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

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

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104 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)3100-3109
Number of pages10
JournalJournal of Clinical Oncology
Volume31
Issue number25
DOIs
StatePublished - Sep 1 2013

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ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Smith, S. M., Burns, L. J., Inwards, D. J., Van Besien, K., Wiernik, P. H., Cairo, M. S., Le Rademacher, J., He, W., Hari, P. N., Fenske, T. S., Suzuki, R., Hsu, J. W., Hale, G. A., Maharaj, D., Schouten, H. C., Holmberg, L. A., Sureda, A., Gale, R. P., Montoto, S., ... Laport, G. G. (2013). Hematopoietic cell transplantation for systemic mature T-cell non-hodgkin lymphoma. Journal of Clinical Oncology, 31(25), 3100-3109. https://doi.org/10.1200/JCO.2012.46.0188