Long-term disease-free survival in patients with angioimmunoblastic T-cell lymphoma after high-dose chemotherapy and autologous stem cell transplantation.
[en] BACKGROUND AND OBJECTIVES: Patients with angioimmunoblastic T-cell lymphoma (AIL) have a poor prognosis with conventional treatment. DESIGN AND METHODS: We initiated an EBMT-based survey studying the impact of high-dose chemotherapy (HDCT) and autologous hematopoietic stem cell transplantation in patients with AIL. Data on 29 patients, who were transplanted between 1992 and 1998 in 16 transplant centers, were collected on standardized documentation forms. RESULTS: The median age at transplantation was 53 years. HDCT was given as part of 1st-line therapy (N=14; 48%) or 2nd/3rd-line therapy (N=15; 52%). Regimens for the mobilization of peripheral blood stem cells (PBSC) included VIPE (N=7; 26%), DexaBEAM (N=6; 22%), CHOP-like regimens (N=6; 22%), other regimens (N=5; 19%) or alternatively growth factor alone (N=3; 11%). The median yield of PBSC was 3.8x106 CD34+cells/kg. Two patients received autologous bone marrow. The HDCT consisted of BEAM-type regimens in 16 patients, ICE-type regimens in 7, and other regimens in 6 patients. There was one treatment-related death. The rate of complete remissions increased from 45% before HDCT to 76% after HDCT. As of January 2003, after a median observation time of living patients of 5 years (range 2.5 to 10 years), 14 patients have died (13 from progressive disease), and 15 patients are alive. The probability of 5-year overall and event-free survival was 44% (95% CI, 22% to 66%) and 37% (95% CI, 17% to 57%), respectively. Long-term disease-free survival was observed in patients transplanted during 1st-line treatment as well as in the context of 2nd/3rd-line therapy. INTERPRETATION AND CONCLUSIONS: There is evidence that AIL is susceptible to high-dose chemotherapy. HDCT and autologous stem cell transplantation should be considered in selected patients with AIL.
Disciplines :
Hematology
Author, co-author :
Schetelig, Johannes
Fetscher, Sebastian
Reichle, Albrecht
Berdel, Wolfgang E
Beguin, Yves ; Centre Hospitalier Universitaire de Liège - CHU > Hématologie clinique
Long-term disease-free survival in patients with angioimmunoblastic T-cell lymphoma after high-dose chemotherapy and autologous stem cell transplantation.
Harris NL, Jaffe ES, Diebold J, Flandrin G, Muller-Hermelink HK, Vardiman J, et al. World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues: report of the Clinical Advisory Committee meeting-Airlie House, Virginia, November 1997. J Clin Oncol 1999;17:3835-49.
Rudiger T, Weisenburger DD, Anderson JR, Armitage JO, Diebold J, MacLennan KA, et al. Peripheral T-cell lymphoma (excluding anaplastic large-cell lymphoma): results from the Non-Hodgkin's Lymphoma Classification Project. Ann Oncol 2002;13:140-9.
Dogan A, Attygalle AD and Kyriakou C. Angioimmunoblastic T-cell lymphoma. Br J Haematol 2003;121:681-91.
Schlegelberger B, Zwingers T, Hohenadel K, Henne-Bruns D, Schmitz N, Haferlach T, et al. Significance of cytogenetic findings for the clinical outcome in patients with T-cell lymphoma of angioimmunoblastic lymphadenopathy type. J Clin Oncol 1996;14:593-9.
Brauninger A, Spieker T, Willenbrock K, Gaulard P, Wacker HH, Rajewsky K, et al. Survival and clonal expansion of mutating "forbidden" (immunoglobulin receptor-deficient) Epstein-Barr virus-infected B cells in angioimmunoblastic T cell lymphoma. J Exp Med 2001;194:927-40.
Willenbrock K, Roers A, Seidl C, Wacker HH, Kuppers R and Hansmann ML. Analysis of T-cell subpopulations in T-cell non-Hodgkin's lymphoma of angioimmunoblastic lymphadenopathy with dysproteinemia type by single target gene amplification of T cell receptor-beta gene rearrangements. Am J Pathol 2001;158:1851-7.
Siegert W, Nerl C, Agthe A, Engelhard M, Brittinger G, Tiemann M, et al. Angioimmunoblastic lymphadenopathy (AILD)-type T-cell lymphoma: prognostic impact of clinical observations and laboratory findings at presentation. The Kiel Lymphoma Study Group. Ann Oncol 1995;6:659-64.
Siegert W, Agthe A, Griesser H, Schwerdtfeger R, Brittinger G, Engelhard M, et al. Treatment of angioimmunoblastic lymphadenopathy (AILD)-type T-cell lymphoma using prednisone with or without the COPBLAM/IMVP-16 regimen. A multicenter study. Kiel Lymphoma Study Group. Ann Intern Med 1992;117:364-70.
Ascani S, Zinzani PL, Gherlinzoni F, Sabattini E, Briskomatis A, de Vivo A, et al. Peripheral T-cell lymphomas. Clinicopathologic study of 168 cases diagnosed according to the R.E.A.L. Classification. Ann Oncol 1997;8:583-92.
Lopez-Guillermo A, Cid J, Salar A, Lopez A, Montalban C, Castrillo JM, et al. Peripheral T-cell lymphomas: initial features, natural history, and prognostic factors in a series of 174 patients diagnosed according to the R.E.A.L. Classification. Ann Oncol 1998;9:849-55.
Gisselbrecht C, Gaulard P, Lepage E, Coiffier B, Briere J, Haioun C, et al. Prognostic significance of T-cell phenotype in aggressive non-Hodgkin's lymphomas. Groupe d'Etudes des Lymphomes de l'Adulte (GELA). Blood 1998;92:76-82.
Pautier P, Devidas A, Delmer A, Dombret H, Sutton L, Zini JM, et al. Angioimmunoblastic-like T-cell non Hodgkin's lymphoma: outcome after chemotherapy in 33 patients and review of the literature. Leuk Lymphoma 1999;32:545-52.
Carbone PP, Kaplan HS, Musshoff K, Smithers DW and Tubiana M. Report of the Committee on Hodgkin's Disease Staging Classification. Cancer Res 1971;31:1860-1.
A predictive model for aggressive non-Hodgkin's lymphoma. The International Non-Hodgkin's Lymphoma Prognostic Factors Project. N Engl J Med 1993;329:987-94.
Cheson BD, Horning SJ, Coiffier B, Shipp MA, Fisher RI, Connors JM, et al. Report of an international workshop to standardize response criteria for non-Hodgkin's lymphomas. NCl Sponsored International Working Group. J Clin Oncol 1999;17:1244.
Fisher RI, Gaynor ER, Dahlberg S, Oken MM, Grogan TM, Mize EM, et al. Comparison of a standard regimen (CHOP) with three intensive chemotherapy regimens for advanced non-Hodgkin's lymphoma. N Engl J Med 1993;328:1002-6.
Chopra R, Linch DC, McMillan AK, Blair S, Patterson KG, Moir D, et al. Mini-BEAM followed by BEAM and ABMT for very poor risk Hodgkin's disease. Br J Haematol 1992;81:197-202.
Velasquez WS, Cabanillas F, Salvador P, McLaughlin P, Fridrik M, Tucker S, et al. Effective salvage therapy for lymphoma with cisplatin in combination with high-dose Ara-C and dexamethasone (DHAP). Blood 1988;71:117-22.
Velasquez WS, McLaughlin P, Tucker S, Hagemeister FB, Swan F, Rodriguez MA, et al. ESHAP-an effective chemotherapy regimen in refractory and relapsing lymphoma: a 4-year follow-up study. J Clin Oncol 1994;12:1169-76.
Brugger W, Birken R, Bertz H, Hecht T, Pressler K, Frisch J, et al. Peripheral blood progenitor cells mobilized by chemotherapy plus granulocyte-colony stimulating factor accelerate both neutrophil and platelet recovery after high-dose VP16, ifosfamide and cisplatin. Br J Haematol 1993;84:402-7.
Kleiner S, Kirsch A, Schwaner I, Kingreen D, Schwella N, Huhn D, et al. High-dose chemotherapy with carboplatin, etoposide and ifosfamide followed by autologous stem cell rescue in patients with relapsed or refractory malignant lymphomas: a phase I/II study. Bone Marrow Transplant 1997;20:953-9.
Clift RA, Radich J, Appelbaum FR, Martin P, Flowers ME, Deeg HJ, et al. Long-term follow-up of a randomized study comparing cyclophosphamide and total body irradiation with busulfan and cyclophosphamide for patients receiving allogenic marrow transplants during chronic phase of chronic myeloid leukemia. Blood 1999;94:3960-2.
Blystad AK, Enblad G, Kvaloy S, Berglund A, Delabie J, Holte H, et al. High-dose therapy with autologous stern cell transplantation in patients with peripheral T cell lymphomas. Bone Marrow Transplant 2001;27:711-6.
Lindahl J, Kimby E, Bjorkstrand B, Christensson B and Hellstrom-Lindberg E. High-dose chemotherapy and APSCT as a potential cure for relapsing hemolysing AILD. Leuk Res 2001;25:267-70.
Rodriguez J, Munsell M, Yazji S, Hagemeister FB, Younes A, Andersson B, et al. Impact of high-dose chemotherapy on peripheral T-cell lymphomas. J Clin Oncol 2001;19:3766-70.
O'Reilly SE, Hoskins P, Klimo P, Connors JM. MACOP-B and VACOP-B in diffuse large cell lymphomas and MOPP/ABV in Hodgkin's disease. Ann Oncol 1991;2:17-23.
