Prolonged Survival in Patients with Angioimmunoblastic T-Cell Lymphoma (AIL) after High-Dose Chemotherapy and Autologous Stem Cell Transplantation (ASCT). The GELTAMO Experience.

Conventional treatment of patients with AIL offers poor results with a median survival ranging from 15 to 24 months. No standard treatment for this disease has been established. Thus, our aim in this report is to provide our experience within a cooperative group in patients with this type of lymphoma who underwent ASCT. Nineteen patients were transplanted in the GELTAMO cooperative group in the last 12 years. Median age at transplant was 46 years. Fifteen patients (79%) underwent the procedure as front line therapy, 8 out of these 15 pts as consolidation of first CR, 5 in first PR and 2 in induction failure condition. Four patients who relapse received the procedure as salvage therapy. Most patients (90%) received peripheral stem cell product and the conditioning regimen was based in BEAM or BEAC in 79% of patients. Seventy-nine percent of patients achieved a CR with the transplant, 5% a PR and 16% of patients failed the transplant. With a median follow up of 25 months for alive patients, 11 patients are alive and free of disease at present. The OS at 5 years is 60% and the PFS, 55%. Eight patients died, 7 of them of disease and 1 patient of a second neoplasia. Prognostic factors associated with a poor outcome were the presence of extranodal disease at transplant, bone marrow involvement, the presence of more than 1 factor of the age-adjusted-IPI (a-IPI) and be transplanted in refractory disease. Patients with AIL who underwent ASCT in chemosensitive disease have 60% of probability to be alive at 5 years, most of them free of disease. Patients who received the procedure as consolidation either as first CR or in first PR have similar outcome. However patients in refractory disease do not benefit of this therapeutic modality. The presence of extranodal disease at transplant predicts an unfavourable outcome.