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Allogeneic Stem Cell Transplantation With Reduced Intensity Conditioning As Treatment For Mature T-Cell Lymphomas

Year: 2010

Type: article

Abstract: For aggressive lymphomas a T-cell phenotype confers a poor prognosis. Current therapeutic strategies for T-cell non-Hodgkin lymphoma (NHL) are poorly defined. Allogeneic stem cell transplantation (Allo-HCT) is a potentially curative option but associated with high non-relapse mortality (NRM). Reduced intensity conditioning (RIC) is designed to minimize NRM while using the benefits of the graft-versus-lymphoma effect. Here we report retrospective analysis of patients with T-cell NHL who underwent Allo-HCT with RIC using fludarabine and melphalan. A consecutive case-series of 27 patients with mature T-cell NHL were included. All patients underwent RIC with fludarabine and melphalan. Histologies included: PTCL NOS (n=5); AILD (n=3); ALCL (n=2; both alk+); rare histologies (n=6) (NK/T cell, enteropathy type, hepatosplenic); and cutaneous T-cell lymphomas (n=11). Most patients (n=18, 67%) had advanced disease at the time of transplant: relapse/induction failure=17, progression=1. The rest of the patients were in CR1=1, CR2=5, PR=3. The median age was 50 years (range: 19-68), 74% were male (n=20). The time from diagnosis to transplant for majority of the patients (n=20, 74%) was more than one year. The median number of prior regimens was 4 (range: 1-9); one patient had a prior autologous transplant. All patients received stem cells, 56% from HLA-matched sibling and 44% from matched unrelated donor. 18 patients (67%) received GVHD prophylaxis with sirolimus/tacrolimus, while 9 patients (33%) received cyclosporine/cellcept based prophylaxis. The median follow-up for the 16 (59%) surviving patients was 24.2 months (range: 5.6-95.3). Day 100 mortality was 22% (n=6). There were a total of 11 deaths; 5 from disease progression/relapse and 6 from non-relapse causes. 13 patients (48%) experienced acute GVHD: grade I=4, grade II=5, grade IV=4. Among the 17 patients who are evaluable for chronic GVHD, 11 (63%) patients developed an extensive GVHD. The 2-year probability of overall (OS) and disease-free (DFS) survival were 55% (95%CI: 43-65%) and 43% (95%CI: 34-52%) respectively. The relapse/progression and NRM rates at 2 years were 37% (95%CI: 26-52%) and 28% (95%CI: 16-46%) respectively. The overall results show that good long term survival rates and disease control can be achieved with acceptable non-relapse mortality in patients with mature T-cell lymphomas using reduced intensity conditioning.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2009.12.253

Authors: M.L. Delioukina, J. Palmer, J.M. Zain, N. Tsai, S. Forman

Institutions: City Of Hope National Medical Center, NYU Langone Health

Language: English

Topic: Hematopoietic Stem Cell Transplantation

Subfield: Hematology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,650