Journal
LEUKEMIA
Volume 20, Issue 9, Pages 1533-1538Publisher
NATURE PUBLISHING GROUP
DOI: 10.1038/sj.leu.2404306
Keywords
high-dose chemotherapy; autologous stem cell transplantation; peripheral T-cell lymphomas
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We report the results of two prospective phase II studies investigating the role of high-dose sequential chemotherapy, followed by autologous stem cell transplantation ( ASCT) in 62 patients with advanced stage peripheral T-cell lymphomas (PTCLs) at diagnosis. Conditioning regimen consisted of mitoxantrone (60mg/m(2)) and melphalan (180mg/m(2)) or carmustine, etoposide, Ara-C and melphalan followed by peripheral blood stem cell autografting. In an intent-to-treat analysis, 46 out of 62 patients (74%) completed the whole programme, whereas 16 patients did not undergo ASCT, mainly because of disease progression. At a median follow-up of 76 months, the estimated 12-year overall ( OS), disease-free and event-free survival (EFS) were 34, 55 and 30%, respectively. OS and EFS were significantly better in patients with anaplastic lymphomakinase (ALK)-positive anaplastic large-cell lymphoma (ALCL), as compared with the remaining PTCL. Multivariate analysis showed that patients attaining complete remission (CR) before ASCT had a statistically significant benefit in terms of OS and EFS (P < 0.0001). Overall treatment-related mortality rate was 4.8%. In conclusion, our findings indicate ( 1) up-front high-dose therapy and ASCT are feasible, but could induce a high rate of long-term CR only in patients with ALK-positive ALCL and ( 2) the achievement of CR before autografting is a strong predictor of better survival.
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