Publication Only: Aggressive non-Hodgkin lymphoma - Clinical
Peripheral T-cell lymphoma (PTCL) is a rare heterogeneous lymphoma with a poor long-term survival.
Our purpose was to assess the efficacy and prognosis of autologous stem cell transplantation (ASCT) as a frontline treatment for PTCL.
Patients (pts) with primary diagnosed PTCL received 6-8 weeks of pre transplant induction chemotherapy. If in complete or partial remission, they proceeded to consolidation with BEAM based ASCT. We retrospectively analyzed all consecutive patients with PTCL treated with ASCT in the Tunisian National Center of Bone Marrow transplantation from January 2004 to February 2017. PTCL diagnosis confirmed by immunohistochemistry according to 2016 WHO classification criteria.
In all, 32 pts were enrolled. Median age at ASCT was 41 years (range 24 to 60 years) and 23 patients (72%) were male. PTCL subtypes included ALK-negative anaplastic T cell lymphoma (TCL) (n = 12); PTCL not otherwise specified, (n = 9); angioimmunblastic TCL (n = 2); enteropathy type TCL (n = 2); extra nodal natural killer TCL, nasal type (n = 2); and hepato splenic TCL (n = 2). 81.2% had advanced disease (Ann Arbor stage III or IV). Three patients (9,4%) had bone marrow involvement and 47 % had elevated serum lactate dehydrogenase. 72 % of all patients had a good PS (WHO 0 to 1). According to IPI, pts were classified low risk (33%), low intermediate (53%) or high intermediate (13%). Pre-transplant first line chemotherapy was CHOP/CHOEP regimen (60%) or ACVBP regimen (40%). 30% of pts had refractory disease and received second line chemotherapy. Pts achieved CR (61%) or PR (39%) prior to ASCT. The median time to neutrophil engraftment was 9 days (range 7 to 16) and the median time to platelet engraftment was 11 days (range 6 to 18). The median hospital stay was 33 days (range 17 to 99). After a median follow-up post ASCT of 23 months (range 5 to 150), 12 patients remained alive. The main cause of death was lymphoma progression (73%). Non-relapse mortality was 3%. The 5-year DFS and OS rate was 35% and 38% respectively. Patients transplanted in CR had a 5-year OS rate of 42%, compared with an OS of 31% in patients in PR.
Frontline ASCT following conventional chemotherapy in PTCL is safe and may be beneficial