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A randomized phase 3 trial of autologous vs allogeneic transplantation as part of first-line therapy in poor-risk peripheral T-NHL

Item Type:Article
Title:A randomized phase 3 trial of autologous vs allogeneic transplantation as part of first-line therapy in poor-risk peripheral T-NHL
Creators Name:Schmitz, N. and Truemper, L.H. and Bouabdallah, K. and Ziepert, M. and Leclerc, M. and Cartron, G. and Jaccard, A. and Reimer, P. and Wagner-Drouet, E.M. and Wilhelm, M. and Sanhes, L. and Lamy, T. and de Leval, L. and Rosenwald, A. and Roussel, M. and Kroschinsky, F.P. and Lindemann, W.W. and Dreger, P. and Viardot, A. and Milpied, N.J. and Gisselbrecht, C. and Wulf, G.G. and Gyan, E. and Gaulard, P. and Bay, J.O. and Glass, B. and Poeschel, V. and Damaj, G. and Sibon, D. and Delmer, A.J. and Bilger, K. and Banos, A. and Haenel, M. and Dreyling, M. and Metzner, B. and Keller, U. and Braulke, F. and Friedrichs, B. and Nickelsen, M. and Altmann, B. and Tournilhac, O.
Abstract:Standard first-line therapy for younger patients with peripheral T-cell lymphoma consists of six courses of CHOP or CHOEP consolidated by high-dose therapy and autologous stem cell transplantation (AutoSCT). We hypothesized that consolidative allogeneic transplantation (AlloSCT) could improve outcome. 104 patients with nodal peripheral T-cell lymphoma except ALK+ ALCL, 18 to 60 years of age, all stages and IPI scores except stage 1 and aaIPI 0, were randomized to receive 4 x CHOEP and 1 x DHAP followed by high-dose therapy and AutoSCT or myeloablative conditioning and AlloSCT. The primary endpoint was event-free survival (EFS) at three years. After a median follow-up of 42 months, 3-year EFS of patients undergoing AlloSCT was 43% (95% confidence interval [CI]: 29%; 57%) as compared to 38% (95% CI: 25%; 52%) after AutoSCT. Overall survival at 3 years was 57% (95% CI: 43%; 71%) versus 70% (95% CI: 57%; 82%) after AlloSCT or AutoSCT, without significant differences between treatment arms. None of 21 responding patients proceeding to AlloSCT as opposed to 13 of 36 patients (36%) proceeding to AutoSCT relapsed. Eight of 26 patients (31%) and none of 41 patients died due to transplant-related toxicity after allogeneic and autologous transplantation, respectively. In younger patients with T-cell lymphoma standard chemotherapy consolidated by autologous or allogeneic transplantation results in comparable survival. The strong graft-versus-lymphoma effect after AlloSCT was counterbalanced by transplant-related mortality. CHO(E)P followed by AutoSCT remains the preferred treatment option for transplant-eligible patients. AlloSCT is the treatment of choice for relapsing patients also after AutoSCT.
Keywords:Allografts, Antineoplastic Combined Chemotherapy Protocols, Autologous Transplantation, Cisplatin, Combined Modality Therapy, Consolidation Chemotherapy, Cyclophosphamide, Cytarabine, Dexamethasone, Doxorubicin, Etoposide, Graft vs Host Disease, Kaplan-Meier Estimate, Myeloablative Agonists, Peripheral Blood Stem Cell Transplantation, Peripheral T-Cell Lymphoma, Prednisolone, Prospective Studies, Risk, Second Primary Neoplasms, Transplantation Conditioning, Vincristine
Publisher:American Society of Hematology
Page Range:2646-2656
Date:13 May 2021
Additional Information:Copyright © 2021 by The American Society of Hematology
Official Publication:https://doi.org/10.1182/blood.2020008825
External Fulltext:View full text on PubMed Central
PubMed:View item in PubMed

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