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.

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.

Disappointing Outcomes of Peripheral T Cell Lymphoma after Autologous Stem Cell Transplantation.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5428-5428
Author(s):  
Stephen D. Smith ◽  
John William Sweetenham ◽  
Lisa Rybicki ◽  
Stacey Brown ◽  
Robert M. Dean ◽  
...  
Keyword(s):  
Stem Cell ◽  
T Cell ◽  
Cell Lymphoma ◽  
Patient Characteristics ◽  
T Cell Lymphoma ◽  
High Dose ◽  
Peripheral T Cell Lymphoma ◽  
First Remission ◽  
Alk Positive

Abstract The role of high dose therapy and autologous stem cell transplantation (ASCT) for patients with peripheral T-cell lymphoma (PTCL) is poorly defined. Comparisons of outcomes between PTCL and B-cell NHL following HDT have yielded conflicting results, in part due to the rarity and heterogeneity of PTCL. Older retrospective studies found comparable survival rates after ASCT for pts with T-cell and B-cell NHL.1,2 In this study, we report our single center experience over one decade using a uniform high-dose regimen for patients with PTCL. Patients and Methods The transplant database of the BMT program at Cleveland Clinic was reviewed, and 32 patients undergoing ASCT for PTCL between 1996 and 2005 were identified. Twenty-one patients (66%) had anaplastic large cell lymphoma (ALCL), and 11 (34%) had peripheral T cell, not otherwise specified (PTCL-NOS). Patient characteristics are summarized in table 1. Stem cell mobilization with VP16 and GCSF priming provided a median CD34 cell dose of 5.01× 106/kg (range 2.05–29.69). Patients received a preparative regimen consisting of busulfan (either 1 mg/kg orally or 0.8mg/kg IV for 14 doses), followed by VP16 60 mg/kg IV continuous infusion, then cyclophosphamide 60mg/m2 IV daily for two days. Standard supportive care measures were employed. Results Recovery to 500 neutrophils/uL occurred at a median of 10 days post transplant (range 9–12 days) and platelet recovery to 20 000 at a median of 14 (range 7–60) days. Kaplan-Meier 5 year overall survival and relapse-free survival for all patients is 34% and 18%, respectively; median survival for all patients is 36 months (see figure 1). Median follow-up of 10 survivors is 25 months. No obvious plateau was observed on the overall or relapse fee survival curves. No significant difference in outcomes based on subgroup (ALCL versus PTCL-NOS) was observed. Staining for anaplastic lymphoma kinase (ALK) was available for 11 (of 21 total) anaplastic T cell lymphoma patients: 4/5 ALK-positive patients are alive compared to 2/6 ALK-negative patients at last follow-up. Four of five patients undergoing ASCT as consolidation following initial therapy are alive at a median 25 months. Based on this small patient population, and in contrast to some recent studies, our results suggest a poor outcome for patients with PTCL after ASCT. The outcome for pts undergoing ASCT in first remission, and for ALK-positive (versus ALK-negative) ALCL, requires prospective investigation. Table 1: Patient Characteristics Characteristic N (%) ALCL 21 (66) PTCL NOS 11 (34) Male 21 (66) Age: median(range) 44 (16-69) 2 prior chemo regimens 22 (69) 3 or more prior chemo regimens 7 (22) Transplant in first remission 5 (16) Relapsed/Refractory 25 (78) Figure Figure

Long Term Results of Autologous Hematopoietic Cell Transplantation (AHCT) for Peripheral T Cell Lymphoma: The Stanford Experience.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1906-1906 ◽  
Author(s):  
Andy I. Chen ◽  
Alex McMillan ◽  
Robert S. Negrin ◽  
Sandra J. Horning ◽  
Ginna G. Laport
Keyword(s):  
Bone Marrow ◽  
T Cell ◽  
Cell Lymphoma ◽  
Large Cell ◽  
T Cell Lymphoma ◽  
Long Term Results ◽  
High Dose ◽  
Refractory Disease ◽  
Anaplastic Lymphoma ◽  
First Remission

Abstract The peripheral T cell lymphomas (PTCL) are uncommon malignancies that typically carry a worse prognosis than the B cell non-Hodgkins lymphomas. There is no uniform standard therapy for PTCL, and AHCT is often offered at relapse or as consolidation in first remission due to the inherently poor prognoses. We conducted a retrospective review of patients who underwent AHCT for PTCL from 1989 to 2006 at Stanford, excluding mycosis fungoides and lymphoblastic lymphoma. Fifty-eight cases were identified: systemic anaplastic large cell (ALCL, n=18), PTCL unspecified (NOS, n=17), angioimmunoblastic (AITL, n=9), nasal type extranodal NK/T (nNK/T, n=7), primary cutaneous anaplastic large cell (n=5), hepatosplenic (n=2), and adult T cell lymphoma/leukemia (n=1). The median age at AHCT was 45 years (range 18–73), and 57% were male. The graft source was mobilized peripheral blood HC in 86% and bone marrow in 14%. The graft was T cell purged in 86% of cases. The conditioning regimen was high dose cyclophosphamide, carmustine, and etoposide in 83% of cases with the rest receiving total body irradiation, carmustine, and etoposide. Fifteen patients were transplanted in first complete or partial response (CR/PR1); 32 in second or beyond CR or PR (CR/PR2+); and 11 with primary refractory disease (REF). The PTCL subtypes transplanted in CR1 (n=12) and PR1 (n=3) included nNK/T (5), AITL (4), NOS (2), hepatosplenic (2), and ALCL (2). Multiple regimens were required to achieve first response in 5 patients. Only one ALK+ (anaplastic lymphoma kinase) ALCL pt was transplanted in CR/PR1 and required 3 induction regimens. The median follow up was 5 years (yr) (range 1–12). For all subjects, five yr overall survival (OS) was 49% and 5 yr progression free survival (PFS) was 24%. Disease status at AHCT had a strong impact on PFS (p=.004) and OS (p=0.06). Five yr PFS was 51%, 17%, and 0%, respectively, and the PFS curve appeared to plateau at 5 yrs. Corresponding OS at 5 yrs for the CR/PR1, CR/PR2+, and REF patients were 76%, 41%, and 36%, respectively. The number of prior regimens and achievement of CR at day +90 post AHCT were also significant factors for PFS by univariate analysis. Age, bone marrow involvement, B symptoms, stage, and histology were not significant for PFS or OS. By multivariate analysis, CR at day +90 remained a highly significant factor for both PFS and OS (p<0.0001 and p=0.0025, respectively). Only 1 patient died from treatment related mortality (<2%). Of interest, 8 patients who progressed after AHCT had a stable CR to subsequent salvage therapy or allogeneic transplant. In summary, about half of PTCL transplanted in CR/PR1 are progression free at 5 yrs, but CR/PR2+ and REF patients fared poorly. CR status at day +90 after AHCT was also a robust predictor for PFS and OS. Based on these results, AHCT may benefit PTCL patients who are consolidated in first remission and deserves further study. In contrast, those with relapsed or refractory disease experienced minimal benefit, and thus novel strategies are especially needed for this group of patients.

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