A Retrospective Analysis of Peripheral T-Cell Lymphoma Treated With the Intention to Transplant in the First Remission

Peripheral T-cell lymphomas (PTCLs) are aggressive lymphomas without standard treatment. We retrospectively identified 65 patients with PTCL initially treated with the intention to perform autologous (HD-ASCT) or allogenic (allo-HSCT) stem cell transplant in the first complete remission (CR). Treatment with allo-HSCT and HD-ASCT had overall survival (OS) at 4 years of 66% and 67%, respectively. Baseline International Prognostic Index (IN) score and interim response to CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) might also predict outcome. Background: Peripheral T-cell lymphomas are aggressive lymphomas that have no standard treatment. Studies suggest that HD-ASCT in the first CR improves outcome. Few data exist regarding allo-HSCT in the first CR. Patients and Methods: We retrospectively identified patients (2001-2011) with PTCL-not otherwise specified, angioimmunoblastic T-cell lymphoma, and anaplastic lymphoma kinase-negative anaplastic large cell lymphoma, initially treated with CHOP, CHOP-ICE (ifosfamide, carboplatin, etoposide), or other therapy with the intention to transplant in the first CR. Disease characteristics, therapy, progression-free survival (PFS), and OS were evaluated. Results: Sixty-five patients were identified. PFS and OS were 38% and 52%, respectively, at 4 years. CHOP and CHOP-ICE regimens had similar outcomes. Treatment with allo-HSCT and HD-ASCT had OS at 4 years of 66% and 67%, respectively. Patients who did not proceed to transplant had OS of 27%. IPI score <= 2 and Prognostic Index for T-cell Lymphomas scores <= 1 predicted improved outcome. Combined analysis of interim response to CHOP and IPI score also predicted PFS and OS. Conclusion: Our results support consolidation of first CR with transplantation. The addition of etoposide did not improve outcomes. Baseline IPI and interim response to CHOP can predict outcomes and guide decisions about transplantation in first CR in PTCL. Randomized trials are necessary to confirm the efficacy of this approach.