Comparison of Total Body Irradiation (TBI) Conditioning with Non-TBI for Autologous Stem Cell Transplantation in Newly Diagnosed or Relapsed Mature T- and NK-Cell Non-Hodgkin Lymphoma

Abstract

Purpose: This retrospective study was conducted for comparison of survival outcomes and toxicities of autologous stem cell transplantation (ASCT) based on the use of total body irradiation (TBI) as a part of the conditioning regimen in patients with mature T- and natural killer (NK)-cell lymphomas.

Materials and methods: Patients who underwent ASCT in the upfront or salvage setting between January 2000 and December 2013 were analyzed. Patients were dichotomized according to the TBI group (n=38) and non-TBI group (n=60) based on the type of conditioning regimen for ASCT.

Results: Patients with responsive disease underwent upfront ASCT (TBI, n=16; non-TBI, n=29) whereas patients with refractory disease (TBI, n=9; non-TBI, n=12) or relapsed disease (TBI, n=13; non-TBI, n=19) underwent ASCT after salvage treatment. Hematologic and non-hematologic toxicities were manageable, and the median cumulative toxicity score according to Seattle criteria was estimated as 2 (range, 0 to 7) in both groups. No significant difference in 100-day mortality was observed between the TBI (13%, 5/38) and non-TBI (12%, 12/60) groups, and most deaths were related to disease progression. There was no difference in overall and progression-free survival; however, the TBI group showed a trend of better survival in upfront and salvage ASCT than the non-TBI group. However, patients with refractory disease showed the worst outcome regardless of the use of TBI. Patients who showed complete response before ASCT showed better progression-free survival than thosewho showed partial response.

Conclusion: TBI could be used as an effective part of conditioning for ASCT in patients with mature T- and NK-cell lymphomas.

Keywords: Lymphoma; Nutural killer cells; Stem cell transplantation; T-lymphocytes; Whole-body irradiation.

Fig. 1.

Classification of patients according to response to induction treatment and time of autologous stem cell transplantation. CR, complete response; PR, partial response; PD, progressive disease; TBI, total body irradiation; ASCT, autologous stem cell transplantation; PTCL, peripheral T-cell lymphoma; AITL, angioimmunoblastic T-cell lymphoma; ALCL, anaplastic large cell lymphoma; ENKTL, extranodal natural killer/T-cell lymphoma.

Fig. 2.

(A, B) Comparison of overall and progression-free survival according to the use of total body irradiation (TBI). (C, D) Comparison of progression-free survival between TBI and non-TBI group in upfront and salvage autologous stem cell transplantation. (E, F) Comparison of progression-free survival between TBI and non-TBI group in T-cell lymphomas and extranodal natural killer (NK)/T-cell lymphoma.

Fig. 3.

(A, B) Comparison of progression-free survival between patients with pre-transplantation complete response (CR) and partial response (PR) in the total body irradiation (TBI) and non-TBI group. (C, D) Association of pre-transplantation CR assessed by positron emission tomography (PET) computed tomography and progression-free survival in the TBI and non-TBI group. (E, F) Comparison of progression-free survival according to the response to induction treatment in the TBI and non-TBI group.

Fig. 4.

(A-C) Comparison of progression-free survival of patients with responsive, refractory, and relapsed disease between the total body irradiation (TBI) and non-TBI groups. (D, E) The TBI group showed a trend of better progression-free survival than the non-TBI group in extranodal natural killer (NK)/T-cell lymphoma with responsive disease and T-cell lymphoma with relapsed disease. (F) No difference in progression-free survival of refractory disease was observed in patients with extranodal NK/T-cell lymphoma.