Abstract 2284Poster Board II-261 Background:To evaluate the role of autologous and allogeneic SCT in the treatment of PTCLs, Japan Study Group for Cell Therapy and Transplantation conducted a multicenter retrospective survey in Japan and Korea. Methods:After excluding patients with adult T-cell leukemia/lymphoma and NK-cell tumors, patient data were newly collected from 330 patients (222 male and 108 female) with a median age of 49 years (range, 13–71) who underwent SCT between 9/1991 and 12/2008 (196 autologous and 134 allogeneic including 31 patients with previous autograft). Allogeneic SCT (53 BM, 54 PB, 1 BM+PB, 26 CB) was performed using a reduced-intensity conditioning (RIC) in 84 patients (63%). While a pathologic central review will be performed, currently there were 159 (48%) patients with PTCL, not otherwise specified, 63 (19%) with angioimmunoblastic T-cell lymphoma, 47(14%) with anaplastic large cell lymphoma (23 ALK-negative, 14 ALK-positive and 10 unknown), 12 (4%) with enteropathy-associated T-cell lymphoma, and others. The disease status at transplant in the allo-group was significantly worse than that in the auto-group (Table 1). The median number of chemotherapy regimens was 2 (range, 1–7), and the median duration between diagnosis and transplant was 267 days (range, 120-4889 days). Results:The median follow-up for surviving patients was 45 mo (range, 2.3–141 mo). There was no significant difference in overall survival among different groups, including histological subtypes, RIC and myeloablative conditioning in the allo-group and high-dose chemotherapy regimens in the auto-group. Early survival rate after transplant was significantly better for auto-group than allo-group (Wilcoxon P=0.001), but the difference was marginal in the total course (Logrank P=0.06) (Figure). The non-relapse mortality (NRM) in the auto-group was significantly lower than that in the allo-group (P<0.0001) (Table 2). Grade II-IV acute GVHD occurred in 49% of the patients after allogeneic SCT. The causes of death that contributed to NRM were infection in 16/21 (auto/allo), organ failure in 6/12, GVHD in 0/5, secondary cancer in 5/0 and other in 7/5. The long-term relapse rate in the auto-group was significantly higher than that in the allo-group (Fleming-Harrington P=0.03). Univariate analyses showed that the risks of survival were bulky mass at diagnosis, age, recurrence after frontline therapy, number of chemotherapy regimens (>1), cell source (CB/BM+PB), and performance status (PS; >1), stage, chemorefractory disease, international prognostic index (IPI; H-I/H risk) and prognostic index for PTCL, unspecified (PIT; group 3/4) at transplant. The risk factors in the allo-group were bulky mass at diagnosis, age (>50 years), cell source, and PS, stage, IPI and PIT at transplant, while those in the auto-group were age (>40 years), recurrence after frontline therapy, number of chemotherapy regimens, and stage, chemorefractory disease, IPI and PIT at transplant. Conclusions:Despite a worse disease status at transplant in the allo-group, the overall survival was comparable to that in the auto-group. This supports the notion that early allogeneic SCT is a valuable treatment option for PTCLs, although a large-scale randomized trial to identify a suitable upfront-transplant type for chemosensitive patients with PTCLs is warranted.Table 1:Disease statusAuto (n=196)Allo (n=134)PBulky mass at diagnosis25 (13%)10 (8%)0.147Performance status 2-4 at SCT19 (10%)35 (26%)<0.0001Stage at SCT:Complete remission114 (59%)27 (20%)<0.0001Limited stage (I/II)28 (14%)17 (13%)Advanced stage (III/IV)53 (27%)90 (67%)IPI 3-5 at diagnosis72 (37%)57 (42%)0.420PIT 2-4 at diagnosis74 (38%)62 (46%)0.172IPI 3-5 at SCT24 (12%)43 (32%)<0.0001PIT 2-4 at SCT23 (12%)45 (34%)<0.0001Table 2:Study OutcomesAuto (n=196)Allo (n=134)P (Logrank)P (Wilcoxon)P (F-H)1-year/3-year NRM8%/10%30%/33%<0.0001<0.00010.011-year/3-year relapse38%/45%29%/37%0.190.490.031-year/3-year PFS57%/49%50%/43%0.180.020.611-year/3-year OS74%/59%55%/52%0.060.0010.151-year/3-year OS (CR at SCT)84%/72%70%/66%0.230.100.781-year/3-year OS (stage I-II at SCT)71%/56%76%/76%0.200.380.071-year/3-year OS (stage III-IV at SCT)54%/33%47%/43%0.910.270.01Abbreviation: F-H, Fleming and Harrington [Display omitted] Disclosures:No relevant conflicts of interest to declare.
Read full abstract