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Autografting

The role of high-dose therapy and stem cell rescue in the management of T-cell malignant lymphomas: a BSBMT and ABMTRR study

Abstract

Peripheral T-cell lymphomas (PTCL) are a rare and heterogeneous subset of lymphomas with a poorer prognosis compared with B-cell lymphomas. We conducted a retrospective study of 82 patients who received high-dose therapy for PTCL (autologous SCT (ASCT) N=64; allogeneic SCT (Allo-SCT) N=18). With a median follow-up from ASCT of 37 months from transplant, 33 patients were alive; 20 died of progressive disease, 10 died from non-relapse mortality (NRM) with 1 unknown cause. Three-year overall survival (OS) and progression-free survival (PFS) were 53% (95% confidence interval (CI) 42, 67) and 50% (95% CI 39, 64), respectively. Factors significantly affecting OS and PFS on univariate analysis were histological subtype and chemotherapy sensitivity. In a multivariate analysis, the only factor with significant impact was chemotherapy sensitivity. After a median follow-up from Allo-SCT of 57 months, five patients were alive; five died of progressive disease and eight died from NRM. The 3-year OS and PFS were 39% (95% CI 22, 69) and 33% (95% CI 17, 64), respectively, and the 3-year relapse rate was 28% (95% CI 6, 50). These results demonstrate that high-dose chemotherapy with autologous stem cell rescue has a substantial role in the management of T-cell lymphoma. The use of full-intensity allogeneic transplantation is limited by high transplant-related mortality, and exploration of reduced intensity regimens is warranted.

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Acknowledgements

SF is funded by the Arnold J Tunstall Research Fellowship. The Clinical Trials Committee of BSBMT is supported by The Leukaemia Research Fund (Grant 03/100, Dr DI Marks). The authors would like to thank the following transplant centres (Director/Data manager) for their contribution: Queen Elizabeth Hospital (C Craddock/C Porter), Birmingham, UK; United Hospitals Bristol (D Marks/A Nunn), Bristol, UK; Addenbrookes Hospital (R Marcus/C Howlett), Cambridge, UK; Canterbury Health Laboratories (N Patton/J Sanders), Christchurch, New Zealand; Western General Hospital (J Davies/A Robertson), Edinburgh, UK; Leeds Teaching Hospital (G Cook/L Barnard), Leeds, UK; Guys Hospital (S Schey/M Rahman), London, UK; Royal Free Hospital (S MacKinnon/J Ankrah), London, UK; Christie Hospital (J Cavet/B Foulkes), Manchester, UK; Kings College Hospital (A Pagluica/M Kenyon), London, UK; Newcastle Mater Misericordiae Hospital (A Enno/H Zang), Newcastle, Australia; Nottingham City Hospital (N Russell/P Nelson), Nottingham, UK; Peter MacCallum Cancer Centre (HM Prince/T Joyce), Melbourne, Australia; Royal Adelaide Hospital (LB To/K Olson), Adelaide, Australia; Royal Prince Alfred Hospital (J Gibson/AM Johnston), Sydney, Australia; Royal Hallamshire Hospital (J Snowden/B Holt), Sheffield, UK; Southampton University Hospitals (K Orchard/C Hurlock), Southampton, UK; St Vincent's Hospital (AJ Dodds/A Jiamsakul), Sydney, Australia; Taunton (S Rule/M Ewings), Taunton, UK; and Westmead Hospital (K Bradstock/G Huang), Sydney, Australia.

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Feyler, S., Prince, H., Pearce, R. et al. The role of high-dose therapy and stem cell rescue in the management of T-cell malignant lymphomas: a BSBMT and ABMTRR study. Bone Marrow Transplant 40, 443–450 (2007). https://doi.org/10.1038/sj.bmt.1705752

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