Abstract
The early experiment result in our hospital showed that anti-thymocyte globulin (ATG) inhibited the proliferation of lymphoid tumor cells in the T-cell tumors. We used the ATG as the part of the conditioning regimen and to evaluate the long-term anti-leukemia effect, the safety and complication in the patients with highly aggressive T-cell lymphomas. Twenty-three patients were enrolled into this study. At the time of transplant, six patients reached first or subsequent complete response, three patients had a partial remission and 14 patients had relapsed or primary refractory disease. The conditioning regimen consisted of ATG, total body irradiation, toposide and cyclophosphamide. The complete remission rate after transplant was 95.7%. At a median follow-up time of 25 months, 16 (69.6%) patients are alive and free from diseases, including nine patients in refractory and progressive disease. Seven patients died after transplant, five from relapse and two from treatment-related complications. The incidence of grades II–IV acute graft-vs-host disease (GvHD) was 39.1%. The maximum cumulative incidence of chronic GvHD was 30%. The most frequent and severe conditioning-related toxicities observed in 8 out of 23 patients were grades III/IV infections during cytopenia. Thus, ATG-based conditioning is a feasible and effective alternative for patients with highly aggressive T-cell tumors.
Highlights
Aggressive T-cell lymphomas represent 10–15% of non-Hodgkin’s lymphomas in adults
Aggressive T-cell lymphomas show a worse prognosis than B-cell lymphoma and T-lineage acute lymphoblast leukemia (ALL) show a worse prognosis
More intensified conditioning regimens improve the rate of complete remission (CR), the relapse has remained a significant cause of death in the high-risk patients.[2]
Summary
Aggressive T-cell lymphomas represent 10–15% of non-Hodgkin’s lymphomas in adults. Aggressive T-cell lymphomas show a worse prognosis than B-cell lymphoma and T-lineage acute lymphoblast leukemia (ALL) show a worse prognosis. Myeloablative conditioning therapy followed by allogeneic hematopoietic stem cell transplantation (HSCT) may be the good choice for these high-risk patients. A combination of cyclophosphamide (120 mg/kg) and total body irradiation (12 Gy in six fractions) have been used as a standard myeloablative conditioning regimen in ALL patients and aggressive T-cell lymphomass for the past 30 years.[3] Antithymocyte globulin (ATG) is used in allo-HSCT for the prophylaxis and treatment of acute graft-versus-host disease (aGvHD). On the basis of these promising results, we conducted a prospective clinical study to observe the safety and efficacy of a conditioning regimen consisting of ATG as well as 10 Gy total body irradiation, cyclophosphamide and etoposide for the patients with high-risk, primary refractory or relapsed T-cell tumors. Non-relapse mortality was defined as death resulting from any cause related to alloHSCT and not resulting from disease relapse or progression
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