A randomized phase 3 trial of autologous vs allogeneic transplantation as part of first-line therapy in poor-risk peripheral T-NHL

Tools

Item Type:	Article
Title:	A randomized phase 3 trial of autologous vs allogeneic transplantation as part of first-line therapy in poor-risk peripheral T-NHL
Creators Name:	Schmitz, N., Truemper, L.H., Bouabdallah, K., Ziepert, M., Leclerc, M., Cartron, G., Jaccard, A., Reimer, P., Wagner-Drouet, E.M., Wilhelm, M., Sanhes, L., Lamy, T., de Leval, L., Rosenwald, A., Roussel, M., Kroschinsky, F.P., Lindemann, W.W., Dreger, P., Viardot, A., Milpied, N.J., Gisselbrecht, C., Wulf, G.G., Gyan, E., Gaulard, P., Bay, J.O., Glass, B., Poeschel, V., Damaj, G., Sibon, D., Delmer, A.J., Bilger, K., Banos, A., Haenel, M., Dreyling, M., Metzner, B., Keller, U., Braulke, F., Friedrichs, B., Nickelsen, M., Altmann, B. and Tournilhac, O.
Abstract:	Standard first-line therapy for younger patients with peripheral T-cell lymphoma consists of six courses of CHOP or CHOEP consolidated by high-dose therapy and autologous stem cell transplantation (AutoSCT). We hypothesized that consolidative allogeneic transplantation (AlloSCT) could improve outcome. 104 patients with nodal peripheral T-cell lymphoma except ALK+ ALCL, 18 to 60 years of age, all stages and IPI scores except stage 1 and aaIPI 0, were randomized to receive 4 x CHOEP and 1 x DHAP followed by high-dose therapy and AutoSCT or myeloablative conditioning and AlloSCT. The primary endpoint was event-free survival (EFS) at three years. After a median follow-up of 42 months, 3-year EFS of patients undergoing AlloSCT was 43% (95% confidence interval [CI]: 29%; 57%) as compared to 38% (95% CI: 25%; 52%) after AutoSCT. Overall survival at 3 years was 57% (95% CI: 43%; 71%) versus 70% (95% CI: 57%; 82%) after AlloSCT or AutoSCT, without significant differences between treatment arms. None of 21 responding patients proceeding to AlloSCT as opposed to 13 of 36 patients (36%) proceeding to AutoSCT relapsed. Eight of 26 patients (31%) and none of 41 patients died due to transplant-related toxicity after allogeneic and autologous transplantation, respectively. In younger patients with T-cell lymphoma standard chemotherapy consolidated by autologous or allogeneic transplantation results in comparable survival. The strong graft-versus-lymphoma effect after AlloSCT was counterbalanced by transplant-related mortality. CHO(E)P followed by AutoSCT remains the preferred treatment option for transplant-eligible patients. AlloSCT is the treatment of choice for relapsing patients also after AutoSCT.
Keywords:	Allografts, Antineoplastic Combined Chemotherapy Protocols, Autologous Transplantation, Cisplatin, Combined Modality Therapy, Consolidation Chemotherapy, Cyclophosphamide, Cytarabine, Dexamethasone, Doxorubicin, Etoposide, Graft vs Host Disease, Kaplan-Meier Estimate, Myeloablative Agonists, Peripheral Blood Stem Cell Transplantation, Peripheral T-Cell Lymphoma, Prednisolone, Prospective Studies, Risk, Second Primary Neoplasms, Transplantation Conditioning, Vincristine
Source:	Blood
ISSN:	0006-4971
Publisher:	American Society of Hematology
Volume:	137
Number:	19
Page Range:	2646-2656
Date:	13 May 2021
Additional Information:	Copyright © 2021 by The American Society of Hematology
Official Publication:	https://doi.org/10.1182/blood.2020008825
External Fulltext:	View full text on PubMed Central
PubMed:	View item in PubMed

Repository Staff Only: item control page