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Poor outcome of CHOEP induction followed by gemcitabine/busulfan/melphalan high-dose therapy and stem cell rescue for patients with newly diagnosed peripheral T-cell lymphoma

Bone Marrow Transplantation volume 57, pages 1719–1720 (2022)Cite this article

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Frontline treatment of peripheral T-cell lymphomas (PTCL) is induction chemotherapy with or without brentuximab vedotin (BV) followed by autologous stem cell transplantation (ASCT). However, many patients are unable to undergo ASCT or relapse after ASCT. The prognosis for these patients is poor. Several reports have demonstrated excellent outcomes with the use of gemcitabine, busulfan, and melphalan (GBM) as conditioning for ASCT [1, 2]. This regimen is attractive for PTCL given that gemcitabine is active in PTCL but not utilized in standard induction regimens [3]. Previous reports of GBM in patients with relapsed/refractory PTCL undergoing ASCT demonstrated promising progression-free survival (PFS) [2].

We designed a front-line regimen of CHOEP (cyclophosphamide, doxorubicin, vincristine, etoposide and prednisone), a standard PTCL induction regimen, followed by GBM-conditioned ASCT for patients with newly diagnosed PTCL [4]. This prospective phase II trial enrolled patients aged 18–70 years with any PTCL subset according to World Health Organization 2008 criteria [except ALK + anaplastic large cell lymphoma (ALCL)]. No prior anti- lymphoma treatment was allowed, except for palliative steroids or one cycle of CHOP prior to enrollment. Patients received 6 cycles of CHOEP (5 for those who had received a cycle of CHOP prior to enrollment) every 21 days at standard doses, with etoposide 100 mg/m2 intravenously or 200 mg/m2 orally on days 1–3 of each cycle. Filgrastim or pegfilgrastim were administered at the discretion of the treating physician. Restaging was performed with PET-CT after 3 and 6 cycles of therapy according to standard criteria with baseline and end of treatment bone marrow biopsy (if involved at baseline) [5]. Patients who had a PR or CR after 6 cycles of chemotherapy underwent stem cell mobilization using filgrastim and plerixafor (if necessary) per institutional protocol within 4 weeks of the completion of chemotherapy. A minimum of 2 × 10(6) CD34 + cells/kg was required to proceed to ASCT.

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Data availability

The datasets generated during and/or analysed during the current study are not publicly available due to protection of research participants’ privacy but are available from the corresponding author on reasonable request.

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Funding

This work was funded in part by Otsuka Pharmaceutical (Rockville, MD). PA was supported by career development awards from the Conquer Cancer/ASCO Foundation and the ASH Foundation. EJ was supported by the Reid Family Fund for Lymphoma Research.

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Authors and Affiliations

  1. Department of Medical Oncology, Boston, MA, USA

    Eric D. Jacobsen, Erin Jeter, Caron Jacobson, David C. Fisher & Philippe Armand

  2. Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA

    Haesook T. Kim

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  1. Eric D. Jacobsen
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  2. Haesook T. Kim
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  3. Erin Jeter
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  4. Caron Jacobson
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  5. David C. Fisher
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Contributions

EDJ and PA were responsible for designing and writing the protocol, interpreting results, and writing the final manuscript; HTK was responsible for design of the protocol, statistical analysis, and final approval of the manuscript; EJ was responsible for data collection; CJ and DCF enrolled patients on the protocol and approved the final manuscript.

Corresponding author

Correspondence to Eric D. Jacobsen.

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Competing interests

EDJ reports the following conflicts: Consultancy: Daiichi, Secura Bio, ADC Therapeutics, Bayer, Imbrium, Eisai, Merck; Research Funding: Beigene, Novartis, Janssen/Pharmacyclics; PA reports the following conflicts: Consultancy: Merck, Bristol-Meyers Squibb, ADC Therapeutics, Tessa, GenMab, C4, Enterome, Regeneron, Epizyme, Astra Zeneca, Genentech, Xencor; Research funding: Merck, BMS, Adaptive, Genentech, IGM, Kite Honoraria: Merck; CJ reports the following conflicts: Consultancy: Kite/Gilead, Novartis, Bristol-Meyers Squib/Celgene, Nkarta, Precision Biosciences, Bluebird bio, Epizyme, Abbvie, Lonza, Ipsen, Instill Bio; Research funding: Pfizer and Kite/Gilead. HTK, EJ, and DCF report no conflicts.

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Jacobsen, E.D., Kim, H.T., Jeter, E. et al. Poor outcome of CHOEP induction followed by gemcitabine/busulfan/melphalan high-dose therapy and stem cell rescue for patients with newly diagnosed peripheral T-cell lymphoma. Bone Marrow Transplant 57, 1719–1720 (2022). https://doi.org/10.1038/s41409-022-01784-6

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