Abstract
Simple SummaryThe role of haematopoietic stem cell transplantation in the management of peripheral T-cell lymphomas is not clearly defined and therapeutic decisions vary widely across different institutions. This review examines the current body of evidence to best delineate the role and timing of transplantation in an era where diagnostic techniques and targeted therapies are rapidly evolving.Peripheral T-cell lymphomas (PTCLs) are distinct pathological entities with clinical advancements lagging behind their B-cell lymphoma counterpart. Frequently aggressive in their clinical behaviour, clinicians are constantly challenged with low complete remission rates, early relapses and failure to achieve long-term responses despite aggressive first-line chemotherapy, resulting in poor overall survival in the majority of patients. There is currently no consensus regarding the optimal therapy for PTCL and treatment approaches are mainly derived from prospective phase II studies, registry data and retrospective studies. Despite its biological heterogeneity, a less than satisfactory “one-size-fits-all” approach has been adopted to date. Although its role remains controversial, for many years, haematopoietic stem cell transplantation has been adopted by clinicians with the aim of overcoming poor outcomes by consolidating responses. In this review, we aim to define the role of both autologous and allogeneic stem cell transplantation in PTCL in both frontline and salvage settings, especially in the context of recent advancements in this field.
Highlights
Due to the rarity and heterogeneity of peripheral T-cell lymphomas (PTCLs), few randomised prospective controlled trials currently exist to guide their management
In addition to inferior overall response rates compared with B-cell non-Hodgkin lymphoma (B-NHL), Peripheral T-cell lymphomas (PTCLs) have inferior complete remission (CR) rates, poor progression-free survival (PFS) and overall survival (OS), even in the more favourable anaplastic large-cell lymphoma (ALCL), anaplastic lymphoma kinase (ALK)-positive subtype [1]
According to the pooled results, up-front autologous stem cell transplantation (autoSCT) showed a non-statistically significant trend in survival benefit in PTCL patients compared with conventional chemotherapy alone (HR 0.81, 95% CI 0.31–2.13)
Summary
Due to the rarity and heterogeneity of peripheral T-cell lymphomas (PTCLs), few randomised prospective controlled trials currently exist to guide their management. Despite the wide variation in clinical and biological behaviours of each PTCL subtype, management has largely taken a less than satisfactory “one-size-fits-all” approach, applying non-targeted therapy to a heterogeneous disease entity. Extrapolating from the management of B-cell non-Hodgkin lymphoma (B-NHL), anthracyclinecontaining regimens such as cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP) or Cancers 2020, 12, 3125; doi:10.3390/cancers12113125 www.mdpi.com/journal/cancers. CHOP-like regimens represent the cornerstone of frontline treatment for PTCLs. outcomes have been inferior with overall response rates for PTCL ranging from 50–70% compared with the more favourable overall response rates of 80–90% in B-NHL [1,2]. In addition to inferior overall response rates compared with B-NHL, PTCLs have inferior complete remission (CR) rates, poor progression-free survival (PFS) and overall survival (OS), even in the more favourable anaplastic large-cell lymphoma (ALCL), anaplastic lymphoma kinase (ALK)-positive subtype [1]. A number of phase I and phase II trials have attempted to improve these results by intensifying treatment either with (i) alternative more aggressive chemotherapy regimens, (ii) the addition of a novel agent to a CHOP-backbone and/or (iii) consolidation with haematopoietic stem cell transplantation (HSCT)
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