First-line chemotherapy followed by high-dose therapy and autologous stem cell transplantation (auto-SCT) is the preferred treatment for patients under 60 with peripheral T-cell non-Hodgkin lymphoma (T-NHL), according to research published in Blood.
Cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or CHOP plus etoposide (CHOEP) is first-line treatment for younger patients with T-NHL. Some studies have shown improvement in overall survival with allogeneic stem cell transplantation or with auto-SCT.
The study authors compared auto-SCT to allogeneic SCT (allo-SCT) as consolidation after CHOEP in patients with T-NHL.
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The prospective, randomized, phase 3 study included 103 patients between 18 and 60 years of age. 54 patients were randomized to receive auto-SCT and 49 to allo-SCT. All patients received CHOEP and patients who achieved a response received dexamethasone, cytosine-arabinoside, and platinum (DHAP).
A total of 20 patients were unable to undergo transplantation because of disease progression, change of diagnosis or toxicity. A total of 26 patients underwent allo-SCT, and 8 patients who were randomized to receive allo-SCT underwent auto-SCT, most often because no donor was found. In total, 41 patients underwent auto-SCT.
In the allo-SCT arm, 51% of patients (25/49) and 39% (21/54) in the auto-SCT arm achieve a complete response or unconfirmed complete response (CR/CRu).
After a median follow-up of 42 months, the 3-year event-free survival (EFS) was 43% in the allo-SCT arm and 38% in the auto-SCT arm. The 3-year progression-free survival (PFS) was 43% with allo-SCT and 39% with auto-SCT. The 3-year overall survival (OS) was 57% for the allo-SCT group and 70% for the auto-SCT group.
The authors performed a subgroup analysis of only the patients that underwent transplantation. The 3-year EFS of patients who underwent allo-SCT was 65%, compared with 57% of patients who underwent auto-SCT. The PFS and OS for allo-SCT was 65%, and was 57% and 81%, respectively, for those who underwent auto-SCT.
The authors have a long-term follow-up of the study patients planned to gain more understanding of allo-SCT.
The authors noted that more than a third of patients had disease progression that prevented them from undergoing transplantation, which is consistent with other studies. The authors suggested that patients who are chemorefractory upfront should be spared further ineffective, toxic treatment.
Relapse rates remain a challenge after auto-SCT. This study had a relatively high treatment-related mortality of 31% (8 patients) with allo-SCT, and newer drugs may induce remission after auto-SCT fails. The authors suggest reserving allo-SCT for patients in whom auto-SCT fails.
Disclosure: The study author(s) declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Reference
Schmitz N, Truemper L, Bouabdallah K, et al. A randomized phase 3 trial of autologous vs allogeneic transplantation as part of first-line therapy in poor-risk peripheral T-NHL. Blood. 2021;137(19):2646-2656. doi:10.1182/blood.2020008825
