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The impact of stem cell transplantation on the natural course of peripheral T-cell lymphoma: a real-world experience

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Abstract

The role of autologous stem cell transplantation (autoSCT) as consolidating treatment for peripheral T-cell lymphoma (PTCL) is unsettled. The aim of this analysis was to investigate the impact of autoSCT in the upfront setting by intent-to-treat and to study salvage strategies after relapse. Retrospective follow-up of all patients aged 18–70 years and treated at our institution for ALK-PTCL diagnosed between 2001 and 2014. Of 117 eligible patients, diagnosis was PTCL-NOS in 34, ALCL ALK− in 31, AITL in 28, and other PTCL in 24 patients. Disregarding 20 patients who received first-line treatment externally, upfront autoSCT was not intended in 34 due to comorbidity, higher age, low IPI, physician’s decision or unknown reasons (nITT), while intent-to-transplant (ITT) was documented in 63 patients. ITT was not associated with significant benefits for 5-year progression-free survival (PFS) and overall survival (OS) with 46 and 23% in the ITT group vs. 42 and 25% in the nITT group, even after multivariate adjustment for confounders. Altogether, 91 of all 117 patients relapsed or progressed. Thirty-one patients managed to proceed to salvage allografting and achieved a 5-year OS of 52%. In contrast, all 7 patients receiving salvage autoSCT relapsed and died, and only 3 of the 51 patients not eligible for SCT salvage survived. In this study, a significant benefit of intending first-line autoSCT over non-transplant induction in patients with ALK-PTCL did not emerge. Most patients fail first-line treatment and have a poor outlook if salvage alloSCT cannot be performed.

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Authors and Affiliations

  1. Department of Medicine V, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany

    Sarah Rohlfing, Sascha Dietrich, Ute Hegenbart, Stefan Schönland, Thomas Luft, Anthony D. Ho & Peter Dreger

  2. Department of Medicine I and Outpatient Clinic For Hematology And Oncology, Fürst-Stirum-Klinik Bruchsal, Bruchsal, Germany

    Sarah Rohlfing

  3. University of Heidelberg, Medical Faculty Heidelberg, Heidelberg, Germany

    Mathias Witzens-Harig

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  1. Sarah Rohlfing
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Rohlfing, S., Dietrich, S., Witzens-Harig, M. et al. The impact of stem cell transplantation on the natural course of peripheral T-cell lymphoma: a real-world experience. Ann Hematol 97, 1241–1250 (2018). https://doi.org/10.1007/s00277-018-3288-7

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