Combination chemotherapy followed by autologous stem cell transplant for enteropathy‐associated T‐cell lymphoma

Abstract

I read with interest the short report by Bishton and Haynes (2006), regarding combination chemotherapy and autologous stem cell transplantation for enteropathy-associated T-cell lymphoma (EATL). However, I believe the comment ‘use of peripheral blood stem cell transplantation in EATL has been reported anecdotally by Lymphoma Groups in unpublished findings’ does not accurately reflect the efforts of other workers in the field. On behalf of the Scotland and Newcastle Lymphoma Group (SNLG), I carried out a comprehensive review of all patients that presented with EATL/intestinal T-cell lymphoma (ITCL) in our population of 8 million people over a 5-year period (1994–1999). There were 55 such patients and with conventional treatment [mainly CHOP (cyclophosphamide, hydroxydaunomycin, Oncovin, prednisone)-based therapy] the median survival was 7 months. Consequently, in 1999 the SNLG changed its policy for this rare group of patients and piloted an aggressive primary therapy approach using Ifosfamide, etoposide (VP16) and Epirubicin (IVE) alternating with intermediate dose Methotrexate (MTX) and consolidated with an autologous bone marrow transplant (ABMT). Data on the first eight patients to proceed to autologous transplantation were presented at the 8th International Conference on Malignant Lymphoma in Lugano in June 2002 (Lennard et al, 2002). Following the presentation and publication of the proceedings of the meeting, colleagues around the UK and in continental Europe have used the regimen, and a register of patients with ITCL who have been treated with IVE/MTX ± ABMT has been compiled. Dr Haynes has kindly contributed two of his cases to this register, which now numbers 17 patients. Subsequently, a national phase II protocol with two major aims has been developed. To register as many UK cases of ITCL as possible with review of histology and collection of treatment and outcome data. To evaluate the efficacy and toxicity of IVE/MTX/ABMT in patients considered eligible for intensive chemotherapy. The protocol has been peer reviewed and has Cancer Research UK support. The study is now proceeding through the Central Office for Research Ethics Committees and should be open in 2007. It will be supported by the National Cancer Research Network and administered by the Lymphoma Trials office in London. The short report by Bishton and Haynes (2006) confirms my conclusions from 2002: That aggressive treatment is feasible in some patients with ITCL. IVE/MTX/ABMT-treated patients have superior outcomes to conventionally treated patients. It is to be hoped that all haematologists in the UK will support the forthcoming study. The long-term goal should be to transform the outcome for these rare patients in the same way that, by national and international collaboration, we have changed the prognosis for patients with Burkitt Lymphoma in the last decade.