Abstract 2284

Poster Board II-261

Background:

To evaluate the role of autologous and allogeneic SCT in the treatment of PTCLs, Japan Study Group for Cell Therapy and Transplantation conducted a multicenter retrospective survey in Japan and Korea.

Methods:

After excluding patients with adult T-cell leukemia/lymphoma and NK-cell tumors, patient data were newly collected from 330 patients (222 male and 108 female) with a median age of 49 years (range, 13–71) who underwent SCT between 9/1991 and 12/2008 (196 autologous and 134 allogeneic including 31 patients with previous autograft). Allogeneic SCT (53 BM, 54 PB, 1 BM+PB, 26 CB) was performed using a reduced-intensity conditioning (RIC) in 84 patients (63%). While a pathologic central review will be performed, currently there were 159 (48%) patients with PTCL, not otherwise specified, 63 (19%) with angioimmunoblastic T-cell lymphoma, 47(14%) with anaplastic large cell lymphoma (23 ALK-negative, 14 ALK-positive and 10 unknown), 12 (4%) with enteropathy-associated T-cell lymphoma, and others. The disease status at transplant in the allo-group was significantly worse than that in the auto-group (Table 1). The median number of chemotherapy regimens was 2 (range, 1–7), and the median duration between diagnosis and transplant was 267 days (range, 120-4889 days).

Results:

The median follow-up for surviving patients was 45 mo (range, 2.3–141 mo). There was no significant difference in overall survival among different groups, including histological subtypes, RIC and myeloablative conditioning in the allo-group and high-dose chemotherapy regimens in the auto-group. Early survival rate after transplant was significantly better for auto-group than allo-group (Wilcoxon P=0.001), but the difference was marginal in the total course (Logrank P=0.06) (Figure). The non-relapse mortality (NRM) in the auto-group was significantly lower than that in the allo-group (P<0.0001) (Table 2). Grade II-IV acute GVHD occurred in 49% of the patients after allogeneic SCT. The causes of death that contributed to NRM were infection in 16/21 (auto/allo), organ failure in 6/12, GVHD in 0/5, secondary cancer in 5/0 and other in 7/5. The long-term relapse rate in the auto-group was significantly higher than that in the allo-group (Fleming-Harrington P=0.03). Univariate analyses showed that the risks of survival were bulky mass at diagnosis, age, recurrence after frontline therapy, number of chemotherapy regimens (>1), cell source (CB/BM+PB), and performance status (PS; >1), stage, chemorefractory disease, international prognostic index (IPI; H-I/H risk) and prognostic index for PTCL, unspecified (PIT; group 3/4) at transplant. The risk factors in the allo-group were bulky mass at diagnosis, age (>50 years), cell source, and PS, stage, IPI and PIT at transplant, while those in the auto-group were age (>40 years), recurrence after frontline therapy, number of chemotherapy regimens, and stage, chemorefractory disease, IPI and PIT at transplant.

Conclusions:

Despite a worse disease status at transplant in the allo-group, the overall survival was comparable to that in the auto-group. This supports the notion that early allogeneic SCT is a valuable treatment option for PTCLs, although a large-scale randomized trial to identify a suitable upfront-transplant type for chemosensitive patients with PTCLs is warranted.

Table 1:

Disease status

Auto (n=196)Allo (n=134)P
Bulky mass at diagnosis 25 (13%) 10 (8%) 0.147 
Performance status 2-4 at SCT 19 (10%) 35 (26%) <0.0001 
Stage at SCT:    
    Complete remission 114 (59%) 27 (20%) <0.0001 
    Limited stage (I/II) 28 (14%) 17 (13%)  
    Advanced stage (III/IV) 53 (27%) 90 (67%)  
IPI 3-5 at diagnosis 72 (37%) 57 (42%) 0.420 
PIT 2-4 at diagnosis 74 (38%) 62 (46%) 0.172 
IPI 3-5 at SCT 24 (12%) 43 (32%) <0.0001 
PIT 2-4 at SCT 23 (12%) 45 (34%) <0.0001 
Auto (n=196)Allo (n=134)P
Bulky mass at diagnosis 25 (13%) 10 (8%) 0.147 
Performance status 2-4 at SCT 19 (10%) 35 (26%) <0.0001 
Stage at SCT:    
    Complete remission 114 (59%) 27 (20%) <0.0001 
    Limited stage (I/II) 28 (14%) 17 (13%)  
    Advanced stage (III/IV) 53 (27%) 90 (67%)  
IPI 3-5 at diagnosis 72 (37%) 57 (42%) 0.420 
PIT 2-4 at diagnosis 74 (38%) 62 (46%) 0.172 
IPI 3-5 at SCT 24 (12%) 43 (32%) <0.0001 
PIT 2-4 at SCT 23 (12%) 45 (34%) <0.0001 
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Table 2:

Study Outcomes

Auto (n=196)Allo (n=134)P (Logrank)P (Wilcoxon)P (F-H)
1-year/3-year NRM 8%/10% 30%/33% <0.0001 <0.0001 0.01 
1-year/3-year relapse 38%/45% 29%/37% 0.19 0.49 0.03 
1-year/3-year PFS 57%/49% 50%/43% 0.18 0.02 0.61 
1-year/3-year OS 74%/59% 55%/52% 0.06 0.001 0.15 
1-year/3-year OS (CR at SCT) 84%/72% 70%/66% 0.23 0.10 0.78 
1-year/3-year OS (stage I-II at SCT) 71%/56% 76%/76% 0.20 0.38 0.07 
1-year/3-year OS (stage III-IV at SCT) 54%/33% 47%/43% 0.91 0.27 0.01 
Auto (n=196)Allo (n=134)P (Logrank)P (Wilcoxon)P (F-H)
1-year/3-year NRM 8%/10% 30%/33% <0.0001 <0.0001 0.01 
1-year/3-year relapse 38%/45% 29%/37% 0.19 0.49 0.03 
1-year/3-year PFS 57%/49% 50%/43% 0.18 0.02 0.61 
1-year/3-year OS 74%/59% 55%/52% 0.06 0.001 0.15 
1-year/3-year OS (CR at SCT) 84%/72% 70%/66% 0.23 0.10 0.78 
1-year/3-year OS (stage I-II at SCT) 71%/56% 76%/76% 0.20 0.38 0.07 
1-year/3-year OS (stage III-IV at SCT) 54%/33% 47%/43% 0.91 0.27 0.01 

Abbreviation: F-H, Fleming and Harrington

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Figure:
Figure:. Probabilities of overall survival by type of transplant
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Probabilities of overall survival by type of transplant

Figure:
Figure:. Probabilities of overall survival by type of transplant
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Probabilities of overall survival by type of transplant

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Disclosures:

No relevant conflicts of interest to declare.

Topics:
allogeneic hematopoietic stem cell transplant, korea, lymphoma, t-cell, peripheral, transplantation, allopurinol, chemotherapy regimen, adult t-cell lymphoma/leukemia, angioimmunoblastic lymphadenopathy, cell therapy, complete remission

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2009 by The American Society of Hematology
2009
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