Treatment of Peripheral T-Cell Lymphoma (PTCL) with High-Dose Chemotherapy and Autologous Stem Cell Transplantation (ASCT).

Abstract

Objectives: Although CHOP-type chemotherapy has been the mainstay of therapy, outcome of PTCL has been uniformly disappointing. Despite the poor outcome after conventional chemotherapy, the impact of high-dose chemotherapy (HDCT) and ASCT is not well defined in these patients. The purpose of this study is to evaluate the efficacy of ASCT and the prognostic factors in PTCL with ASCT.Patients and Methods: We performed a retrospective analysis of 40 PTCL patients from the Asan Medical Center treated between January 1995 to December 2005 with HDCT and ASCT.Results: A total 40 patients were enrolled. Median age was 39 years (range 18–63). Twenty patients had PTCL-U, 10 extranodal NK/T cell lymphomas, 5 anaplastic large cell lymphomas, 3 angioimmunoblastic, one hepatosplenic γσ T cell lymphoma, and one disseminated mycosis fungoides. Disease status at transplant were CR1 in 3, CR2 or more in 8, partial remission in 25 (PR1 in 8 and PR2 in 17), and refractory in 4 patients.Three (7.5%) therapy-related mortalities occurred. A median follow-up of 16 months (range, 5 to 135 months) for surviving patients, the median overall survival (OS) was 11.5 months and the 1-year probability of survival was 41.5%. Ten patients (25%) were alive without evidence of disease. The median OS of 11 patients with CR at ASCT were not reached and of these, 7 patients (63.6%) were alive with CR. In multivariate analysis, CR status at HDT and BM involvement at ASCT was the most important prognostic factor for event free survival (P=0.032, P=0.031, respectively). A pretransplant IPI ≤1 and infused CD34+ cell dose ≥5×106/kg were the prognostic factors for an improved overall survival (P = 0.04 and P = 0.025, respectively).Conclusion: The results of HDT with ASCT for the patients with PTCL who did not achieve a CR to first line or salvage chemotherapy are not satisfactory. The patients who did not achieve CR at ASCT and patients with low infused CD34+cell dose, BM involvement or high IPI score at ASCT have poor outcome.