Hematology Department, CHU Lyon Sud, Hospices Civils de Lyon, Pierre Benite, France; Claude Bernard Lyon 1 University, Lyon, France; Cancer Center of Lyon (CRCL), INSERM U1052 - CNRS UMR5286, Lyon, France.
Hematology Department, CHU Lyon Sud, Hospices Civils de Lyon, Pierre Benite, France.
Ann Oncol. 2018 Mar 1;29(3):715-723. doi: 10.1093/annonc/mdx787.
Peripheral 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.
In 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).
Among 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.
The 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.
外周 T 细胞淋巴瘤（PTCL）仍然是一个治疗挑战。由于 PTCL 的罕见性和异质性，即使是一线治疗类型也没有达成共识。因此，自体干细胞移植（ASCT）的益处仍存在激烈争议。
由于没有随机试验来解决 ASCT 的作用，我们进行了一项大型多中心回顾性研究，并使用多变量比例风险模型和倾向评分匹配方法来纠正意向治疗（ITT）中分配或不分配 ASCT 的患者之间的样本选择偏倚。
在法国、比利时和葡萄牙的 14 个中心筛选了 527 名患者后，最终确定了一个年龄≤65 岁的包含未特指外周 T 细胞淋巴瘤（PTCL-NOS）（N=78，29%）、血管免疫母细胞性 T 细胞淋巴瘤（AITL）（N=123，46%）和间变性大细胞淋巴瘤（ALK-ALCL）（N=68，25%）的患者队列，这些患者在诱导后有部分缓解（N=52，19%）或完全缓解（N=217，81%），并在治疗开始前从病历中仔细收集了治疗分配信息。在 ITT 中，134 名患者被分配到 ASCT，135 名患者未被分配。Cox 多变量模型（无进展生存期的 HR=1.02；95%CI：0.69-1.50；总生存期的 HR=1.08；95%CI：0.68-1.69）和倾向评分分析（无进展生存期和总生存期的 logrank P 值分别为 0.90 和 0.66）均未发现 ASCT 作为诱导后缓解患者的巩固治疗具有生存优势。亚组分析未发现根据缓解状态、疾病分期或风险类别，患者之间有任何进一步的差异。
本数据不支持对诱导后部分或完全缓解的所有 PTCL-NOS、AITL 或 ALK-ALCL 患者使用 ASCT 进行一线巩固治疗。
