Autologous Stem Cell Transplantation as First-Line Therapy in Peripheral T-Cell Lymphomas. A Prospective Multicenter Study.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 2074-2074 ◽  
Author(s):  
Peter Reimer ◽  
Thomas Ruediger ◽  
Tobias Schertlin ◽  
Eva Geissinger ◽  
Florian Weissinger ◽  
...  
Keyword(s):  
T Cell ◽  
Cell Lymphoma ◽  
High Dose ◽  
Sustained Remission ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
T Cell Lymphomas

Abstract Peripheral T-cell lymphomas (PTCL) are rare diseases representing only 10–15% of all non Hodgkin’s lymphomas and show a poor outcome following conventional chemotherapy. Long-term remissions are achieved in only 15 to 35% of patients following conventional chemotherapy. However, the impact of more aggressive therapeutic approaches such as high-dose therapy with autologous stem cell transplantation (ASCT) as first-line therapy is poorly defined mainly due to the lack of prospective PTCL-restricted studies. Therefore, in 2000 we initiated the first prospective PTCL-restricted multicenter study in PTCL. The results of the first 30 patients (pts) have recently been published. Here we update our data on all pts. entering the study. Study design: Pts. < 65 years with PTCL of all subtypes without primary cutaneous lymphoma and ALK1+ anaplastic large cell lymphoma were included. Treatment consisted of 4–6 courses of CHOP followed by DexaBEAM or ESHAP regimens before collection of stem cells. Subsequently, pts. underwent total body irradiation (TBI) and high dose cyclophosphamide (60 mg/kg body weight) chemotherapy with ASCT. Patient characteristics: From 6/00 to 7/05 75 pts. (65% male) with a median age of 50 years were enrolled. Main subtypes were Peripheral T-cell lymphoma not otherwise specified (NOS, 41%) and Angioimmunoblastic T-cell lymphoma (AIL, n= 31%). According to the Ann Arbor classification, 75% of the pts had stage III/IV disease. The International Prognostic Index (IPI) was low/low intermediate in 51% and high intermediate/high in 49% of pts, respectively. Results: So far 65 pts are eligible for evaluation. Forty pts could be transplanted (62%). After a median follow-up of 10 months post-transplant 22 pts (42%) are in sustained remission and 8 pts (15%) have relapsed. Treatment-related mortality was 2/65 (3%, one secondary AML, one multiorgan failure). Twenty-five pts (38%) did not proceed to ASCT mainly due to progressive disease (n= 18). Treatment-related toxicity was comparable to other high-dose studies in B-cell lymphomas. The IPI does not seem to have a significant impact on response to therapy, progression during CHOP therapy, or relapse rate following ASCT. Conclusion: Our data confirm the feasibility and efficacy of first line ASCT following myeloablative radiochemotherapy in PTCL. A sustained remission seems achievable for a significant proportion of pts. However, additional treatment strategies are required to prevent early progression before myeloablative therapy. Longer follow up is necessary to confirm long term remission rates.

Autologous Stem Cell Transplantation as First Line Therapy in Peripheral T Cell Lymphomas. Update of a Prospective Multicenter Study.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 904-904 ◽  
Author(s):  
Peter Reimer ◽  
Thomas Ruediger ◽  
Tobias Schertlin ◽  
Eva Geissinger ◽  
Florian Weissinger ◽  
...  
Keyword(s):  
T Cell ◽  
Cell Lymphoma ◽  
High Dose ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
T Cell Lymphomas ◽  
Peripheral T Cell Lymphomas

Abstract Peripheral T-cell lymphomas (PTCL) represent a heterogeneous group of non-Hodgkin’s lymphomas, which in general show a poor outcome following conventional chemotherapy. Long-term remissions are achieved in only 15 to 35 %. However, the impact of more aggressive therapeutic approaches such as myeloablative therapy with autologous stem cell transplantation (ASCT) as first line therapy is poorly defined mainly due to the lack of prospective PTCL-restricted studies. In 6/00 we initiated the first prospective PTCL-restricted multicenter study of myeloablative radiochemotherapy in primary diagnosed PTCL. The results of the first 30 patients (pts) are in press. We update our data on all pts entering the study. Study design: Pts < 65 years with PTCL of all subtypes without primary cutaneous lymphoma and ALK1 expressing anaplastic large cell lymphoma were included. Treatment consisted of 4–6 courses of CHOP protocol followed by DexaBEAM or ESHAP regimen and collection of stem cells. Subsequently pts underwent total body irradiation (TBI) and high dose cyclophosphamide chemotherapy (60 mg/kg body weight) with ASCT. Patient characteristics: From 6/00 to 8/04 65 pts (42 male) with a median age of 50 years were enrolled. Main subtypes were Peripheral T-cell lymphoma not otherwise specified (NOS, n= 26) and Angioimmunioblastic T-cell lymphoma (AILT, n= 19). According to the Ann Arbor classification, 81% of the pts had stage III/IV disease. The International Prognostic Index (IPI) was low/low intermediate in 54% and intermediate high/high in 46% of the pts, respectively. Results: So far 54 of 65 pts are eligible for evaluation, while the remaining 11 pts are still under therapy. Thirty-three pts could be transplanted (61%). After a median follow up of 10 months after transplantation 22 pts (67%) are in sustained remission and 8 pts (27%) had relapsed. Post transplantation two pts died treatment-related (one secondary AML, one multiorgan failure). Twenty-one pts (39%) did not proceed to ASCT mainly due to progressive disease (n= 16). Treatment-related toxicity was comparable to other high-dose studies in malignant lymphomas. Conclusion: Our data show feasibility and efficacy of first-line ASCT following myeloablative radiochemotherapy in PTCL. Sustaining remission seems achievable for a majority of pts. However, additional treatment strategies are required to prevent early progression prior myeloablative therapy. Longer follow-up is necessary to confirm long-term remission rate.

scholarly journals A randomized phase 3 trial of auto vs. allo transplantation as part of first-line therapy in poor-risk peripheral T-NHL

Blood ◽  
2020 ◽  
Author(s):  
Norbert Schmitz ◽  
Lorenz H Truemper ◽  
Krimo Bouabdallah ◽  
Marita Ziepert ◽  
Mathieu Leclerc ◽  
...  
Keyword(s):  
T Cell ◽  
Cell Lymphoma ◽  
Allogeneic Transplantation ◽  
T Cell Lymphoma ◽  
High Dose ◽  
First Line ◽  
High Dose Therapy ◽  
Peripheral T Cell Lymphoma ◽  
First Line Therapy ◽  
Line Therapy

Standard first-line therapy for younger patients with peripheral T-cell lymphoma consists of six courses of CHOP or CHOEP consolidated by high-dose therapy and autologous stem cell transplantation (AutoSCT). We hypothesized that consolidative allogeneic transplantation (AlloSCT) could improve outcome. 104 patients with nodal peripheral T-cell lymphoma except ALK+ ALCL, 18 to 60 years of age, all stages and IPI scores except stage 1 and aaIPI 0, were randomized to receive 4 x CHOEP and 1 x DHAP followed by high-dose therapy and AutoSCT or myeloablative conditioning and AlloSCT. The primary endpoint was event-free survival (EFS) at three years. After a median follow-up of 42 months, 3-year EFS of patients undergoing AlloSCT was 43% (95% confidence interval [CI]: 29%; 57%) as compared to 38% (95% CI: 25%; 52%) after AutoSCT. Overall survival at 3 years was 57% (95% CI: 43%; 71%) versus 70% (95% CI: 57%; 82%) after AlloSCT or AutoSCT, without significant differences between treatment arms. None of 21 responding patients proceeding to AlloSCT as opposed to 13 of 36 patients (36%) proceeding to AutoSCT relapsed. Eight of 26 patients (31%) and none of 41 patients died due to transplant-related toxicity after allogeneic and autologous transplantation, respectively. In younger patients with T-cell lymphoma standard chemotherapy consolidated by autologous or allogeneic transplantation results in comparable survival. The strong graft-versus-lymphoma effect after AlloSCT was counterbalanced by transplant-related mortality. CHO(E)P followed by AutoSCT remains the preferred treatment option for transplant-eligible patients. AlloSCT is the treatment of choice for relapsing patients also after AutoSCT.

First-line therapy for T cell lymphomas: a retrospective population-based analysis of 906 T cell lymphoma patients

2019 ◽  
Vol 98 (8) ◽  
pp. 1961-1972 ◽  
Author(s):  
Andrea Janikova ◽  
Renata Chloupkova ◽  
Vit Campr ◽  
Pavel Klener ◽  
Jitka Hamouzova ◽  
...  
Keyword(s):  
T Cell ◽  
Cell Lymphoma ◽  
Population Based ◽  
T Cell Lymphoma ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
T Cell Lymphomas

Lymphoma Patients Secondary to Congenital and Acquired Immunodeficiency Syndroms in a Turkish Pediatric Oncology Center

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5445-5445
Author(s):  
Nurdan Tacyildiz ◽  
Gulsah Tanyildiz ◽  
Gulsan Yavuz ◽  
Emel Unal ◽  
Handan Dincaslan ◽  
...  
Keyword(s):  
T Cell ◽  
B Cell ◽  
Progressive Disease ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Lymphoproliferative Syndrome

Abstract PURPOSE An increased incidence of lymphoma is seen in various types of immune deficiency syndromes,including congenital immune deficiency diseases, organ transplantation with iatrogenic immunosuppression and autoimmune disorders. Prognosis of the lymphomas secondary to immunodeficiencies is stil poor. We aimed to analyse clinical features and treatment results of our patients that diagnosed as lymphoma and have immundeficiency syndrom. PATIENTS Between 2002-2014, we have seen 12 (7male, 5 female) childhood lymphoma that related immunodeficiencies. Ages of patients were between 4-15 years (median 8 years).The follow up period is 1-140 months (median: 38.5 months) and survival rate is %58. Five of patients died because of the progressive disease. The characteristics of patients are summarized in the table. TABLE- Clinical characteristics of patients Patient Age (year) Gender Diagnosis Follow up (months) Survival 1. G.C 10 Male T-NHL + AT 6 Alive (lost to follow up) 2. İ.D 4 Male T-NHL + ALPS 9 Eksitus 3. M.K 12 Female T cell rich B cell lymphoma+ CVID 2 Eksitus 4. S.K 9 Female B cell lymphoblastic lymphoma+AT 54 Alive 5. B.C 5 Male BL + Renal transplantation 1 Eksitus 6. S.K 7 Female BL + AT 6 Eksitus 7. C.G 12 Male BL + WAS 48 Eksitus 8. K.B 11 Female BL+EBV associated lymphoproliferative syndrome 29 Alive 9. M.Y 15 Female HL + CVID 140 Alive 10. B.Ç 4 Male HL + selective IgA deficiency 132 Alive 11. S.S 7 Male HL + AT 70 Alive 12. B.K 5 Male HL + AT 48 Alive TOTAL n = 12 4-15 years Median : 8 4 female 8 male 8 NHL (survival % 37.5) 4 HL (survival% 100) 1-140 months Median : 38.5 Survival %58 RESULTS Two of 5 Ataxia Telangiectasia (AT) patients diagnosed as Hodgkin's lymphoma (HL) while other three diagnosed as non-Hodgkin's lymphoma (NHL) (1 Burkitt's lymphoma-BL,1 B cell lymphoblastic lymphoma-BCLL,1 T-cell NHL). One of 2 common variable immunodeficiency (CVID) patient diagnosed as HL and the other one diagnosed T-cell rich B-cell lymphoma (TCRBCL). Wiscott-Aldrich syndome (WAS), autoimmune lymphoproliferative syndrome (ALPS ) and selective immunoglobulin A deficiency patients diagnosed as large B-cell lymphoma (LBCL), T-cell NHL and HL, respectively. In one patient, EBV associated BL developed secondary to renal transplantation. Another EBV associated BL patient has been diagnosed recently who has DNA instability defect. Follow-up period of patients were between 1-140 months (median 38.5 months). Almost half of the patients ( 42%) were diagnosed as BL,BCLL or TCRBCL. Although, survival of our patients for median 38.5 months is 58% (5 patients died with progressive disease) ,four of the 5 BL&TCRBCL patients have been died. Two patients who are living after BL and BCLL diagnosis in that group are treated with Rituximab as first line therapy. CONCLUSİON BL is most common lymphoma type in immundeficient lymphoma patients which may be subject for future research . Although special attention has been given to these patients, especially survival of BL lymphoma secondary to immunodeficiencies are poor. Special treatment modalities, like targeted terapies may be necessary as first line therapy to improve survival of these patients. Disclosures No relevant conflicts of interest to declare.

scholarly journals Prognostic Value of End of Treatment FDG-PET Scan in T-Cell Lymphoma, a 20-Year Single Institution Study

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3003-3003 ◽  
Author(s):  
Enrico Derenzini ◽  
Angela Gueli ◽  
Safaa Ramadan ◽  
Anna Vanazzi ◽  
Simona Sammassimo ◽  
...  
Keyword(s):  
T Cell ◽  
Fdg Pet ◽  
Prognostic Value ◽  
Cell Lymphoma ◽  
T Cell Lymphoma ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
T Cell Lymphomas ◽  
End Of Treatment

Abstract T-cell lymphomas represent a rare and heterogeneous group of non-Hodgkin lymphomas (NHLs) characterized by dismal prognosis. Current first line chemotherapeutic approaches have not significantly changed during the last 20 years, and several efforts have been made for early risk stratification of T-cell NHL patients with unsatisfactory results. Functional imaging with 2-deoxy-2-[fluorine-18]fluoro- D-glucose positron emission tomography scan (FGD-PET) has demonstrated improved outcome stratification and response evaluation in Hodgkin lymphoma and B-cell NHL, in comparison with computed tomography (CT) scan. Most T-cell lymphomas are FDG avid and FDG-PET is routinely used in clinical practice, however limited and conflicting data are available on the value of FDG-PET in response assessment at the end of treatment (FDG-PETend). With the aim of evaluating the prognostic value of FDG-PETend in T-cell lymphomas we performed a retrospective study evaluating all T-cell NHL patients treated at the European Institute of Oncology (IEO, Milan) over the past 20 years. Clinical data of all T-cell NHL patients treated at IEO from 1995 to 2015 were retrospectively collected. The back bone of first line therapy did not significantly change over time, being based on the administration of CHOP/CHOP-like chemotherapy eventually followed by treatment intensification with autologous stem cell transplantation (ASCT). Post first-line therapy FDG-PET scans were visually evaluated according to the criteria of the international Harmonization Project (positive vs negative). Ninety-eight consecutive patients (58 males, 40 females) with complete clinical data were considered in this analysis. FDG-PET was used for response evaluation starting from 2002, but only 18 patients considered in the present analysis were treated before 2002. Median age at diagnosis was 54 years (range 14-82). Fifty-two patients (53.1%) had Peripheral T-cell lymphomas not otherwise specified (PTCL-NOS), 23 (23.5%) had anaplastic large T-cell lymphoma (ALCL), 15 (15.3%) had acute lymphoblastic T-cell lymphoma (LAL-T), 8 (8.1%) had NK/T-cell lymphoma. Ten patients were diagnosed in stage I, 21 in stage II, 17 in stage III, 50 patients in stage IV. Thirty-two patients underwent ASCT during the study period. Median follow-up was 16 months (range 1-182). 42 patients were evaluated with FDG-PET at the end of first line therapy: 25 had negative (60%), and 17 (40%) positive PET scans. In 56 patients response was evaluated with CT scan only, and complete responses or complete responses unconfirmed (CR/CRu) were detected in 29 cases (51%). The 10-year progression free survival (PFS) and overall survival (OS) of the whole patient cohort were 22% and 32% respectively. To determine the prognostic value of FDG-PETend we first assessed the PFS of PET positive vs PET negative patients. Those patients who were PET positive at the end of treatment had a statistically inferior PFS compared to PET negative ones (5-year PFS: 29% vs 47% respectively; p<0.01). These data indicate that although a negative PET after initial therapy is a good prognostic predictor, about half of all patients still relapse after achievement of a negative PET. To better define the prognostic value of FDG-PETend scan in T-cell lymphomas, we restricted our analysis to those patients who obtained a CR after first line therapy, comparing the outcome of PET negative patients (n=25) with the outcome of patients who did not have a PET scan but were deemed in CR after a negative CT scan (n=17). Interestingly we did not observe significant differences between the 2 groups (5-year PFS was 47% in both groups). These data were also confirmed when the analysis was restricted to the PTCL-NOS and ALCL subgroups, suggesting unsatisfactory improvements in the quality of CR assessment with a limited negative predictive value of negative PET scans after first line therapy. In conclusion, although our data confirm the prognostic value of end of treatment FDG-PET scan in T-cell lymphoma, they also highlight the limits of current prognostic stratification tools suggesting that different timing of response evaluation or alternative methods to detect minimal residual disease in those patients in CR after first line therapy are warranted. Disclosures No relevant conflicts of interest to declare.

Lenalidomide, Bendamustine, and Rituximab As First-Line Therapy For Patients >65 Years With Mantle Cell Lymphoma: Preliminary Results From The Nordic Lymphoma Group MCL4 (LENA-BERIT) Phase I-II Trial

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4377-4377 ◽  
Author(s):  
Mats Jerkeman ◽  
Alexandra Albertsson-Lindblad ◽  
Arne Kolstad ◽  
Anna Laurell ◽  
Riikka Räty ◽  
...  
Keyword(s):  
Phase I ◽  
Mantle Cell Lymphoma ◽  
Cell Lymphoma ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Mantle Cell

Abstract Background Mantle cell lymphoma is a disease of the elderly, with a median age of 70 years. Younger patients may be treated with potentially curative treatment including high dose chemotherapy. For elderly patients, however, no standard therapy has been defined. In the current trial, we investigate if the addition of lenalidomide (LEN) to rituximab (R)+bendamustine (B) (B 90 mg/m2 D1-2 and R 375 mg/m2 D1) followed by maintenance with LEN for 7 months may enhance efficacy, with manageable toxicity, for the older population of MCL patients. Methods Eligibility criteria were age > 65 years, or ≤ 65 years, unable to tolerate high dose chemotherapy, with untreated mantle cell lymphoma, stage II-IV. BR was given for 6 cycles q4w. In the phase I part, the MTD of LEN was established as 10 mg days 1-14 during the induction phase, cycles 2-6. Prednisolone 20 mg days 1-14 was given during cycle 2. When LEN was initially given from cycle 1, we encountered unexpected grade III-IV toxicity in the form of cutaneous and allergic reactions. In the maintenance phase, LEN single therapy was given as follows: cycles 7-8 - 10 mg days 1-21, cycles 9-13 - 15 mg days 1-21. Results The trial was concluded June 1, 2013, after inclusion of 51 patients, of whom 24 were in the phase I part. The median age is 72 years. According to MIPI, 55% were high risk. Presently, 29 patients are evaluable for response after 6 cycles LBR. ORR is 28/29 (97%), CR+CRu 23 (79%). 17 out of 28 evaluable patients (61%) were MRD-negative after 6 cycles. After a median follow-up of 18 months, the median PFS has not been reached, and the estimated PFS at 2 years is 74%. Eight patients have died, 3 due disease progression, 3 due to treatment related toxicity, 1 of lung cancer in a heavy smoker, 1 of CMML. Overall survival at 2 years is 87%. Conclusions When omitted in cycle 1, lenalidomide in combination with R-bendamustine is feasible as first-line therapy in older patients with MCL, and is associated with a high response rate, also as assessed by MRD. The long term efficacy of this regimen remains to be established by longer follow-up. Disclosures: No relevant conflicts of interest to declare.

Angioimmunoblastic T-Cell Lymphoma: A Large Series Outcome Analysis.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 2810-2810
Author(s):  
Charalampia Kyriakou ◽  
Ayoma Attygalle ◽  
David Linch ◽  
Anthony Goldstone ◽  
Paul Smith ◽  
...  
Keyword(s):  
T Cell ◽  
Cell Lymphoma ◽  
Performance Status ◽  
T Cell Lymphoma ◽  
Outcome Analysis ◽  
High Dose ◽  
First Line ◽  
Angioimmunoblastic T Cell Lymphoma ◽  
First Line Therapy ◽  
Line Therapy

Abstract Angioimmunoblastic T-cell Lymphoma (AITL) is a rare Peripheral T-cell lymphoma that primarily affects the elderly, presenting as advanced disease characterized by aggressive behaviour and very poor outcome. Despite the unfavourable prognosis, the best approach for treating patients with AITL is still unknown. We report a retrospective multicentre study of 64 AITL patients (37 male, 27 female) who were diagnosed as AITL in our institution based on typical histology and molecular clonality analysis between 1995 and 2004. The median age at diagnosis was 60 years (range 25 to 87). Fifty-two patients (81%) presented with advanced stage III–IV disease, 41 (64%) had B symptoms and 49 (76%) elevated LDH. ECOG performance status was 1 for 40%, 2 for 53% and 3 for 9% of the patients. Based on IPI risk factors 12% of the patients were classified as low risk, 17% low intermediate, 29% high intermediate and 42% as high risk. Six patients developed autoimmune haemolytic anaemia. Therapeutic approach varied from no treatment to high dose therapy (HDT). The majority of the patients had received CHOP chemotherapy. Overall 19 patients (30%) had received 1 treatment line, 20 (31%) had 2, 19 (30%) 3, 4 patients (6%) were treated with ≥4 and 2 (3%) were not eligible for any treatment. Twenty patients (31%) proceeded to an autologous and 2 to allogeneic transplantation after achieving CR (n=12), PR (n=7) while 3 had progressive disease. Following first line therapy 37 patients (58%) achieved CR, 15 (23%) PR and 10 (16%) had primary refractory disease. Median time to relapse or progression was 6 months (1 to 89). Interestingly three patients relapsed as EBV driven DLBCL, 1as DLBCL and 2 as EBV driven Hodgkin’s lymphoma. With a median follow-up of 19 months (1 to 119) twenty-six patients (41%) were alive. Eighteen (28%) of these patients were in CR, and 8 in PR (13%). Thirty-seven patients (58%) died, 29 (45%) from disease progression. Twelve patients developed toxic complications -infectious complications (n=8), haemorrhage (n=1), thrombosis (n=1) myocardial infarction (n=2). The estimated PFS rates at 1 and 2 years were 33% and 27% respectively. Overall survival rates were estimated at 55% and 28% at 2 and 4 years. By univariate and multivariate analyses, no response to first line therapy (p=0.035) and male sex (p=0.0161), were significantly associated with higher relapse rate. Application of HDT resulted to significantly superior PFS (p=0.002). Poor performance status at presentation was the only factor found to be significant for the OS (p= 0.0317). In conclusion analysis of the results of this large cohort of AITL patients showed that although the initial overall response rate was 73% this was short lived. It is estimated that less than 30% of the patients will survive and remain disease free at 4 years. Considering the dismal outcome with current therapeutic approaches, new strategies using novel agents to improve further and most importantly maintain initial response are needed. The role of frontline HDT either autologous or allogeneic for eligible AITL patients is worth exploring in prospective collaborative studies.

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