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The role of high-dose therapy and stem cell rescue in the management of T-cell malignant lymphomas: a BSBMT and ABMTRR study

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Abstract

Peripheral T-cell lymphomas (PTCL) are a rare and heterogeneous subset of lymphomas with a poorer prognosis compared with B-cell lymphomas. We conducted a retrospective study of 82 patients who received high-dose therapy for PTCL (autologous SCT (ASCT) N=64; allogeneic SCT (Allo-SCT) N=18). With a median follow-up from ASCT of 37 months from transplant, 33 patients were alive; 20 died of progressive disease, 10 died from non-relapse mortality (NRM) with 1 unknown cause. Three-year overall survival (OS) and progression-free survival (PFS) were 53% (95% confidence interval (CI) 42, 67) and 50% (95% CI 39, 64), respectively. Factors significantly affecting OS and PFS on univariate analysis were histological subtype and chemotherapy sensitivity. In a multivariate analysis, the only factor with significant impact was chemotherapy sensitivity. After a median follow-up from Allo-SCT of 57 months, five patients were alive; five died of progressive disease and eight died from NRM. The 3-year OS and PFS were 39% (95% CI 22, 69) and 33% (95% CI 17, 64), respectively, and the 3-year relapse rate was 28% (95% CI 6, 50). These results demonstrate that high-dose chemotherapy with autologous stem cell rescue has a substantial role in the management of T-cell lymphoma. The use of full-intensity allogeneic transplantation is limited by high transplant-related mortality, and exploration of reduced intensity regimens is warranted.

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References

  1. A clinical evaluation of the International Lymphoma Study Group classification of non-Hodgkin's lymphoma. The Non-Hodgkin's Lymphoma Classification Project. Blood 1997; 89: 3909–3918.

  2. Armitage JO, Vose JM, Linder J, Weisenburger D, Harrington D, Casey J et al. Clinical significance of immunophenotype in diffuse aggressive non-Hodgkin's lymphoma. J Clin Oncol 1989; 7: 1783–1790.

    Article  CAS  PubMed  Google Scholar 

  3. Coiffier B, Brousse N, Peuchmaur M, Berger F, Gisselbrecht C, Bryon PA et al. Peripheral T-cell lymphomas have a worse prognosis than B-cell lymphomas: a prospective study of 361 immunophenotyped patients treated with the LNH-84 regimen. The GELA (Groupe d'Etude des Lymphomes Agressives). Ann Oncol 1990; 1: 45–50.

    Article  CAS  PubMed  Google Scholar 

  4. Melnyk A, Rodriguez A, Pugh WC, Cabannillas F . Evaluation of the revised European-American lymphoma classification confirms the clinical relevance of immunophenotype in 560 cases of aggressive non-Hodgkin's lymphoma. Blood 1997; 89: 4514–4520.

    CAS  PubMed  Google Scholar 

  5. Zamkoff KW, Matulis MD, Mehta AC, Beaty MW, Hutchison RE, Gentile TC . High-dose therapy and autologous stem cell transplant does not result in long-term disease-free survival in patients with recurrent chemotherapy-sensitive ALK-negative anaplastic large-cell lymphoma. Bone Marrow Transplant 2004; 33: 635–638.

    Article  CAS  PubMed  Google Scholar 

  6. Rodriguez J, Munsell M, Yazji S, Hagemeister FB, Younes A, Andersson B et al. Impact of high-dose chemotherapy on peripheral T-cell lymphomas. J Clin Oncol 2001; 19: 3766–3770.

    Article  CAS  PubMed  Google Scholar 

  7. Song KW, Mollee P, Keating A, Crump M . Autologous stem cell transplant for relapsed and refractory peripheral T-cell lymphoma: variable outcome according to pathological subtype. Br J Haematol 2003; 120: 978–985.

    Article  PubMed  Google Scholar 

  8. Jagasia M, Morgan D, Goodman S, Hamilton K, Kinney M, Shyr Y et al. Histology impacts the outcome of peripheral T-cell lymphomas after high dose chemotherapy and stem cell transplant. Leuk Lymphoma 2004; 45: 2261–2267.

    Article  CAS  PubMed  Google Scholar 

  9. Kewalramani T, Zelenetz AD, Teruya-Feldstein J, Hamlin P, Yahalom J, Horwitz S et al. Autologous transplantation for relapsed or primary refractory peripheral T-cell lymphoma. Br J Haematol 2006; 134: 202–207.

    Article  PubMed  Google Scholar 

  10. Ratanatharathorn V, Uberti J, Karanes C, Abella E, Lum LG, Momin F et al. Prospective comparative trial of autologous versus allogeneic bone marrow transplantation in patients with non-Hodgkin's lymphoma. Blood 1994; 84: 1050–1055.

    CAS  PubMed  Google Scholar 

  11. Tsai T, Goodman S, Saez R, Schiller G, Adkins D, Callander N et al. Allogeneic bone marrow transplantation in patients who relapse after autologous transplantation. Bone Marrow Transplant 1997; 20: 859–863.

    Article  CAS  PubMed  Google Scholar 

  12. Corradini P, Dodero A, Zallio F, Caracciolo D, Casini M, Bregni M 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: 2172–2176.

    Article  PubMed  Google Scholar 

  13. Gray R . A class of K-sample tests for comparing the cumulative incidence of a competing risk. Ann Stat 1988; 16: 1141–1154.

    Article  Google Scholar 

  14. Blystad AK, Enblad G, Kvaloy S, Berglund A, Delabie J, Holte H et al. High-dose therapy with autologous stem cell transplantation in patients with peripheral T cell lymphomas. Bone Marrow Transplant 2001; 27: 711–716.

    Article  CAS  PubMed  Google Scholar 

  15. Jantunen E, Wiklund T, Juvonen E, Putkonen M, Lehtinen T, Kuittinen O et al. Autologous stem cell transplantation in adult patients with peripheral T-cell lymphoma: a nation-wide survey. Bone Marrow Transplant 2004; 33: 405–410.

    Article  CAS  PubMed  Google Scholar 

  16. Rodriguez J, Caballero MD, Gutierrez A, Marin J, Lahuerta JJ, Sureda A et al. High-dose chemotherapy and autologous stem cell transplantation in peripheral T-cell lymphoma: the GEL-TAMO experience. Ann Oncol 2003; 14: 1768–1775.

    Article  CAS  PubMed  Google Scholar 

  17. Reimer P, Schertlin T, Rudiger T, Geissinger E, Roth S, Kunzmann V et al. Myeloablative radiochemotherapy followed by autologous peripheral blood stem cell transplantation as first-line therapy in peripheral T-cell lymphomas: first results of a prospective multicenter study. Hematol J 2004; 5: 304–311.

    Article  CAS  PubMed  Google Scholar 

  18. Fanin R, Ruiz de Elvira MC, Sperotto A, Baccarani M, Goldstone A . Autologous stem cell transplantation for T and null cell CD30-positive anaplastic large cell lymphoma: analysis of 64 adult and paediatric cases reported to the European Group for Blood and Marrow Transplantation (EBMT). Bone Marrow Transplant 1999; 23: 437–442.

    Article  CAS  PubMed  Google Scholar 

  19. Peggs KS, Mackinnon S, Linch DC . The role of allogeneic transplantation in non-Hodgkin's lymphoma. Br J Haematol 2005; 128: 153–168.

    Article  PubMed  Google Scholar 

  20. Robinson SP, Goldstone AH, Mackinnon S, Carella A, Russell N, de Elvira CR et al. Chemoresistant or aggressive lymphoma predicts for a poor outcome following reduced-intensity allogeneic progenitor cell transplantation: an analysis from the Lymphoma Working Party of the European Group for Blood and Bone Marrow Transplantation. Blood 2002; 100: 4310–4316.

    Article  CAS  PubMed  Google Scholar 

  21. Kahl C, Leithauser M, Wolff D, Steiner B, Hartung G, Casper J et al. Treatment of peripheral T-cell lymphomas (PTCL) with high-dose chemotherapy and autologous or allogeneic hematopoietic transplantation. Ann Hematol 2002; 81: 646–650.

    Article  CAS  PubMed  Google Scholar 

  22. Dhedin N, Giraudier S, Gaulard P, Esperou H, Ifrah N, Michallet M et al. Allogeneic bone marrow transplantation in aggressive non-Hodgkin's lymphoma (excluding Burkitt and lymphoblastic lymphoma): a series of 73 patients from the SFGM database. Societ Francaise de Greffe de Moelle. Br J Haematol 1999; 107: 154–161.

    Article  CAS  PubMed  Google Scholar 

  23. Herbert KE, Spencer A, Grigg A, Ryan G, McCormack C, Prince HM . Graft-versus-lymphoma effect in refractory cutaneous T-cell lymphoma after reduced-intensity HLA-matched sibling allogeneic stem cell transplantation. Bone Marrow Transplant 2004; 34: 521–525.

    Article  CAS  PubMed  Google Scholar 

  24. Russell NH, Byrne JL, Faulkner RD, Gilyead M, Das-Gupta EP, Haynes AP . Donor lymphocyte infusions can result in sustained remissions in patients with residual or relapsed lymphoid malignancy following allogeneic haemopoietic stem cell transplantation. Bone Marrow Transplant 2005; 36: 437–441.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

SF is funded by the Arnold J Tunstall Research Fellowship. The Clinical Trials Committee of BSBMT is supported by The Leukaemia Research Fund (Grant 03/100, Dr DI Marks). The authors would like to thank the following transplant centres (Director/Data manager) for their contribution: Queen Elizabeth Hospital (C Craddock/C Porter), Birmingham, UK; United Hospitals Bristol (D Marks/A Nunn), Bristol, UK; Addenbrookes Hospital (R Marcus/C Howlett), Cambridge, UK; Canterbury Health Laboratories (N Patton/J Sanders), Christchurch, New Zealand; Western General Hospital (J Davies/A Robertson), Edinburgh, UK; Leeds Teaching Hospital (G Cook/L Barnard), Leeds, UK; Guys Hospital (S Schey/M Rahman), London, UK; Royal Free Hospital (S MacKinnon/J Ankrah), London, UK; Christie Hospital (J Cavet/B Foulkes), Manchester, UK; Kings College Hospital (A Pagluica/M Kenyon), London, UK; Newcastle Mater Misericordiae Hospital (A Enno/H Zang), Newcastle, Australia; Nottingham City Hospital (N Russell/P Nelson), Nottingham, UK; Peter MacCallum Cancer Centre (HM Prince/T Joyce), Melbourne, Australia; Royal Adelaide Hospital (LB To/K Olson), Adelaide, Australia; Royal Prince Alfred Hospital (J Gibson/AM Johnston), Sydney, Australia; Royal Hallamshire Hospital (J Snowden/B Holt), Sheffield, UK; Southampton University Hospitals (K Orchard/C Hurlock), Southampton, UK; St Vincent's Hospital (AJ Dodds/A Jiamsakul), Sydney, Australia; Taunton (S Rule/M Ewings), Taunton, UK; and Westmead Hospital (K Bradstock/G Huang), Sydney, Australia.

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Authors and Affiliations

  1. BMTU, St James's University Hospital, Leeds, UK

    S Feyler & G Cook

  2. Department of Haematology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia

    H M Prince

  3. BSBMT, University College Hospital, London, UK

    R Pearce & K Towlson

  4. ABMTRR, St Vincent's Hospital, Sydney, Australia

    I Nivison-Smith

  5. Department of Haematology, King's College Hospital, London, UK

    S Schey

  6. Department of Haematology, Royal Prince Alfred Hospital, Sydney, Australia

    J Gibson

  7. Canterbury Health Laboratories, Christchurch, New Zealand

    N Patton

  8. Department of Haematology, Westmead Hospital, Sydney, Australia

    K Bradstock

  9. Department of Haematology, United Bristol Healthcare Trust, Bristol, UK

    D I Marks

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  1. S Feyler
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  11. G Cook
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Feyler, S., Prince, H., Pearce, R. et al. The role of high-dose therapy and stem cell rescue in the management of T-cell malignant lymphomas: a BSBMT and ABMTRR study. Bone Marrow Transplant 40, 443–450 (2007). https://doi.org/10.1038/sj.bmt.1705752

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  • DOI: https://doi.org/10.1038/sj.bmt.1705752

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