Role of Autologous or Allogeneic Stem Cell Transplantation in Patients with Peripheral T Cell Lymphomas (PTCLs)

Background

Peripheral T cell lymphomas (PTCLs) are heterogeneous group which present diverse clinical and molecular characteristics. Stem cell transplantation (SCT) has been known to improve survival outcomes. However, there are still no standard guidelines for choosing high-dose chemotherapy followed by autologous-SCT (auto-SCT) or allogeneic-SCT (allo-SCT) in patients with up-front or salvage setting.

Methods

We retrospectively analyzed data from 599 patients with PTCLs who underwent auto-SCT or allo-SCT over the past 10 years. Patients between 15 and 70 years were included in this study. Event-free survival (EFS) was determined from the date of SCT to the date of disease progression or death from any cause. Overall survival (OS) was determined from the date of SCT to the date of death or last follow-up.

Results

A total of 446 patients were analyzed, and the median age at the time of SCT was 49.6 (range, 15.2-69.7) years old. Histology subtypes were PTCL-NOS (n=184), NK/T lymphoma (n=89), angioimmunoblastic T lymphomas (AITL, n=79), anaplastic large cell lymphoma (ALCL, n=64), enteropathy-associated T cell lymphoma (EATL, n=15), and adult T cell leukemia/lymphoma (ATLL, n=15). Up-front SCT was conducted in 379 patients in which CR1 were 229 patients, PR1 were 89, and primary refractory were 61, respectively. As a part of front-line therapy, 302 patients received auto-SCT while 77 patients underwent allo-SCT. Auto-SCT showed significantly superior OS than allo-SCT in patients with CR1 or PR1 at the time of SCT (p=0.026). Survival outcomes in patients with primary refractory disease were also statistically superior in auto-SCT group (EFS, p=0.049; OS, p=0.018). In patients with CR≥2, PR≥2, patients who underwent salvage chemotherapy followed by auto-SCT reported better OS (p=0.011). However, in patients who underwent SCT in a relapsed state, allo-SCT group showed better survival tendency in terms of EFS (p=0.077) and OS (p=0.058). Majority cause of poor outcomes in allo-SCT group was treatment related mortality (TRM). In the allo-SCT group, total body irradiation (TBI) and CR or PR status at the time of SCT were identified as favorable factors in the multivariate analysis. Donor type and conditioning regimen were not affected the transplantation outcomes.

Conclusion

Auto-SCT was effected as a part of front-line therapy or as a part of salvage setting. Allo-SCT could be considered in relapsed state patients with TBI based conditioning regimen.

Yoon:Amgen: Consultancy; Novartis: Consultancy; Kyowa Kirin: Research Funding; Astellas Pharma: Consultancy; Celgene: Consultancy; Janssen Pharmaceutical: Consultancy; Takeda: Consultancy; Chugai Pharmaceutical: Consultancy; Roche-Genetech: Research Funding; Yuhan Pharmaceutical: Research Funding; Tikaros: Consultancy.