A randomized phase 3 trial of autologous vs allogeneic transplantation as part of first-line therapy in poor-risk peripheral T-NHL

Schmitz, Norbert; Truemper, Lorenz; Bouabdallah, Krimo; Ziepert, Marita; Leclerc, Mathieu; Cartron, Guillaume; Jaccard, Arnaud; Reimer, Peter; Wagner, Eva; Wilhelm, Martin; Sanhes, Laurence; Lamy, Thierry; de Leval, Laurence; Rosenwald, Andreas; Roussel, Muriel; Kroschinsky, Frank; Lindemann, Walter; Dreger, Peter; Viardot, Andreas; Milpied, Noeel; Gisselbrecht, Christian; Wulf, Gerald; Gyan, Emmanuel; Gaulard, Philippe; Bay, Jacques Olivier; Glass, Bertram; Poeschel, Viola; Damaj, Gandhi; Sibon, David; Delmer, Alain; Bilger, Karin; Banos, Anne; Haenel, Mathias; Dreyling, Martin; Metzner, Bernd; Keller, Ulrich; Braulke, Friederike; Friedrichs, Birte; Nickelsen, Maike; Altmann, Bettina und Tournilhac, Olivier (2021): A randomized phase 3 trial of autologous vs allogeneic transplantation as part of first-line therapy in poor-risk peripheral T-NHL. In: Blood, Bd. 137, Nr. 19: S. 2646-2656

Abstract

First-line therapy for younger patients with peripheral T-cell non-Hodgkin lymphoma (T-NHL) consists of 6 courses of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) with or without etoposide (CHOEP), consolidated by high-dose therapy and autologous stem cell transplantation (auto-SCT). We hypothesized that allogeneic stem cell transplantation (allo-SCT) could improve outcomes. 104 patients with peripheral T-cell non-Hodgkin lymphoma, except ALK1 anaplastic large cell lymphoma, 18 to 60 years, all stages, and all age adjusted International Prognostic Index scores, except 0 and stage I, were randomized to 4 cycles of CHOEP and 1 cycle of dexamethasone, cytosine-arabinoside, and platinum (DHAP) followed by high-dose therapy and auto-SCT or myeloablative conditioning and allo-SCT. The primary end point was event-free survival (EFS) at 3 years. After a median follow-up of 42 months, the 3-year EFS after allo-SCT was 43%, as compared with 38% after auto-SCT. Overall survival at 3 years was 57% vs 70% after allo- or auto-SCT, without significant differences between treatment arms. None of the 21 responding patients proceeding to allo-SCT relapsed, as opposed to 13 of 36 patients (36%) proceeding to auto-SCT. Eight of 26 patients (31%) and none of 41 patients died of transplant-related toxicity after allo- and auto-SCT, respectively. The strong graft-versus-lymphoma effect after allo-SCT was counterbalanced by transplant-related mortality.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 0006-4971
• Sprache: Englisch