High-dose therapy and autologous stem-cell transplantation in angioimmunoblastic lymphoma: complete remission at transplantation is the major determinant of Outcome-Lymphoma Working Party of the European Group for Blood and Marrow Transplantation.

Abstract

PURPOSE:

Patients with angioimmunoblastic T-cell lymphoma (AITL) have poor prognoses with current conventional chemotherapy. The aim of this study was to evaluate the effect of high-dose therapy (HDT) followed by autologous stem-cell transplantation (ASCT) on patients with AITL.

PATIENTS AND METHODS:

We report a retrospective, multicenter study of 146 patients with AITL who received ASCT. The source of the stem cells was peripheral blood in 143 patients. The conditioning regimen varied, and 74% of the patients received carmustine and 1,3-bis(2-chloroethyl)-1-nitrosourea; etoposide; ara-C; and melphalan chemotherapy.

RESULTS:

After a median follow-up of 31 months (range, 3 to 174 months), 95 patients (65%) remained alive, and 51 patients (35%) died. Forty-two patients died as a result of disease progression, and nine died as a result of regimen-related toxicity. The cumulative incidence of nonrelapse mortality was 5% and 7% at 12 and 24 months, respectively. The actuarial overall survival (OS) was 67% at 24 months and 59% at 48 months. The cumulative incidence of relapse was estimated at 40% and 51% at 24 and 48 months, respectively. Disease status at transplantation was the major factor that impacted outcome. Patients who received a transplant during first complete remission (CR) had significantly superior progression-free survival and OS. The estimated PFS rates for patients who received their transplants in CR were 70% and 56% at 24 and 48 months, respectively; 42% and 30% for patients with chemotherapy-sensitive disease at those time points, respectively; and 23% at both time points for patients with chemotherapy-refractory disease.

CONCLUSION:

This study shows that HDT and ASCT offers the possibility of long-term disease-free survival to patients with AITL. Early transplantation is necessary to achieve optimal results.

• Authors: Charalampia Kyriakou, Carmen Canals, Anthony Goldstone, Dolores Caballero, Bernd Metzner, Guido Kobbe, Hans-Jochem Kolb, Joachim Kienast, Peter Reimer, Jurgen Finke, Gunnar Oberg, Ann Hunter, Niklas Theorin, Anna Sureda, Norbert Schmitz, Outcome-Lymphoma Working Party of the European Group for Blood and Marrow Transplantation
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 26 Issue 2 Pg. 218-24 (Jan 10 2008) ISSN: 1527-7755 [Electronic] United States
• PMID: 18182664 (Publication Type: Journal Article, Multicenter Study)

Chemical References

• Cytarabine
• Etoposide
• Melphalan
• Carmustine

Topics

• Aged
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Carmustine (administration & dosage)
• Combined Modality Therapy
• Cytarabine (administration & dosage)
• Disease Progression
• Etoposide (administration & dosage)
• Female
• Humans
• Immunoblastic Lymphadenopathy (drug therapy, therapy)
• Male
• Melphalan (administration & dosage)
• Middle Aged
• Neoplasm Recurrence, Local
• Proportional Hazards Models
• Remission Induction
• Retrospective Studies
• Stem Cell Transplantation
• Survival Analysis
• Transplantation Conditioning
• Treatment Outcome