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Lymphoma

Allogeneic transplantation following a reduced-intensity conditioning regimen in relapsed/refractory peripheral T-cell lymphomas: long-term remissions and response to donor lymphocyte infusions support the role of a graft-versus-lymphoma effect

Leukemia volume 26, pages 520–526 (2012)Cite this article

Abstract

Rescue chemotherapy or autologous stem cell transplantation (autoSCT) gives disappointing results in relapsed peripheral T-cell lymphomas (PTCLs). We have retrospectively evaluated the long-term outcome of 52 patients receiving allogeneic SCT for relapsed disease. Histologies were PTCL-not-otherwise specified (n=23), anaplastic large-cell lymphoma (n=11), angioimmunoblastic T-cell lymphomas (n=9) and rare subtypes (n=9). Patients were allografted from related siblings (n=33, 64%) or alternative donors (n=13 (25%) from unrelated and 6 (11%) from haploidentical family donors), following reduced-intensity conditioning (RIC) regimens including thiotepa, fludarabine and cyclophosphamide. Most of the patients had chemosensitive disease (n=39, 75%) and 27 (52%) failed a previous autoSCT. At a median follow-up of 67 months, 27 of 52 patients were found to be alive (52%) and 25 (48%) were dead (n=19 disease progression, n=6 non-relapse mortality (NRM)). The cumulative incidence (CI) of NRM was 12% at 5 years. Extensive chronic graft-versus-host disease increased the risk of NRM (33% versus 8%, P=0.04). The CI of relapse was 49% at 5 years, influenced by disease status at the time of allografting (P=0.0009) and treatment lines (P=0.007). Five-year overall survival and progression-free survival (PFS) were 50% (95% CI, 36 – 63%) and 40% (95% CI, 27 – 53%), respectively. The current PFS was 44% (95% CI, 30–57%). In all, 8 out of 12 patients (66%) who received donor-lymphocytes infusions for disease progression had a response. At multivariable analysis, refractory disease and age over 45 years were independent adverse prognostic factors. RIC allogeneic SCT is an effective salvage treatment with a better outcome for younger patients with chemosensitive disease.

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Acknowledgements

This study was supported in part by grants from Associazione Italiana Ricerca sul Cancro (AIRC) and MIUR.

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Authors and Affiliations

  1. Division of Hematology and Bone Marrow Transplantation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy

    A Dodero, F Spina, S Dalto & P Corradini

  2. Department of Hematology, University of Modena, Modena, Italy

    F Narni

  3. Department of Hematology, University of Udine, Udine, Italy

    F Patriarca

  4. Department of Hematology, Ospedale San Maurizio, Bolzano, Italy

    I Cavattoni

  5. Department of Hematology, Policlinico GB Rossi, Verona, Italy

    F Benedetti

  6. Department of Hematology, Ospedale San Raffaele, Milano, Italy

    F Ciceri

  7. Department of Hematology, Ospedale Oncologico A. Businco, Cagliari, Italy

    D Baronciani

  8. Department of Bone Marrow Transplantation, Ospedale Cervello, Palermo, Italy

    R Scimè

  9. Department of Hematology, University Milano Bicocca, Milano, Italy

    E Pogliani

  10. Department of Hematology, Ospedale Riuniti, Bergamo, Italy

    A Rambaldi

  11. Department of Hematology-Oncology, University of Bologna, Bologna, Italy

    F Bonifazi

  12. Department of Hematology, University of Torino, Torino, Italy

    B Bruno

  13. Department of Hematology, University of Milano, Milano, Italy

    P Corradini

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  1. A Dodero
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  2. F Spina
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  5. I Cavattoni
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  13. S Dalto
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  14. B Bruno
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  15. P Corradini
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Correspondence to A Dodero.

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Dodero, A., Spina, F., Narni, F. et al. Allogeneic transplantation following a reduced-intensity conditioning regimen in relapsed/refractory peripheral T-cell lymphomas: long-term remissions and response to donor lymphocyte infusions support the role of a graft-versus-lymphoma effect. Leukemia 26, 520–526 (2012). https://doi.org/10.1038/leu.2011.240

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