Peripheral T-cell lymphomas (PTCL) are a heterogeneous group of mature T-cell neoplasms that generally have poor prognosis with conventional treatment. Although there are no randomized studies demonstrating its efficacy, consolidation with autologous stem cell transplantation (ASCT) after first-line chemotherapy has been used in many institutions to try to improve the results. The main objective of our study is to analyse the progression-free survival (PFS) and overall survival (OS) of patients with PTCL who underwent ASCT in complete remission (CR) after first-line of chemotherapy, compared to a control group with the same characteristics who did not undergo ASCT as part of first-line treatment.
This is a retrospective, multicenter study performed in 44 hospitals from GELTAMO and FIL groups. Inclusion criteria were: i) Histological diagnosis of PTCL between 01-01-2001 and 31-12-2010; ii) patients deemed fit for ASCT at the time of diagnosis; and iii) partial remission (PR) or CR after anthracycline-based first-line treatment. A landmark analysis was performed, with time zero defined as the time at which the assessment after the first-line was carried out.
Two hundred eighty one patients were registered. For this preliminary analysis, we have only considered 176 patients who were in CR or uncertain CR after first-line chemotherapy with any type of PTCL excluding ALK positive anaplastic large cell lymphoma. A total of 104 patients underwent ASCT (cases) and 72 did not (controls). The causes for not receiving ASCT were: medical decision (N=56), poor performance status (N=8), patient decision (N=5) and other reasons (N=3). The baseline clinicopathologic characteristics of the patients are listed in table 1. The median age was similar between cases and controls. The histologic subtypes were similar in both groups, although angioimmunoblastic T-cell lymphoma was more frequent in the transplant group (30% versus 22%), and anaplastic large cell lymphoma, ALK negative type was more frequent in the control group (29% versus 18%). More patients in the transplant group have advanced Ann Arbor Stage (III or IV) and an intermediate-high or high-risk prognostic index (IPI and PIT), as compared to the control group (table 1). First-line treatment was similar in cases and controls. With a median follow up of 77 months, the PFS was significantly better in the patients who underwent ASCT (65,4% versus 46,6% at 5 years, p=0,02), and OS was also better in the transplanted patients, although the difference did not reach statistical significance (74,1% versus 66% at 5 years, p=0,053) (Figs 1 and 2).
Our results indicate that ASCT in 1st CR improves the progression free survival and may improve the overall survival of patients with PTCL other than ALK+ anaplastic large-cell lymphoma. These results should be confirmed in a prospective randomized study, but given the difficulty of conducting a phase 3 study in PTCL, due to its low incidence, our results support ASCT as part of the first-line treatment.
Rambaldi: Novartis, Roche/Genentech, Amgen, Italfarmaco: Consultancy; Novartis, Amgen, Celgene, Sanofi: Other: Travel, Accomodations, Expenses. Gutierrez: JANSSEN: Consultancy, Research Funding, Speakers Bureau; ROCHE: Research Funding, Speakers Bureau; SERVIER: Speakers Bureau; GILEAD: Honoraria; TAKEDA: Speakers Bureau; PFIZER: Consultancy. Vitolo: Takeda: Honoraria; Roche: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Gilead: Honoraria; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Mundipharma: Honoraria. Corradini: Amgen: Honoraria; Janssen: Honoraria; Novartis: Honoraria; Sanofi: Honoraria; Takeda: Honoraria; Gilead: Honoraria; Roche: Honoraria; Celgene: Honoraria. Rossi: Gilead: Membership on an entity's Board of Directors or advisory committees; Roche: Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees; Sanofi: Membership on an entity's Board of Directors or advisory committees; AbbVie: Membership on an entity's Board of Directors or advisory committees; Teva: Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees; Amgen: Membership on an entity's Board of Directors or advisory committees. Federico: takeda: Honoraria, Research Funding. Martín: Servier: Consultancy, Honoraria; Celgene: Consultancy, Honoraria; Gilead: Consultancy; Janssen: Honoraria; Roche: Consultancy, Honoraria.
Asterisk with author names denotes non-ASH members.