Rescue chemotherapy or autologous stem cell transplantation (autoSCT) gives disappointing results in relapsed peripheral T-cell lymphomas (PTCLs). We have retrospectively evaluated the long-term outcome of 52 patients receiving allogeneic SCT for relapsed disease. Histologies were PTCL-not-otherwise specified (n=23), anaplastic large-cell lymphoma (n=11), angioimmunoblastic T-cell lymphomas (n=9) and rare subtypes (n=9). Patients were allografted from related siblings (n=33, 64%) or alternative donors (n=13 (25%) from unrelated and 6 (11%) from haploidentical family donors), following reduced-intensity conditioning (RIC) regimens including thiotepa, fludarabine and cyclophosphamide. Most of the patients had chemosensitive disease (n=39, 75%) and 27 (52%) failed a previous autoSCT. At a median follow-up of 67 months, 27 of 52 patients were found to be alive (52%) and 25 (48%) were dead (n=19 disease progression, n=6 non-relapse mortality (NRM)). The cumulative incidence (CI) of NRM was 12% at 5 years. Extensive chronic graft-versus-host disease increased the risk of NRM (33% versus 8%, P=0.04). The CI of relapse was 49% at 5 years, influenced by disease status at the time of allografting (P=0.0009) and treatment lines (P=0.007). Five-year overall survival and progression-free survival (PFS) were 50% (95% CI, 36 - 63%) and 40% (95% CI, 27 - 53%), respectively. The current PFS was 44% (95% CI, 30-57%). In all, 8 out of 12 patients (66%) who received donor-lymphocytes infusions for disease progression had a response. At multivariable analysis, refractory disease and age over 45 years were independent adverse prognostic factors. RIC allogeneic SCT is an effective salvage treatment with a better outcome for younger patients with chemosensitive disease.
Allogeneic transplantation following a reduced-intensity conditioning regimen in relapsed/refractory peripheral T-cell lymphomas : long-term remissions and response to donor lymphocyte infusions support the role of a graft-versus-lymphoma effect / A. Dodero, F. Spina, F. Narni, F. Patriarca, I. Cavattoni, F. Benedetti, F. Ciceri, D. Baronciani, R. Scimè, E. Pogliani, A. Rambaldi, F. Bonifazi, S. Dalto, B. Bruno, P. Corradini. - In: LEUKEMIA. - ISSN 0887-6924. - 26:3(2012 Mar), pp. 520-526.
|Titolo:||Allogeneic transplantation following a reduced-intensity conditioning regimen in relapsed/refractory peripheral T-cell lymphomas : long-term remissions and response to donor lymphocyte infusions support the role of a graft-versus-lymphoma effect|
|Parole Chiave:||Young Adult ; Lymphoma, Large B-Cell, Diffuse ; Transplantation Conditioning ; Humans ; Transplantation, Homologous ; Lymphoma, T-Cell, Peripheral ; Recurrence ; Tissue Donors ; Adult ; Hematopoietic Stem Cell Transplantation ; Immunotherapy, Adoptive ; Graft vs Host Disease ; Middle Aged ; Sibling Relations ; Adolescent ; Female ; Male ; Survival Analysis|
|Settore Scientifico Disciplinare:||Settore MED/15 - Malattie del Sangue|
|Data di pubblicazione:||mar-2012|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1038/leu.2011.240|
|Appare nelle tipologie:||01 - Articolo su periodico|