High-Dose Chemotherapy and Autologous Hematopoietic Cell Transplantation Early during the Course of Disease Appears to Improve Outcomes of Patients T Cell Non-Hodgkin Lymphoma: Results of a Single-Institution Experience

Mature T-Cell lymphoma (PTCL) is a heterogeneous group of malignancies characterized by a poor outcome when treated with antracycline-based chemotherapy regimens. High-dose chemotherapy with autologous transplantation (auto-HCT) has emerged as a commonly used strategy for patients in first remission or at the time of first chemosensitive relapse. However, data are limited and the role of autografting remains undefined. Here, we present a retrospective analysis of 67 patients with PTCL who underwent autoHCT at our center between January 2000 and December 2011. Histological subtypes included anaplastic large cell lymphoma (ALCL, n=27, 40.3%), peripheral T-cell lymphoma not other specified (PTCL-NOS, n=25, 37.3%), angioimmunoblastic T-cell lymphoma (AITL, n=7, 10.4%), other (n=8, 11.9%).

Median age at the time of auto-HCT was 52 years (22-75), median time from diagnosis to HCT was 10 months (6-193) and median follow up for surviving patients was 38 months (6-136). Forty-one (61%) were male. At diagnosis, 52 (77%) had stage III/IV, 39 (58%) had at least one extranodal site of disease, 18 (27%) had intermediate-high or high-risk by international prognostic index (IPI) and 16 (24%) had intermediate-high or high-risk by PTCL prognostic index (PIT). At transplantation, 32 (48%) had received 1 line of therapy and 35 (52%) had received 2 or more. Thirty-six patients (54%) were in first complete remission (CR1) and 62 (92%) had shown sensitivity to most recent therapy. BEAM (carmustine, etoposide, cytarabine and melphalan) was used as conditioning regimen in 52 patients (78%) and no patient received a radiation based regimen.

Five-year overall survival (OS) was 65%. In univariate analysis, OS was associated with number of lines of therapy [>1 vs. 1, (Hazard ratio (HR)=3.604; 95% CI: 1.335, 9.725; p=0.011)] and remission status [(CR1 vs. other (HR=0.303, 95% CI: 0.124, 0.741; p=0.009); (CR vs. other (HR= 0.223, 95% CI: 0.096, 0.518; p=0.0005)]. PFS was associated with age [age >50 vs. ≤50 (HR=2.308, 95% CI: 1.01, 5.26, p=0.047)] and remission status [CR1 vs. other (HR= 0.396, 95% CI: 0.185, 0.849, p=0.017), CR vs. other (HR=0.246, 95% CI: 0.115, 0.525, p<0.001)]. Only 4 patients died of causes other than relapse.

In conclusion, patients with PTCL who underwent an auto-HCT early in the course of the disease appear to benefit the most, achieving durable remissions. Disease relapse remains the most common cause of failure. Maintenance strategies with novel therapies remain a reasonable research question to address in large prospective clinical trials.