Treatment of Peripheral T-Cell Lymphoma (PTCL) with High-Dose Chemotherapy and Autologous Stem Cell Transplantation (ASCT).

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4682-4682
Author(s):  
Min Kyoung Kim ◽  
Shin Kim ◽  
Seoung Sook Lee ◽  
Sun Jin Sym ◽  
Dae Ho Lee ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
T Cell ◽  
Cell Lymphoma ◽  
High Dose Chemotherapy ◽  
T Cell Lymphoma ◽  
High Dose ◽  
Cell Dose ◽  
Poor Outcome ◽  
The Impact

Abstract Objectives: Although CHOP-type chemotherapy has been the mainstay of therapy, outcome of PTCL has been uniformly disappointing. Despite the poor outcome after conventional chemotherapy, the impact of high-dose chemotherapy (HDCT) and ASCT is not well defined in these patients. The purpose of this study is to evaluate the efficacy of ASCT and the prognostic factors in PTCL with ASCT. Patients and Methods: We performed a retrospective analysis of 40 PTCL patients from the Asan Medical Center treated between January 1995 to December 2005 with HDCT and ASCT. Results: A total 40 patients were enrolled. Median age was 39 years (range 18–63). Twenty patients had PTCL-U, 10 extranodal NK/T cell lymphomas, 5 anaplastic large cell lymphomas, 3 angioimmunoblastic, one hepatosplenic γσ T cell lymphoma, and one disseminated mycosis fungoides. Disease status at transplant were CR1 in 3, CR2 or more in 8, partial remission in 25 (PR1 in 8 and PR2 in 17), and refractory in 4 patients.Three (7.5%) therapy-related mortalities occurred. A median follow-up of 16 months (range, 5 to 135 months) for surviving patients, the median overall survival (OS) was 11.5 months and the 1-year probability of survival was 41.5%. Ten patients (25%) were alive without evidence of disease. The median OS of 11 patients with CR at ASCT were not reached and of these, 7 patients (63.6%) were alive with CR. In multivariate analysis, CR status at HDT and BM involvement at ASCT was the most important prognostic factor for event free survival (P=0.032, P=0.031, respectively). A pretransplant IPI ≤1 and infused CD34+ cell dose ≥5×106/kg were the prognostic factors for an improved overall survival (P = 0.04 and P = 0.025, respectively). Conclusion: The results of HDT with ASCT for the patients with PTCL who did not achieve a CR to first line or salvage chemotherapy are not satisfactory. The patients who did not achieve CR at ASCT and patients with low infused CD34+cell dose, BM involvement or high IPI score at ASCT have poor outcome.

Alternating non-cross-resistant multiagent chemotherapy (ANCRC) and high-dose chemotherapy followed by autologous stem cell support (HDC-ASCS) in first remission to improve outcome in patients with T-cell lymphoma.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e18538-e18538
Author(s):  
Potjana Jitawatanarat ◽  
Richa Dawar ◽  
Kaweesak Chittawatanarat ◽  
Nicolas Batty ◽  
Myron Stefan Czuczman ◽  
...  
Keyword(s):  
T Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Final Analysis ◽  
High Dose Chemotherapy ◽  
T Cell Lymphoma ◽  
High Dose ◽  
Front Line ◽  
First Remission ◽  
The Impact

e18538 Background: T-cell lymphomas represent a challenge for the practicing oncologist as evidence-based medicine is limited and the ORR to chemotherapy, PFS and OS rates are inferior when compared to B-cell lymphoma. CHOP offers limited activity, and there is a growing consensus that alternative regimens should be tested. We studied the impact of ANCRC or HDC-ASCS vs. CHOP in outcome of T-cell lymphoma. Methods: We retrospectively analyzed differences between the ORR, PFS and OS of T-cell lymphoma patients excluding ALCL treated with CHOP or HyperCVAD regimen alternating with HDAM in the front-line setting following by observation or HDC-ASCS. Pre-treatment demographic, clinical, and pathological characteristics were collected. Differences in outcomes were analyzed using a Cox proportional analysis. Results: ALCL, PTCL-NOS and AITL were the most common subtypes. After excluding ALCL (N=29), a total of 49 patients were included in the final analysis; 23 pts treated with CHOP; 12 pts with HyperCVAD/HDAM and 14 pts treated with other induction regimens. After induction therapy, 12 patients underwent HDC-ASCS in first remission. There were no differences in demographic and clinical characteristics between groups analyzed. There was a higher ORR and PFS among patients treated with hyperCVAD/HDAM (83.3%) vs. pts treated with CHOP (62%). However it did not improved OS when compared to CHOP. The use of HDC-ASCS in first remission was associated with improved OS. The median OS for pts observed after front-line chemotherapy was 32 months and 59 months for pts that received HDC-ASCS [Hazard ratio 0.54 (95% CI 0.16-1.83) (p=0.32)]. Conclusions: Our data suggest that hyperCVAD/HDAM results in higher ORR and PFS in T-cell lymphoma than CHOP. More importantly, the use of HDC-ASCS in first remission appears to improve the OS of non-ALCL T-cell lymphoma patients. ANCRC regimens incorporating novel agents follow by HDC-ASCS in first remission is emerging as an attractive therapeutic intervention for a selected group of T-cell lymphoma patients been evaluated in ongoing clinical trials.

Prognostic factors and the impact of frontline therapy in peripheral T-cell lymphoma: 10 years of ‘real-world’ experience from Western Australia

2019 ◽  
Vol 60 (14) ◽  
pp. 3417-3425
Author(s):  
James A. Kuzich ◽  
Andrew P. Hutchison ◽  
Kenneth J. C. Lim ◽  
Portia Smallbone ◽  
Kate Denning ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
T Cell ◽  
Western Australia ◽  
Real World ◽  
Cell Lymphoma ◽  
T Cell Lymphoma ◽  
Peripheral T Cell Lymphoma ◽  
Frontline Therapy ◽  
The Impact

Overall Survival in Erythrodermic Cutaneous T-Cell Lymphoma: An Analysis of Prognostic Factors in a Cohort of Erythrodermic Cutaneous T-Cell Lymphoma Patients.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3574-3574
Author(s):  
Kelley A. Vidulich ◽  
Rakhshandra Talpur ◽  
Roland L. Bassett ◽  
Madeleine Duvic
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
T Cell ◽  
Cell Count ◽  
Cell Lymphoma ◽  
Receptor Gene ◽  
Staging System ◽  
T Cell Lymphoma ◽  
Cutaneous T Cell Lymphoma ◽  
Cell Counts

Abstract Most common cutaneous T-cell lymphomas (CTCL) are Mycosis fungoides (MF) and a leukemic, erythrodermic (E) variant known as Sézary Syndrome (SS). Blood (B) criteria were not previously considered for staging purposes and are evolving. E-CTCL can be divided into E-MF versus SS based on new criteria, B0-B2, published by the ISCL guidelines. Historically, overall survival (OS) of “SS” patients is 2–4 years. To determine if hematologic staging and prognostic variables affects overall survival, we retrospectively studied 1197 MF/CTCL patients seen at MDACC since 1987 from which were identified 124 (10%) patients with E-CTCL. Median age at diagnosis was 63 (range 0–89), 71 males and 53 females. Hematologic (H) stage was based on quantitative Sézary cell counts (manual or by flow as absolute CD4+26−). Overall survival curves were estimated by Kaplan and Meier and compared using log-rank tests. Median OS all 124 E-CTCL patients was 5.1 years [range=0.4–18.6]. We also considered patients divided by the H0–H4 staging system (Russell-Jones 2000). For H0–H2, OS was 7.6 years, H3 was 5.4 years, and H4 was 2.4 years (p=0.011). Treatment with systemic steroids, advanced age, increased serum LDH at presentation, WBC > 20,000 were significant prognostic factors. Large cell transformation (p=0.758), positive T-cell receptor gene rearrangement in the skin (p=0.54), stage of disease (p=0.955), prior exposure to multiple treatments (p=0.953), and CD4:CD8 ratio (p=0.068) were not significant. In conclusion, we provide evidence that absolute Sézary cell counts can be used to define three groups of patients with E-CTCL with different overall survival patterns and propose a modification to the ISCL B ratings as follows: B0, absolute Sézary cell count < 1.0 KuL−1; B1: absolute Sézary cell count ≥ 1.0–10.0 KuL−1; and B2: absolute Sézary cell count >10.0 KuL−1. Serum LDH and CD4/8 ratio may be used to estimate tumor burden, as they correlate with Sézary counts.

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