Peripheral Tcell Lymphoma

The prognostic significance of the T-cell phenotype in NHL is controversial but it has generally been shown that patients with peripheral T-cell lymphoma (PTCL) have a worse outcome compared to patients with B-cell diffuse lymphoma72,73 when treated with conventional chemotherapy. It has been challenging to draw definitive conclusions regarding the effect of HDC with AHCT in this patient population due to the low incidence of this subtype and the heterogeneity of the lymphomas that fall under this classification that are not always clearly delineated in published studies. Rodriguez et al. of the Spanish GEL-TAMO group (Spanish Group for Lymphoma and Autologous Transplantation) has reported the largest series to date of 115 patients with PTCL treated with AHCT.74 The 5-year OS and DFS rates were 60% and 56%, respectively, with a median follow-up of 37 months. When the outcome of the 37 patients who were transplanted in first remission was examined separately, OS increased to 80%, which was statistically significant. The age-adjusted IPI and LDH at transplant were of relevant prognostic significance in this particular study. In contrast, the patients with refractory disease had a 0% OS which concurred with an EBMT report of 64 patients of varying remission status in which most of the 8 refractory patients experienced dismal outcomes.75 Actuarial OS at 10 years was 70% for all patients. The Princess Margaret Group and two Scandinavian studies showed that PTCL patients of the anaplastic large cell lymphoma (ALCL) subtype tended to experience better outcomes after AHCT compared to the other histo-logic subtypes under PTCL.76—78 Jantunen et al. reported a 5-year OS of 85% for ALCL patients compared to 35% for the other PTCL histologies. Song et al. from the Princess Margaret Hospital compared 36 patients with PTCL to 97 patients with B-cell DLCL and found no difference in EFS (37% vs 42%, respectively) and OS (48% vs 53%, respectively) after AHCT. Again, more favorable outcomes among the ALCL patients compared to the other PTCL patients were observed. The ALCL patients had superior survivals relative to the PTCL-not otherwise specified subgroup but similar outcomes compared to the DLCL patients. The Memorial Sloan Kettering series excluded ALCL patients and also reported no difference in EFS or OS between PTCL patients and corresponding DLCL patients.79 The secondary age-adjusted IPI was a strong predictor for EFS as patients in the high-intermediate-or high-risk groups faired poorly regardless of chemosensitivity. An MD Anderson series of 36 PTCL patients reported the predictive relevance of the pre-transplant IPI for OS but not for PFS with pretrans-plant LDH affecting both PFS and OS.80 The GEL-TAMO group also examined the impact of AHCT in 35 patients who were primary induction failures and obtained a 5-year DFS and OS of 43% and 51%, respectively, thus indicating that HDC/AHCT can rescue initial chemotherapy failures.81 On the basis of these data, a subset of patients with PTCL may be cured with AHCT, especially those who demonstrate chemosensi-tive disease. The role of HDC as frontline therapy is less clear although the limited available data show encouraging results.

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