The use of autologous stem cell transplantation (ASCT) as a consolidation strategy in patients with peripheral T-cell lymphoma (PTCL) was associated with better survival outcomes compared with those who did not undergo ASCT, according to the results of the GELTAMO/FIL study published in Haematologica.
At 5-years, a higher proportion of patients who underwent ASCT exhibited a significantly better progression-free survival (PFS) rate (63%) compared with those who did not undergo ASCT (48%).
With a median follow-up of 65.5 months, the median PFS was significantly prolonged in the ASCT cohort (not reached [NR]); 95% CI not estimable) compared with the non-ASCT cohort (50.5 months; 95% CI, 0-110.9; P =.042).
Patients with PTCL generally have poor prognoses with currently available treatments. Although upfront consolidation with ASCT is frequently utilized to treat these patients, its efficacy has never been investigated in randomized trials.
Investigators from the Spanish (GELMATO) and Italian (FIL) Lymphoma groups conducted an international, retrospective study comparing PFS and overall survival (OS) in patients with PTCL who underwent ASCT after first-line therapy with those who did not undergo ASCT as part of first-line treatment.
The primary analysis of the multicenter GELTAMO/FIL study included 174 patients with PTCL excluding ALK-positive anaplastic large cell lymphoma who were fit for ASCT at the time of diagnosis and were in complete remission (CR) or uncertain CR after induction therapy (CR1).
Of the 174 patients, 103 underwent ASCT, while 71 did not because the physician decided against upfront ASCT in most cases (n=53). Patients in the non-ASCT cohort were older (median age, 54 years) compared with the ASCT cohort (median age, 50 years; P =.037).
Roughly, 90% of patients in both cohorts had a nodal PTCL. A larger proportion of patients in the ASCT cohort had adverse prognostic factors, such as advanced-stage or elevated lactate dehydrogenase levels.
The 5-year OS rate was significantly improved in the ASCT cohort (74%) compared with the non-ASCT cohort (62%), with a median OS NR for the ASCT cohort and 100.6 months for the non-ASCT cohort. However, the difference was not statistically significant (P =.124).
In the subgroup with advanced-stage disease, the OS was significantly longer among patients who underwent ASCT (median NR) compared with those who did not (median 71.0 months). The 5-year OS rate in the ASCT patients with the advanced-stage disease was significantly higher (70%) compared with the non-ASCT patients (50%; P = .028).
In multivariate analysis, first-line ASCT was strongly associated with prolonged PFS (HR, 0.57; 95% CI, 0.35-0.93) and OS (HR, 0.57; 95% CI, 0.33-0.99).
A separate analysis of patients with a partial response after first-line chemotherapy showed a trend towards better PFS in the ASCT cohort compared with the non-ASCT cohort, with no significant difference in OS at 5-years (P =.96).
In conclusion, the researchers stated “our study supports the use of ASCT as a consolidation strategy for patients with PTCL in CR1.” These results should be confirmed in a prospective randomized study.
Disclosure: Some study author(s) declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
García-Sancho A, Bellei M, López-Parra M, et al. Autologous stem cell transplantation as consolidation of first-line chemotherapy in patients with peripheral T-cell lymphoma: a multicenter GELTAMO/FIL study. Haematologica. Published online March 24, 2022. doi: 10.3324/haematol.2021.279426