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Therapy

Long-term follow-up of patients with peripheral T-cell lymphomas treated up-front with high-dose chemotherapy followed by autologous stem cell transplantation

Leukemia volume 20, pages 1533–1538 (2006)Cite this article

Abstract

We report the results of two prospective phase II studies investigating the role of high-dose sequential chemotherapy, followed by autologous stem cell transplantation (ASCT) in 62 patients with advanced stage peripheral T-cell lymphomas (PTCLs) at diagnosis. Conditioning regimen consisted of mitoxantrone (60 mg/m2) and melphalan (180 mg/m2) or carmustine, etoposide, Ara-C and melphalan followed by peripheral blood stem cell autografting. In an intent-to-treat analysis, 46 out of 62 patients (74%) completed the whole programme, whereas 16 patients did not undergo ASCT, mainly because of disease progression. At a median follow-up of 76 months, the estimated 12-year overall (OS), disease-free and event-free survival (EFS) were 34, 55 and 30%, respectively. OS and EFS were significantly better in patients with anaplastic lymphoma-kinase (ALK)-positive anaplastic large-cell lymphoma (ALCL), as compared with the remaining PTCL. Multivariate analysis showed that patients attaining complete remission (CR) before ASCT had a statistically significant benefit in terms of OS and EFS (P<0.0001). Overall treatment-related mortality rate was 4.8%. In conclusion, our findings indicate (1) up-front high-dose therapy and ASCT are feasible, but could induce a high rate of long-term CR only in patients with ALK-positive ALCL and (2) the achievement of CR before autografting is a strong predictor of better survival.

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References

  1. Gisselbrecht C, Gaulard P, Lepage E, Coiffier B, Brière J, Haioun C et al. Prognostic significance of T-cell phenotype in aggressive non-Hodgkin's lymphomas. Groupe d’Etudes des Lymphomes de l’Adulte (GELA). Blood 1998; 92: 76–82.

    CAS  PubMed  Google Scholar 

  2. Philip T, Armitage JO, Spitzer G, Chauvin F, Jagannath S, Cahn J et al. High-dose therapy and autologous bone marrow transplantation after failure of conventional chemotherapy in adults with intermediate-grade or high-grade non-Hodgkin's lymphoma. N Engl J Med 1987; 316: 1493–1498.

    Article  CAS  Google Scholar 

  3. Milpied N, Deconinck E, Gaillard F, Delwail V, Foussard C, Berthou C et al. Groupe Ouest-Est des Leucemies et des Autres Maladies du Sang. Initial treatment of aggressive lymphoma with high-dose chemotherapy and autologous stem-cell support. N Engl J Med 2004; 350: 1287–1295.

    Article  CAS  Google Scholar 

  4. Rodriguez J, Munsell M, Yazji S, Hagemeister F, Younes A, Andersson B et al. Impact of high-dose chemotherapy on peripheral T-cell lymphomas. J Clin Oncol 2001; 19: 3766–3770.

    Article  CAS  Google Scholar 

  5. Song KW, Mollee P, Keating A, Crump M . Autologous stem cell transplant for relapsed and refractory peripheral T-cell lymphoma: variable outcome according to pathological subtype. Br J Haematol 2003; 120: 978–985.

    Article  Google Scholar 

  6. Fanin R, Silvestri F, Geromin A, Infanti L, Sperotto A, Cerno M et al. Primary systemic CD30 (Ki-1)-positive anaplastic large cell lymphoma of the adult: sequential intensive treatment with the F-MACHOP regimen (+/− radiotherapy) and autologous bone marrow transplantation. Blood 1996; 87: 1243–1248.

    CAS  PubMed  Google Scholar 

  7. Fanin R, Ruiz de Elvira MC, Sperotto A, Baccarani M, Goldstone A . Autologous stem cell transplantation for T and null cell CD30-positive anaplastic large cell lymphoma: analysis of 64 adult and paediatric cases reported to the European Group for Blood and Marrow Transplantation (EBMT). Bone Marrow Transplant 1999; 23: 437–442.

    Article  CAS  Google Scholar 

  8. Haioun C, Lepage E, Gisselbrecht C, Salles G, Coiffier B, Brice P et al. Survival benefit of high-dose therapy in poor-risk aggressive non-Hodgkin's lymphoma: final analysis of the prospective LNH87-2 protocol – a Groupe d’Etude des Lymphomes de l’Adulte Study. J Clin Oncol 2000; 16: 3025–3030.

    Article  Google Scholar 

  9. Gisselbrecht C, Lepage E, Molina T, Quesnel B, Fillet G, Lederlin P et al. Shortened first-line high-dose chemotherapy for patients with poor-prognosis aggressive lymphoma. J Clin Oncol 2002; 20: 2472–2479.

    Article  CAS  Google Scholar 

  10. Cuttica A, Zallio F, Ladetto M, Di Nicola M, Caracciolo D, Magni M et al. Patients with high-risk aggressive lymphoma treated with frontline intensive chemotherapy and autografting: evidence of marked differences in outcome between patients with age-adjusted International Prognostic Index scores 2 and 3. Cancer 2003; 98: 983–992.

    Article  CAS  Google Scholar 

  11. Tarella C, Di Nicola M, Caracciolo D, Zallio F, Cuttica A, Omedè P et al. High-dose ara-C with autologous peripheral blood progenitor cell support induces a marked progenitor cell mobilization: an indication for patients at risk for low mobilization. Bone Marrow Transplant 2002; 30: 725–732.

    Article  CAS  Google Scholar 

  12. Vitolo U, Cortellazzo S, Liberati AM, Freilone R, Falda M, Bertini M et al. Intensified and high-dose chemotherapy with granulocyte colony-stimulating factor and autologous stem-cell transplantation support as first-line therapy in high-risk diffuse large-cell lymphoma. J Clin Oncol 1997; 15: 491–498.

    Article  CAS  Google Scholar 

  13. Siena S, Bregni M, Brando B, Belli N, Ravagnani F, Gandola L et al. Flow cytometry for clinical estimation of circulating hematopoietic progenitors for autologous transplantation in cancer patients. Blood 1991; 77: 400–409.

    CAS  PubMed  Google Scholar 

  14. Tarella C, Benedetti G, Caracciolo D, Castellino C, Cherasco C, Bondesan P et al. Both early and committed haematopoietic progenitors are more frequent in peripheral blood than in bone marrow during mobilization induced by high-dose chemotherapy+G-CSF. Br J Haematol 1995; 91: 535–543.

    Article  CAS  Google Scholar 

  15. Cheson BD, Horning SJ, Coiffier B, Shipp MA, Fisher RI, Connors JM et al. Report of an international workshop to standardize response criteria for non-Hodgkin's lymphomas. NCI Sponsored International Working Group. J Clin Oncol 1999; 17: 1244–1253.

    Article  CAS  Google Scholar 

  16. Kaplan EL, Meier P . Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958; 53: 457–481.

    Article  Google Scholar 

  17. Cortelazzo S, Rambaldi A, Rossi A, Oldani E, Ghielmini M, Benedetti F et al. Intensification of salvage treatment with high-dose sequential chemotherapy improves the outcome of patients with refractory or relapsed aggressive non-Hodgkin's lymphoma. Br J Haematol 2001; 114: 333–341.

    Article  CAS  Google Scholar 

  18. Jantunen E, Wiklund T, Juvonen E, Putkonen M, Lehtinen T, Kuittinen O et al. Autologous stem cell transplantation in adult patients with peripheral T-cell lymphoma: a nation-wide survey. Bone Marrow Transplant. 2004; 33: 405–410.

    Article  CAS  Google Scholar 

  19. Shipp MA, Mauch PM, Harris NL . Non-Hodgkin's lymphomas. In: DeVita VT, Hellmann S, Rosenberg SA (eds). Cancer. Principles and Practice of Oncology. Lippincott-Raven: Philadelphia, PA, 1997, p 2165.

    Google Scholar 

  20. Blystad AK, Enblad G, Kvaloy S, Berglund A, Delabie J, Holte H et al. High-dose therapy with autologous stem cell transplantation in patients with peripheral T cell lymphomas. Bone Marrow Transplant 2001; 27: 711–716.

    Article  CAS  Google Scholar 

  21. Rodriguez J, Caballero MD, Gutierrez A, Gandarillas M, Sierra J, Lopez-Guillermo A et al. High dose chemotherapy and autologous stem cell transplantation in patients with peripheral T-cell lymphoma not achieving complete response after induction chemotherapy. The GEL-TAMO experience. Haematologica 2003; 88: 1372–1377.

    CAS  PubMed  Google Scholar 

  22. Jagasia M, Morgan D, Goodman S, Hamilton K, Kinney M, Shyr Y et al. Histology impacts the outcome of peripheral T-cell lymphomas after high dose chemotherapy and stem cell transplant. Leukaemia Lymphoma 2004; 45: 2261–2267.

    Article  CAS  Google Scholar 

  23. Reimer P, Schertlin T, Rudiger T, Geissinger E, Roth S, Kunzmann V et al. Myeloablative radiochemotherapy followed by autologous peripheral blood stem cell transplantation as first-line therapy in peripheral T-cell lymphomas: first results of a prospective multicenter study. Hematol J 2004; 5: 304–311.

    Article  CAS  Google Scholar 

  24. Savage KJ, Chhanabhai M, Gascoyne RD, Connors JM . Characterization of peripheral T-cell lymphomas in a single North American institution by the WHO classification. Ann Oncol 2004; 15: 1467–1475.

    Article  CAS  Google Scholar 

  25. Escalon MP, Liu NS, Yang Y, Hess M, Walker PL, Smith TL et al. Prognostic factors and treatment of patients with T-cell non-Hodgkin lymphoma: the MD Anderson Cancer Center experience. Cancer 2005; 103: 2091–2098.

    Article  Google Scholar 

  26. Enblad G, Hagberg H, Erlanson M, Lundin J, MacDonald AP, Repp R et al. A pilot study of alemtuzumab (anti-CD52 monoclonal antibody) therapy for patients with relapsed or chemotherapy-refractory peripheral T-cell lymphomas. Blood 2004; 103: 2920–2924.

    Article  CAS  Google Scholar 

  27. Corradini P, Dodero A, Zallio F, Caracciolo D, Casini M, Bregni M et al. Graft-versus-lymphoma effect in relapsed peripheral T-cell non-Hodgkin's lymphomas after reduced-intensity conditioning followed by allogeneic transplantation of hematopoietic cells. J Clin Oncol 2004; 22: 2172–2176.

    Article  Google Scholar 

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Acknowledgements

This work has been supported in part by grants from Associazione Italiana Ricerca sul Cancro (AIRC), Fondazione Michelangelo and FIRST, University of Milano.

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Authors and Affiliations

  1. Divisione di Ematologia, Istituto Nazionale per lo Studio e la Cura dei Tumori, Università di Milano, Milano, Italy

    P Corradini, F Zallio & A Dodero

  2. Divisione di Ematologia, Università di Torino, Torino, Italy

    C Tarella & M Zanni

  3. Ufficio Operativo, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano, Italy

    P Valagussa

  4. Divisione di Oncologia Medica 3, Istituto Nazionale per lo Studio e la Cura dei Tumori, Università di Milano, Milano, Italy

    A M Gianni

  5. Divisione di Ematologia, Ospedali Riuniti, Bergamo, Italy

    A Rambaldi, T Barbui & S Cortelazzo

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  1. P Corradini
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Correspondence to P Corradini.

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Corradini, P., Tarella, C., Zallio, F. et al. Long-term follow-up of patients with peripheral T-cell lymphomas treated up-front with high-dose chemotherapy followed by autologous stem cell transplantation. Leukemia 20, 1533–1538 (2006). https://doi.org/10.1038/sj.leu.2404306

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