Outcome of salvage therapy for relapsed or refractory peripheral T-cell lymphoma (PTCL), anaplastic large cell lymphoma (ALCL), and diffuse large B-cell lymphoma (DLBCL)

Abstract

6544 Background: Compared to patients with ALCL and DLBCL, PTCL patients have a lower response and higher relapse rate following anthracycline-based chemotherapy. However, in the case of relapsed or primary refractory disease, it is unclear if response to salvage treatment and survival are similarly inferior. Methods: Between 01/01/1995 and 12/30/2004, 45 patients with PTCL, 21 with ALCL, and 171 with DLBCL were referred to our institution for consideration of ASCT. The majority of patients (70%) received a platinum-based salvage regimen. Responding patients then received high-dose etoposide and melphalan followed by autologous stem cell transplant (ASCT). Results: The three groups were similar in age (median 53, range: 19–66), but PTCL patients had more advanced stage disease (III or IV) at salvage than ALCL and DLBCL (71 vs. 61 vs. 48%, p=0.03). Response rates to salvage chemotherapy were similar: 53% for PTCL, 57% for ALCL, and 53% for DLBCL (p=0.94). For T-cell (PTCL and ALCL) patients, there was a trend to better response if a platinum-based regimen was given (61 vs. 35%, p=0.06). Post-transplant, 9/21 PTCL, 3/11 ALCL, and 41/88 DLBCL patients relapsed (43 vs. 27 vs. 46%, p=0.47). Two-year event-free survival (EFS) rates were 28% (95% CI: 14–42%) for PTCL, 45% (23–67%) for ALCL, and 45% (37–53%) for DLBCL (p=0.068). Event-free and overall survival for all patients, and for those who proceeded to ASCT, are shown in the table . Conclusions: Two-year EFS is inferior for patients with relapsed/refractory PTCL treated with the intention of proceeding to ASCT, compared to ALCL and DLBCL, as is 2-year OS rate. However, PTCL patients had similar response to primarily platinum-based salvage chemotherapy, and achieved similar outcome post-ASCT. These findings suggest that strategies to improve the outcome of PTCL patients may include changes to first-line treatment and salvage regimens. [Table: see text] No significant financial relationships to disclose.