M Loirat1, P Chevallier1, C Leux2, A Moreau3, C Bossard3, T Guillaume1, T Gastinne1, J Delaunay1, N Blin1, B Mahé1, V Dubruille1, K Augeul-Meunier1, P Peterlin1, H Maisonneuve4, P Moreau1, N Juge-Morineau6, H Jardel7, M Mohty8, P Moreau1, S Le Gouill9. 1. Department of Hematology. 2. Department of Epidemiology. 3. Department of Pathology, University Hospital of Nantes, Nantes. 4. Department of Hematology, CHD de la Roche-Sur-Yon. 5. Department of Hematology, CH de Lorient, La Roche-Sur-Yon. 6. Department of Hematology, Centre Catherine de Sienne, Rezé 7. Department of Hematology, CH de Vannes, Vannes. 8. Department of Hematology, Saint-antoine, APHP, Paris. 9. Department of Hematology INSERM, UMR892, Equipe 10, Nantes INSERM, CIC 004, Nantes University Hospital, Nantes, France steven.legouill@chu-nantes.fr.
Abstract
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. PATIENTS AND 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.
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. PATIENTS AND 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.
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Authors: A C Mamez; V Lévy; P Chevallier; D Blaise; S Vigouroux; A Xhaard; N Fegueux; N Contentin; Y Beguin; N Ifrah; C E Bulabois; F Suarez; I Yakoub-Agha; P Turlure; E Deconink; T Lamy; J Y Cahn; A Huynh; S Maury; L M Fornecker; M Ouzegdouh; J O Bay; G Guillerm; N Maillard; M Michallet; J V Malfuson; J H Bourhis; F Rialland; R Oumedaly; C Jubert; V Leblond; M Boubaya; M Mohty; S Nguyen Journal: Bone Marrow Transplant Date: 2015-11-23 Impact factor: 5.483
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