Dose modification of alemtuzumab in combination with dexamethasone, cytarabine, and cisplatin in patients with relapsed or refractory peripheral T-cell lymphoma: analysis of efficacy and toxicity

Abstract

Background: There is still no consensus on the role of alemtuzumab as a salvage therapy for relapsed or refractory peripheral T-cell lymphoma (PTCL). We studied the efficacy and toxicity of combination treatment of alemtuzumab, dexamethasone, cytarabine, and cisplatin (A-DHAP) for treating PTCL.

Methods: We enrolled 24 patients with relapsed or refractory PTCL. Each patient received DHAP plus alemtuzumab every 3 weeks for up to three cycles. Two alemtuzumab dosages of 70 mg or 40 mg were used per cycle. After A-DHAP treatment, the responders underwent autologous stem cell transplantation.

Results: The overall response rate was 50.0% (12 of 24 patients), including five complete responders and seven partial responders. Analysis of the responses according to histological type showed a higher objective response rate for PTCL-unspecified (69.2%: four complete responders, five partial responders) than for extranodal NK/T cell lymphoma (12.5%, one partial responder). The median overall survival (OS) after enrollment was 6.0 months (95% confidence interval: 4.20-7.80 months), and the median response duration of responders was 2.93 months (95% confidence interval: 0.93-4.93 months). The overall response rate and OS did not differ significantly according to the dosage of alemtuzumab (70 mg vs. 40 mg, P > 0.05). The most frequent side effect was grade 3/4 leukopenia. Non-disease-related death occurred more frequently in patients who received 70 mg of alemtuzumab.

Conclusions: The combination of alemtuzumab plus DHAP might be effective salvage chemotherapy for PTCL, and 40 mg of alemtuzumab appears to be a more tolerable dosage when used in combination with DHAP.