Benefit Seen with Both Autologous and Allogeneic Hematopoietic Cell Transplantation in T-cell Non-Hodgkin Lymphoma
In a report in Journal of Clinical Oncology, Sonali M. Smith, MD, of University of Chicago Hospitals, and colleagues analyzed outcomes in a large cohort of autologous or allogeneic hematopoietic cell transplantation recipients with the most common T-cell non-Hodgkin lymphoma histologies. Their findings indicate greater effectiveness of these procedures earlier in the disease course and limited utility in multiply relapsed disease. They also suggest that autologous hematopoietic cell transplantation at relapse may be a potential option for select patients, particularly those with anaplastic large-cell lymphoma histology.
Study Details
The analysis included a large cohort of autologous or allogeneic hematopoietic cell transplantation recipients with the three most common T-cell non-Hodgkin lymphoma histologies reported to the Center for International Blood and Marrow Transplant Research (CIBMTR). Patients with T-cell non-Hodgkin lymphoma aged ≤ 60 years who received first autologous or allogeneic hematopoietic cell transplantation between 1996 and 2006 were included.
Outcomes of 241 patients (112 with anaplastic large-cell lymphoma, 102 with peripheral T-cell lymphoma–not otherwise specified, and 27 with angioimmunoblastic T-cell lymphoma) undergoing autologous hematopoietic cell transplantation (n = 115; median age, 43 years) or allogeneic hematopoietic cell transplantation (n = 126; median age, 38 years) were analyzed for nonrelapse mortality, relapse/progression, progression-free survival, and overall survival.
Compared with allogeneic hematopoietic cell transplantation recipients, autologous hematopoietic cell transplantation recipients were more likely to be in first complete remission (CR1; 35% vs 14%, P = .001) and to have chemotherapy-sensitive disease (86% vs 60%, P < .001), anaplastic large-cell lymphoma histology (53% vs 40%, P = .04), and two or fewer lines of prior therapy (65% vs 44%, P < .001).
Survival Outcomes
Both nonrelapse and overall mortality were higher in allogeneic hematopoietic cell transplantation patients. There was no difference in relapse/progression between autologous and allogeneic hematopoietic cell transplantation patients. For autologous hematopoietic cell transplantation patients, the 1- and 3-year progression-free survival rates were 58% and 47%, and overall survival rates were 68% and 59%, respectively. For allogeneic hematopoietic cell transplantation patients, 1- and 3-year progression-free survival rates were 42% and 37%, and overall survival rates were 55% and 46%, respectively.
Patients in CR1 undergoing autologous hematopoietic cell transplantation had 1- and 3-year progression-free survival rates of 75% and 58% and overall survival rates of 80% and 70%, respectively. Few patients underwent allogeneic hematopoietic cell transplantation in CR1. Three-year progression-free survival and overall survival of autologous hematopoietic cell transplantation recipients beyond CR1 were 42% and 53%, respectively. Among allogeneic hematopoietic cell transplantation recipients who received transplantation beyond CR1, 31% remained progression-free at 3 years, despite being more heavily pretreated and having more refractory disease.
Nonrelapse mortality was 3.5-fold higher (P < .001) with allogeneic hematopoietic cell transplantation. In multivariate analysis, chemotherapy sensitivity (hazard ratio [HR] = 1.8, 95% confidence interval [CI] = 1.16–2.87) and two or fewer lines of pretransplantation therapy (HR = 5.02, 95% CI = 2.15–11.72) were prognostic of survival.
Benefit of Autologous Transplantation at Relapse
The authors noted that an intriguing finding in the study is that high-dose chemotherapy as part of autologous hematopoietic cell transplantation can be beneficial at relapse, a finding that conflicts with several previous reports. They observed that, in particular, patients with anaplastic large-cell lymphoma undergoing autologous hematopoietic cell transplantation at relapse had superior overall survival compared with allogeneic hematopoietic cell transplantation recipients; in analysis excluding patients in CR1, 3-year overall survival was 62% vs 33% (P = .0088), with autologous hematopoietic cell transplantation patients having lower transplantation-related mortality (5% vs 32%, P < .001) and exhibiting no difference in progression-free survival or relapse/progression compared with the allogeneic hematopoietic cell transplantation subgroup.
The investigators concluded: “[T]his large series shows that [hematopoietic cell transplantation] can benefit patients with [T-cell non-Hodgkin lymphoma] in both relapsed and first-line settings, and with both [autologous hematopoietic cell transplantation] and [allogeneic hematopoietic cell transplantation] approaches. Importantly, approximately 40% of patients undergoing [autologous hematopoietic cell transplantation] at the time of relapse attain long-term benefit and disease control, particularly for [anaplastic large-cell lymphoma] histology…. Our results suggest that if [hematopoietic cell transplantation] is considered, outcomes are best in chemotherapy-sensitive patients at the time of first- or second-line therapy, perhaps supporting evolving treatment paradigms in [T-cell non-Hodgkin lymphoma] in which [hematopoietic cell transplantation] is considered earlier in overall management.”
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
