H) and CHOP chemotherapy as first-line treatment of peripheral T-cell lymphoma: results of a GITIL (Gruppo Italiano Terapie Innovative nei Linfomi) prospective multicenter trial. Blood. 2007;110(7):2316–23.

    Article  CAS  PubMed  Google Scholar 

  17. O’Connor OA et al. Pralatrexate in patients with relapsed or refractory peripheral T-cell lymphoma: results from the pivotal PROPEL study. J Clin Oncol. 2011;29(9):1182–9.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Piekarz RL et al. Phase 2 trial of romidepsin in patients with peripheral T-cell lymphoma. Blood. 2011;117(22):5827–34.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Younes A et al. Brentuximab vedotin (SGN-35) for relapsed CD30-positive lymphomas. N Engl J Med. 2010;363(19):1812–21.

    Article  CAS  PubMed  Google Scholar 

  20. Pro B et al. Brentuximab vedotin (SGN-35) in patients with relapsed or refractory systemic anaplastic large-cell lymphoma: results of a phase II study. J Clin Oncol. 2012;30(18):2190–6.

    Article  CAS  PubMed  Google Scholar 

  21. Moskowitz AJ, Lunning MA, Horwitz SM. How I treat the peripheral T-cell lymphomas. Blood. 2014;123(17):2636–44.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. Karlin L, Coiffier B. The changing landscape of peripheral T-cell lymphoma in the era of novel therapies. Semin Hematol. 2014;51(1):25–34.

    Article  PubMed  Google Scholar 

  23. Giulia P, Corradini P. Autologous stem cell transplantation for T-cell lymphomas. Semin Hematol. 2014;51(1):59–66.

    Article  CAS  PubMed  Google Scholar 

  24. Reimer P et al. Autologous stem-cell transplantation as first-line therapy in peripheral T-cell lymphomas: results of a prospective multicenter study. J Clin Oncol. 2009;27(1):106–13. There were 83 patients with PTCL who proceeded to autologous transplant after induction with CHOP. One patient died during high-dose conditioning and the 3-year OS rate was 48% for all patients.

    Article  CAS  PubMed  Google Scholar 

  25. Corradini P et al. Long-term follow-up of patients with peripheral T-cell lymphomas treated up-front with high-dose chemotherapy followed by autologous stem cell transplantation. Leukemia. 2006;20(9):1533–8. This study included 62 patients with PTCL including ALK+ ALCL. The 12-year OS, DFS and event-free survival (EFS) were 34%, 55% and 30%, respectively. The achievement of CR prior to ASCT was associated with an OS benefit.

    Article  CAS  PubMed  Google Scholar 

  26. Rodriguez J et al. Frontline autologous stem cell transplantation in high-risk peripheral T-cell lymphoma: a prospective study from The Gel-Tamo Study Group. Eur J Haematol. 2007;79(1):32–8.

    Article  PubMed  Google Scholar 

  27. Mercadal S et al. Intensive chemotherapy (high-dose CHOP/ESHAP regimen) followed by autologous stem-cell transplantation in previously untreated patients with peripheral T-cell lymphoma. Ann Oncol. 2008;19(5):958–63.

    Article  CAS  PubMed  Google Scholar 

  28. Abramson JS et al. Peripheral T-cell lymphomas in a large US multicenter cohort: prognostication in the modern era including impact of frontline therapy. Ann Oncol. 2014;25(11):2211–7. This study described 33 patients who underwent an autologous transplant in first remission. Consolidation with autologous stem cell transplant was associated with an improvement in PFS and OS; however this benefit was lost in multivariate analysis.

    Article  CAS  PubMed  Google Scholar 

  29. Rodriguez J et al. High-dose chemotherapy and autologous stem cell transplantation in peripheral T-cell lymphoma: the GEL-TAMO experience. Ann Oncol. 2003;14(12):1768–75.

    Article  CAS  PubMed  Google Scholar 

  30. Numata A et al. Long-term outcomes of autologous PBSCT for peripheral T-cell lymphoma: retrospective analysis of the experience of the Fukuoka BMT group. Bone Marrow Transplant. 2010;45(2):311–6.

    Article  CAS  PubMed  Google Scholar 

  31. Chen AI et al. Long-term results of autologous hematopoietic cell transplantation for peripheral T cell lymphoma: the Stanford experience. Biol Blood Marrow Transplant. 2008;14(7):741–7.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Ahn JS et al. Autologous stem cell transplantation with busulfan, cyclophosphamide, and etoposide as an intensifying frontline treatment in patients with peripheral T cell lymphomas: a multicenter retrospective trial. Ann Hematol. 2013;92(6):789–97.

    Article  CAS  PubMed  Google Scholar 

  33. Blystad AK et al. High-dose therapy with autologous stem cell transplantation in patients with peripheral T cell lymphomas. Bone Marrow Transplant. 2001;27(7):711–6.

    Article  CAS  PubMed  Google Scholar 

  34. Schmitz N, Wu HS, Glass B. Allogeneic transplantation in T-cell lymphomas. Semin Hematol. 2014;51(1):67–72.

    Article  CAS  PubMed  Google Scholar 

  35. Corradini P et al. Graft-versus-lymphoma effect in relapsed peripheral T-cell non-Hodgkin’s lymphomas after reduced-intensity conditioning followed by allogeneic transplantation of hematopoietic cells. J Clin Oncol. 2004;22(11):2172–6.

    Article  PubMed  Google Scholar 

  36. Corradini P et al. Intensified chemo-immunotherapy with or without stem cell transplantation in newly diagnosed patients with peripheral T-cell lymphoma. Leukemia. 2014;28(9):1885–91.

    Article  CAS  PubMed  Google Scholar 

  37. Loirat M et al. Upfront allogeneic stem-cell transplantation for patients with nonlocalized untreated peripheral T-cell lymphoma: an intention-to-treat analysis from a single center. Ann Oncol. 2015;26(2):386–92.

    Article  CAS  PubMed  Google Scholar 

  38. Beitinjaneh A, et al. Comparison of survival in patients with T cell lymphoma after autologous and allogeneic stem cell transplantation as a frontline strategy or in relapsed disease. Biol Blood Marrow Transplant. 2015;21(5):855–9.

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Conflict of Interest

Manish Sharma declares that he has no conflict of interest.

Barbara Pro has received research support through a grant from Seattle Genetics and has received compensation from Celgene and Spectrum Pharmaceuticals for service as a consultant.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Department of Medical Oncology, Thomas Jefferson University, 835 Chestnut Street, Suite 315, Philadelphia, PA, 19107, USA

    Manish Sharma MD & Barbara Pro MD

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  1. Manish Sharma MD
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  2. Barbara Pro MD
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Correspondence to Barbara Pro MD.

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This article is part of the Topical Collection on Lymphoma

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Sharma, M., Pro, B. Bone Marrow Transplantation for Peripheral T-Cell Non-Hodgkins’ Lymphoma in First Remission. Curr. Treat. Options in Oncol. 16, 34 (2015). https://doi.org/10.1007/s11864-015-0347-3

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  • DOI: https://doi.org/10.1007/s11864-015-0347-3

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