Role of up-front autologous stem-cell transplantation in peripheral T-cell lymphoma for patients in response after induction: an analysis of patients from LYSA centers |
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| Affiliation: | 1. Hematology Department, CHU Lyon Sud, Hospices Civils de Lyon, Pierre Benite, France;2. Claude Bernard Lyon 1 University, Lyon, France;3. Cancer Center of Lyon (CRCL), INSERM U1052 – CNRS UMR5286, Lyon, France;4. Hematology Department, Portuguese Institute of Oncology, Lisbon, Portugal;5. Hematology and Cell Therapy Department, Hôpital Estaing, CHU de Clermont-Ferrand, Clermont-Ferrand, France;6. Clermont Auvergne University, Clermont-Ferrand, France;7. Hematology Department, Centre Leon Berard, Lyon, France;8. Hematology Department, CHU de Strasbourg, Strasbourg, France;9. Hematology Institute, CHU de Caen, Caen, France;10. Hematology Department, CHU Henri Mondor, Creteil, France;11. Hematology Department, CHU de Liège, Liège, Belgium;12. Hematology Department, CHU de Montpellier, Montpellier, France;13. Hematology Department, CHU de Tours, Tours, France;14. Hematology Department, CHU Necker Enfants Malades, AP-HP, Paris, France;15. Hematology Department, CHU de Grenoble, Grenoble, France;16. Hematology Department, CHU de Besançon, Besançon, France;17. Hematology Department, Institut Paoli Calmette, Marseille, France |
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| Abstract: | BackgroundPeripheral T-cell lymphoma (PTCL) remains a therapeutic challenge. Due to the rarity and the heterogeneity of PTCL, no consensus has been achieved regarding even the type of first-line treatment. The benefit of autologous stem-cell transplantation (ASCT) is, therefore, still intensely debated.Patients and methodsIn the absence of randomized trials addressing the role of ASCT, we performed a large multicentric retrospective study and used both a multivariate proportional hazard model and a propensity score matching approach to correct for sample selection bias between patients allocated or not to ASCT in intention-to-treat (ITT).ResultsAmong 527 patients screened from 14 centers in France, Belgium and Portugal, a final cohort of 269 patients ≤65 years old with PTCL-not otherwise specified (NOS) (N = 78, 29%), angioimmunoblastic T-cell lymphoma (AITL) (N = 123, 46%) and anaplastic lymphoma kinase-positive anaplastic large cell lymphoma (ALK-ALCL) (N = 68, 25%) with partial (N = 52, 19%) or complete responses (N = 217, 81%) after induction was identified and information about treatment allocation was carefully collected before therapy initiation from medical records. One hundred and thirty-four patients were allocated to ASCT in ITT and 135 were not. Neither the Cox multivariate model (HR = 1.02; 95% CI: 0.69–1.50 for PFS and HR = 1.08; 95% CI: 0.68–1.69 for OS) nor the propensity score analysis after stringent matching for potential confounding factors (logrank P = 0.90 and 0.66 for PFS and OS, respectively) found a survival advantage in favor of ASCT as a consolidation procedure for patients in response after induction. Subgroup analyses did not reveal any further difference for patients according to response status, stage disease or risk category.ConclusionsThe present data do not support the use of ASCT for up-front consolidation for all patients with PTCL-NOS, AITL, or ALK-ALCL with partial or complete response after induction. |
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