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Upfront Autologuos Stem-Cell Transplantation in Peripheral T-Cell Lymphoma: NLG-T-01.

d'Amore, Francesco; Relander, Thomas LU ; Lauritzsen, Grete F; Jantunen, Esa; Hagberg, Hans; Anderson, Harald LU ; Holte, Harald; Osterborg, Anders; Merup, Mats and Brown, Peter, et al. (2012) In Journal of Clinical Oncology 30(25). p.3093-3099
Abstract
PURPOSE:

Systemic peripheral T-cell lymphomas (PTCLs) respond poorly to conventional therapy. To evaluate the efficacy of a dose-dense approach consolidated by upfront high-dose chemotherapy (HDT) and autologous stem-cell transplantation (ASCT) in PTCL, the Nordic Lymphoma Group (NLG) conducted a large prospective phase II study in untreated systemic PTCL. This is the final report, with a 5-year median follow-up, of the NLG-T-01 study.



PATIENTS AND METHODS:

Treatment-naive patients with PTCL age 18 to 67 years (median, 57 years) were included. Anaplastic lymphoma kinase (ALK) -positive anaplastic large-cell lymphoma (ALCL) was excluded. An induction regimen of six cycles of biweekly CHOEP... (More)
PURPOSE:

Systemic peripheral T-cell lymphomas (PTCLs) respond poorly to conventional therapy. To evaluate the efficacy of a dose-dense approach consolidated by upfront high-dose chemotherapy (HDT) and autologous stem-cell transplantation (ASCT) in PTCL, the Nordic Lymphoma Group (NLG) conducted a large prospective phase II study in untreated systemic PTCL. This is the final report, with a 5-year median follow-up, of the NLG-T-01 study.



PATIENTS AND METHODS:

Treatment-naive patients with PTCL age 18 to 67 years (median, 57 years) were included. Anaplastic lymphoma kinase (ALK) -positive anaplastic large-cell lymphoma (ALCL) was excluded. An induction regimen of six cycles of biweekly CHOEP (cyclophosphamide, doxorubicin, vincristine, etoposide, and prednisone) was administered (in patients age > 60 years, etoposide was omitted). If in complete or partial remission, patients proceeded to consolidation with HDT/ASCT.



Results:

Of 166 enrolled patients, 160 had histopathologically confirmed PTCL. The majority presented with advanced-stage disease, B symptoms, and elevated serum lactate dehydrogenase. A total of 115 underwent HDT/ASCT, with 90 in complete remission at 3 months post-transplantation. Early failures occurred in 26%. Treatment-related mortality was 4%. At 60.5 months of median follow-up, 83 patients were alive. Consolidated 5-year overall and progression-free survival (PFS) were 51% (95% CI, 43% to 59%) and 44% (95% CI, 36% to 52%), respectively. Best results were obtained in ALK-negative ALCL.



CONCLUSION:

Dose-dense induction followed by HDT/ASCT was well tolerated and led to long-term PFS in 44% of treatment-naive patients with PTCL. This represents an encouraging outcome, particularly considering the high median age and adverse risk profile of the study population. Therefore, dose-dense induction and HDT/ASCT are a rational upfront strategy in transplantation-eligible patients with PTCL. (Less)
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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Clinical Oncology
volume
30
issue
25
pages
3093 - 3099
publisher
American Society of Clinical Oncology
external identifiers
  • wos:000308558800015
  • pmid:22851556
  • scopus:84865712593
ISSN
1527-7755
DOI
10.1200/JCO.2011.40.2719
language
English
LU publication?
yes
id
3e875a60-a680-4dcb-8883-21127fcd1e4f (old id 3047851)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/22851556?dopt=Abstract
date added to LUP
2012-09-04 20:32:31
date last changed
2017-11-12 03:09:54
@article{3e875a60-a680-4dcb-8883-21127fcd1e4f,
  abstract     = {PURPOSE:<br/><br>
Systemic peripheral T-cell lymphomas (PTCLs) respond poorly to conventional therapy. To evaluate the efficacy of a dose-dense approach consolidated by upfront high-dose chemotherapy (HDT) and autologous stem-cell transplantation (ASCT) in PTCL, the Nordic Lymphoma Group (NLG) conducted a large prospective phase II study in untreated systemic PTCL. This is the final report, with a 5-year median follow-up, of the NLG-T-01 study. <br/><br>
<br/><br>
PATIENTS AND METHODS:<br/><br>
Treatment-naive patients with PTCL age 18 to 67 years (median, 57 years) were included. Anaplastic lymphoma kinase (ALK) -positive anaplastic large-cell lymphoma (ALCL) was excluded. An induction regimen of six cycles of biweekly CHOEP (cyclophosphamide, doxorubicin, vincristine, etoposide, and prednisone) was administered (in patients age &gt; 60 years, etoposide was omitted). If in complete or partial remission, patients proceeded to consolidation with HDT/ASCT.<br/><br>
<br/><br>
Results:<br/><br>
Of 166 enrolled patients, 160 had histopathologically confirmed PTCL. The majority presented with advanced-stage disease, B symptoms, and elevated serum lactate dehydrogenase. A total of 115 underwent HDT/ASCT, with 90 in complete remission at 3 months post-transplantation. Early failures occurred in 26%. Treatment-related mortality was 4%. At 60.5 months of median follow-up, 83 patients were alive. Consolidated 5-year overall and progression-free survival (PFS) were 51% (95% CI, 43% to 59%) and 44% (95% CI, 36% to 52%), respectively. Best results were obtained in ALK-negative ALCL. <br/><br>
<br/><br>
CONCLUSION:<br/><br>
Dose-dense induction followed by HDT/ASCT was well tolerated and led to long-term PFS in 44% of treatment-naive patients with PTCL. This represents an encouraging outcome, particularly considering the high median age and adverse risk profile of the study population. Therefore, dose-dense induction and HDT/ASCT are a rational upfront strategy in transplantation-eligible patients with PTCL.},
  author       = {d'Amore, Francesco and Relander, Thomas and Lauritzsen, Grete F and Jantunen, Esa and Hagberg, Hans and Anderson, Harald and Holte, Harald and Osterborg, Anders and Merup, Mats and Brown, Peter and Kuittinen, Outi and Erlanson, Martin and Ostenstad, Bjørn and Fagerli, Unn-Merete and Gadeberg, Ole V and Sundström, Christer and Delabie, Jan and Ralfkiaer, Elisabeth and Vornanen, Martine and Toldbod, Helle E},
  issn         = {1527-7755},
  language     = {eng},
  number       = {25},
  pages        = {3093--3099},
  publisher    = {American Society of Clinical Oncology},
  series       = {Journal of Clinical Oncology},
  title        = {Upfront Autologuos Stem-Cell Transplantation in Peripheral T-Cell Lymphoma: NLG-T-01.},
  url          = {http://dx.doi.org/10.1200/JCO.2011.40.2719},
  volume       = {30},
  year         = {2012},
}