PURPOSE: Systemic peripheral T-cell lymphomas (PTCLs) respond poorly to conventional therapy. To evaluate the efficacy of a dose-dense approach consolidated by up-front high-dose chemotherapy (HDT) and autologous stem-cell transplantation (ASCT) in PTCL, the Nordic Lymphoma Group (NLG) conducted a large prospective phase II study in untreated systemic PTCL. This is the final report, with a 5-year median follow-up, of the NLG-T-01 study. PATIENTS AND METHODS: Treatment-naive patients with PTCL age 18 to 67 years (median, 57 years) were included. Anaplastic lymphoma kinase (ALK) -positive anaplastic large-cell lymphoma (ALCL) was excluded. An induction regimen of six cycles of biweekly CHOEP (cyclophosphamide, doxorubicin, vincristine, etoposide, and prednisone) was administered (in patients age > 60 years, etoposide was omitted). If in complete or partial remission, patients proceeded to consolidation with HDT/ASCT. RESULTS: Of 166 enrolled patients, 160 had histopathologically confirmed PTCL. The majority presented with advanced-stage disease, B symptoms, and elevated serum lactate dehydrogenase. A total of 115 underwent HDT/ASCT, with 90 in complete remission at 3 months post-transplantation. Early failures occurred in 26%. Treatment-related mortality was 4%. At 60.5 months of median follow-up, 83 patients were alive. Consolidated 5-year overall and progression-free survival (PFS) were 51% (95% CI, 43% to 59%) and 44% (95% CI, 36% to 52%), respectively. Best results were obtained in ALK-negative ALCL. CONCLUSION: Dose-dense induction followed by HDT/ASCT was well tolerated and led to long-term PFS in 44% of treatment-naive patients with PTCL. This represents an encouraging outcome, particularly considering the high median age and adverse risk profile of the study population. Therefore, dose-dense induction and HDT/ASCT are a rational up-front strategy in transplantation-eligible patients with PTCL.
PURPOSE: Systemic peripheral T-cell lymphomas (PTCLs) respond poorly to conventional therapy. To evaluate the efficacy of a dose-dense approach consolidated by up-front high-dose chemotherapy (HDT) and autologous stem-cell transplantation (ASCT) in PTCL, the Nordic Lymphoma Group (NLG) conducted a large prospective phase II study in untreated systemic PTCL. This is the final report, with a 5-year median follow-up, of the NLG-T-01 study. PATIENTS AND METHODS: Treatment-naive patients with PTCL age 18 to 67 years (median, 57 years) were included. Anaplastic lymphoma kinase (ALK) -positive anaplastic large-cell lymphoma (ALCL) was excluded. An induction regimen of six cycles of biweekly CHOEP (cyclophosphamide, doxorubicin, vincristine, etoposide, and prednisone) was administered (in patients age > 60 years, etoposide was omitted). If in complete or partial remission, patients proceeded to consolidation with HDT/ASCT. RESULTS: Of 166 enrolled patients, 160 had histopathologically confirmed PTCL. The majority presented with advanced-stage disease, B symptoms, and elevated serum lactate dehydrogenase. A total of 115 underwent HDT/ASCT, with 90 in complete remission at 3 months post-transplantation. Early failures occurred in 26%. Treatment-related mortality was 4%. At 60.5 months of median follow-up, 83 patients were alive. Consolidated 5-year overall and progression-free survival (PFS) were 51% (95% CI, 43% to 59%) and 44% (95% CI, 36% to 52%), respectively. Best results were obtained in ALK-negative ALCL. CONCLUSION: Dose-dense induction followed by HDT/ASCT was well tolerated and led to long-term PFS in 44% of treatment-naive patients with PTCL. This represents an encouraging outcome, particularly considering the high median age and adverse risk profile of the study population. Therefore, dose-dense induction and HDT/ASCT are a rational up-front strategy in transplantation-eligible patients with PTCL.
Authors: Kieron Dunleavy; Stefania Pittaluga; Margaret Shovlin; Mark Roschewski; Catherine Lai; Seth M Steinberg; Elaine S Jaffe; Wyndham H Wilson Journal: Haematologica Date: 2015-10-30 Impact factor: 9.941
Authors: Ranjana H Advani; Stephen M Ansell; Mary J Lechowicz; Anne W Beaven; Fausto Loberiza; Kenneth R Carson; Andrew M Evens; Francine Foss; Steven Horwitz; Barbara Pro; Lauren C Pinter-Brown; Sonali M Smith; Andrei R Shustov; Kerry J Savage; Julie M Vose Journal: Br J Haematol Date: 2015-12-02 Impact factor: 6.998
Authors: Zeina Al-Mansour; Hongli Li; James R Cook; Louis S Constine; Stephen Couban; Douglas A Stewart; Thomas C Shea; Pierluigi Porcu; Jane N Winter; Brad S Kahl; Sonali M Smith; Deborah C Marcellus; Kevin P Barton; Glenn M Mills; Michael LeBlanc; Lisa M Rimsza; Stephen J Forman; John P Leonard; Richard I Fisher; Jonathan W Friedberg; Patrick J Stiff Journal: Leuk Lymphoma Date: 2019-01-10
Authors: Carla Casulo; Owen O'Connor; Andrei Shustov; Michelle Fanale; Jonathan W Friedberg; John P Leonard; Brad S Kahl; Richard F Little; Lauren Pinter-Brown; Ranjani Advani; Steven Horwitz Journal: J Natl Cancer Inst Date: 2016-12-31 Impact factor: 13.506