Hematopoietic SCT for peripheral T-cell lymphoma

Results of conventional chemotherapy for high-risk peripheral T-cell lymphoma (PTCL) are poor compared with those for their aggressive B-cell counterparts. We aim to review the current data on the use of hematopoietic SCT in these patients in both frontline and salvage settings. With respect to autologous SCT ( ASCT), conclusions from retrospective studies are that ASCT in the salvage setting is as useful in PTCLas in aggressive B-cell lymphomas and also that consolidation in first complete response of high-risk patients has very good results when compared with conventional chemotherapy ( with long-term PFS higher than 50%). From first frontline prospective clinical trials, it appears that ASCT is feasible and has a low TRM (< 5%); consolidation in first complete response is associated with a very good outcome; around 25% of patients do not undergo ASCT due mainly to disease progression; new approaches aimed at increasing the number of chemosensitive patients should be found. Furthermore, 25-30% of patients deemed complete responders post transplant still relapse afterward. For all these mainly chemoresistant patients, there is preliminary evidence that allogeneic SCT (Allo-SCT) may produce a plateau in survival curves ( with long-term PFS around 50%), which indicates a graft-versus-PTCL effect. For this reason, Allo-SCT procedures are the object of ongoing clinical trials.