The role of autologous stem cell transplantation in patients with nodal peripheral T-cell lymphomas in first complete remission: Report from COMPLETE, a prospective, multicenter cohort study

Abstract

Background: The role of autologous stem cell transplantation (ASCT) in the first complete remission (CR1) of peripheral T-cell lymphomas (PTCLs) is not well defined. This study analyzed the impact of ASCT on the clinical outcomes of patients with newly diagnosed PTCL in CR1.

Methods: Patients with newly diagnosed, histologically confirmed, aggressive PTCL were prospectively enrolled into the Comprehensive Oncology Measures for Peripheral T-Cell Lymphoma Treatment (COMPLETE) study, and those in CR1 were included in this analysis.

Results: Two hundred thirteen patients with PTCL achieved CR1, and 119 patients with nodal PTCL, defined as anaplastic lymphoma kinase-negative anaplastic large cell lymphoma, angioimmunoblastic T-cell lymphoma (AITL), or PTCL not otherwise specified, were identified. Eighty-three patients did not undergo ASCT, whereas 36 underwent consolidative ASCT in CR1. At the median follow-up of 2.8 years, the median overall survival was not reached for the entire cohort of patients who underwent ASCT, whereas it was 57.6 months for those not receiving ASCT (P = .06). ASCT was associated with superior survival for patients with advanced-stage disease or intermediate-to-high International Prognostic Index scores. ASCT significantly improved overall and progression-free survival for patients with AITL but not for patients with other PTCL subtypes. In a multivariable analysis, ASCT was independently associated with improved survival (hazard ratio, 0.37; 95% confidence interval, 0.15-0.89).

Conclusions: This is the first large prospective cohort study directly comparing the survival outcomes of patients with nodal PTCL in CR1 with or without consolidative ASCT. ASCT may provide a benefit in specific clinical scenarios, but the broader applicability of this strategy should be determined in prospective, randomized trials. These results provide a platform for designing future studies of previously untreated PTCL.

Keywords: anaplastic lymphoma kinase (ALK)-negative anaplastic large cell lymphoma; angioimmunoblastic T-cell lymphoma (AITL); autologous stem cell transplant; first complete remission; nodal peripheral T-cell lymphoma; peripheral T-cell lymphoma (PTCL) not otherwise specified (NOS).

Figure 1.

(A) Overall survival and (B) progression-free survival for first complete remission patients with nodal PTCL (non-ASCT and ASCT patients combined) by subtypes: ALK-negative anaplastic large cell lymphoma, angioimmunoblastic T-cell lymphoma, and PTCL NOS. ALK indicates anaplastic lymphoma kinase; ASCT, autologous stem cell transplantation; NOS, not otherwise specified; PTCL, peripheral T-cell lymphoma.

Figure 2.

(A) Overall survival and (B) progression-free survival for first complete remission patients with nodal peripheral T-cell lymphoma: ASCT versus non-ASCT. ASCT indicates autologous stem cell transplantation.

Figure 3.

OS and PFS for first complete remission patients with nodal PTCL by subtypes (ASCT versus non-ASCT): (A,B) OS and PFS with angioimmunoblastic T-cell lymphoma, respectively; (C,D) OS and PFS with PTCL not otherwise specified, respectively; and (E,F) OS and PFS with ALK-negative anaplastic large cell lymphoma, respectively. ALK indicates anaplastic lymphoma kinase; ASCT, autologous stem cell transplantation; OS, overall survival; PFS, progression-free survival; PTCL, peripheral T-cell lymphoma.

Figure 4.

Overall survival in first complete remission patients with nodal peripheral T-cell lymphoma by risk factor: (A,B) limited versus advanced stage and (C,D) low IPI scores (0–1) versus intermediate/high (2–4) IPI scores. IPI indicates International Prognostic Index.