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. 2013 Sep 1;31(25):3100-9.
doi: 10.1200/JCO.2012.46.0188. Epub 2013 Jul 29.

Hematopoietic cell transplantation for systemic mature T-cell non-Hodgkin lymphoma

Sonali M Smith  1 , Linda J Burns, Koen van Besien, Jennifer Lerademacher, Wensheng He, Timothy S Fenske, Ritsuro Suzuki, Jack W Hsu, Harry C Schouten, Gregory A Hale, Leona A Holmberg, Anna Sureda, Cesar O Freytes, Richard Thomas Maziarz, David J Inwards, Robert Peter Gale, Thomas G Gross, Mitchell S Cairo, Luciano J Costa, Hillard M Lazarus, Peter H Wiernik, Dipnarine Maharaj, Ginna G Laport, Silvia Montoto, Parameswaran N Hari
Affiliations

Hematopoietic cell transplantation for systemic mature T-cell non-Hodgkin lymphoma

Sonali M Smith et al. J Clin Oncol. .

Abstract

Purpose: To analyze outcomes of hematopoietic cell transplantation (HCT) in T-cell non-Hodgkin lymphoma.

Patients and methods: Outcomes of 241 patients (112 anaplastic large-cell lymphoma, 102 peripheral T-cell lymphoma not otherwise specified, 27 angioimmunoblastic T-cell lymphoma) undergoing autologous HCT (autoHCT; n = 115; median age, 43 years) or allogeneic HCT (alloHCT; n = 126; median age, 38 years) were analyzed. Primary outcomes were nonrelapse mortality (NRM), relapse/progression, progression-free survival (PFS), and overall survival (OS). Patient, disease, and HCT-related variables were analyzed in multivariate Cox proportional hazard models to determine association with outcomes.

Results: AutoHCT recipients were more likely in first complete remission (CR1; 35% v 14%; P = .001) and with chemotherapy-sensitive disease (86% v 60%; P < .001), anaplastic large-cell histology (53% v 40%; P = .04), and two or fewer lines of prior therapy (65% v 44%; P < .001) compared with alloHCT recipients. Three-year PFS and OS of autoHCT recipients beyond CR1 were 42% and 53%, respectively. Among alloHCT recipients who received transplantations beyond CR1, 31% remained progression-free at 3 years, despite being more heavily pretreated and with more refractory disease. NRM was 3.5-fold higher (95% CI, 1.80 to 6.99; P < .001) for alloHCT. In multivariate analysis, chemotherapy sensitivity (hazard ratio [HR], 1.8; 95% CI, 1.16 to 2.87) and two or fewer lines of pretransplantation therapy (HR, 5.02; 95% CI, 2.15 to 11.72) were prognostic of survival.

Conclusion: These data describe the roles of autoHCT and alloHCT in T-cell non-Hodgkin lymphoma and suggest greater effectiveness earlier in the disease course, and limited utility in multiply relapsed disease. Notably, autoHCT at relapse may be a potential option for select patients, particularly those with anaplastic large-cell lymphoma histology.

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Conflict of interest statement

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
(A) Adjusted progression-free survival (PFS), (B) adjusted overall survival (OS), and (C) nonrelapse mortality (NRM) for all patients (n = 241). (D) PFS, (E) OS, and (F) NRM for patients who underwent nonmyeloablative stem-cell transplantation/reduced-intensity conditioning (RIC) versus myeloablative allogeneic hematopoietic cell transplantation (allo). NS, not significant. (G) PFS, (H) OS, and (I) NRM for patients who underwent HLA-identical sibling versus unrelated donor allo. (J) PFS and (K) OS for patients who underwent autologous HCT (auto) and allo when excluding patients in first complete remission.
Fig 1.
Fig 1.
(A) Adjusted progression-free survival (PFS), (B) adjusted overall survival (OS), and (C) nonrelapse mortality (NRM) for all patients (n = 241). (D) PFS, (E) OS, and (F) NRM for patients who underwent nonmyeloablative stem-cell transplantation/reduced-intensity conditioning (RIC) versus myeloablative allogeneic hematopoietic cell transplantation (allo). NS, not significant. (G) PFS, (H) OS, and (I) NRM for patients who underwent HLA-identical sibling versus unrelated donor allo. (J) PFS and (K) OS for patients who underwent autologous HCT (auto) and allo when excluding patients in first complete remission.
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