Upfront Autologuos Stem-Cell Transplantation in Peripheral T-Cell Lymphoma: NLG-T-01.

Research output: Contribution to journalArticle

Abstract

PURPOSE:
Systemic peripheral T-cell lymphomas (PTCLs) respond poorly to conventional therapy. To evaluate the efficacy of a dose-dense approach consolidated by upfront high-dose chemotherapy (HDT) and autologous stem-cell transplantation (ASCT) in PTCL, the Nordic Lymphoma Group (NLG) conducted a large prospective phase II study in untreated systemic PTCL. This is the final report, with a 5-year median follow-up, of the NLG-T-01 study.

PATIENTS AND METHODS:
Treatment-naive patients with PTCL age 18 to 67 years (median, 57 years) were included. Anaplastic lymphoma kinase (ALK) -positive anaplastic large-cell lymphoma (ALCL) was excluded. An induction regimen of six cycles of biweekly CHOEP (cyclophosphamide, doxorubicin, vincristine, etoposide, and prednisone) was administered (in patients age > 60 years, etoposide was omitted). If in complete or partial remission, patients proceeded to consolidation with HDT/ASCT.

Results:
Of 166 enrolled patients, 160 had histopathologically confirmed PTCL. The majority presented with advanced-stage disease, B symptoms, and elevated serum lactate dehydrogenase. A total of 115 underwent HDT/ASCT, with 90 in complete remission at 3 months post-transplantation. Early failures occurred in 26%. Treatment-related mortality was 4%. At 60.5 months of median follow-up, 83 patients were alive. Consolidated 5-year overall and progression-free survival (PFS) were 51% (95% CI, 43% to 59%) and 44% (95% CI, 36% to 52%), respectively. Best results were obtained in ALK-negative ALCL.

CONCLUSION:
Dose-dense induction followed by HDT/ASCT was well tolerated and led to long-term PFS in 44% of treatment-naive patients with PTCL. This represents an encouraging outcome, particularly considering the high median age and adverse risk profile of the study population. Therefore, dose-dense induction and HDT/ASCT are a rational upfront strategy in transplantation-eligible patients with PTCL.

Details

Authors
  • Francesco d'Amore
  • Thomas Relander
  • Grete F Lauritzsen
  • Esa Jantunen
  • Hans Hagberg
  • Harald Anderson
  • Harald Holte
  • Anders Osterborg
  • Mats Merup
  • Peter Brown
  • Outi Kuittinen
  • Martin Erlanson
  • Bjørn Ostenstad
  • Unn-Merete Fagerli
  • Ole V Gadeberg
  • Christer Sundström
  • Jan Delabie
  • Elisabeth Ralfkiaer
  • Martine Vornanen
  • Helle E Toldbod
Organisations
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cancer and Oncology
Original languageEnglish
Pages (from-to)3093-3099
JournalJournal of Clinical Oncology
Volume30
Issue number25
StatePublished - 2012
Peer-reviewedYes