Levine Cancer Institute, Charlotte, North Carolina.
Memorial Sloan Kettering Cancer Center, New York, New York.
Cancer. 2019 May 1;125(9):1507-1517. doi: 10.1002/cncr.31861. Epub 2019 Jan 29.
The role of autologous stem cell transplantation (ASCT) in the first complete remission (CR1) of peripheral T-cell lymphomas (PTCLs) is not well defined. This study analyzed the impact of ASCT on the clinical outcomes of patients with newly diagnosed PTCL in CR1.
Patients with newly diagnosed, histologically confirmed, aggressive PTCL were prospectively enrolled into the Comprehensive Oncology Measures for Peripheral T-Cell Lymphoma Treatment (COMPLETE) study, and those in CR1 were included in this analysis.
Two hundred thirteen patients with PTCL achieved CR1, and 119 patients with nodal PTCL, defined as anaplastic lymphoma kinase-negative anaplastic large cell lymphoma, angioimmunoblastic T-cell lymphoma (AITL), or PTCL not otherwise specified, were identified. Eighty-three patients did not undergo ASCT, whereas 36 underwent consolidative ASCT in CR1. At the median follow-up of 2.8 years, the median overall survival was not reached for the entire cohort of patients who underwent ASCT, whereas it was 57.6 months for those not receiving ASCT (P = .06). ASCT was associated with superior survival for patients with advanced-stage disease or intermediate-to-high International Prognostic Index scores. ASCT significantly improved overall and progression-free survival for patients with AITL but not for patients with other PTCL subtypes. In a multivariable analysis, ASCT was independently associated with improved survival (hazard ratio, 0.37; 95% confidence interval, 0.15-0.89).
This is the first large prospective cohort study directly comparing the survival outcomes of patients with nodal PTCL in CR1 with or without consolidative ASCT. ASCT may provide a benefit in specific clinical scenarios, but the broader applicability of this strategy should be determined in prospective, randomized trials. These results provide a platform for designing future studies of previously untreated PTCL.
自体干细胞移植（ASCT）在初治外周 T 细胞淋巴瘤（PTCL）完全缓解（CR1）中的作用尚未明确。本研究分析了 ASCT 对初治 CR1 期侵袭性 PTCL 患者临床结局的影响。
前瞻性纳入组织学确诊的初治侵袭性 PTCL 患者至 Comprehensive Oncology Measures for Peripheral T-Cell Lymphoma Treatment（COMPLETE）研究中，对 CR1 期患者进行本分析。
119 例结外 PTCL 患者达到 CR1，其中包括 ALK 阴性间变大细胞淋巴瘤、血管免疫母细胞性 T 细胞淋巴瘤（AITL）或未特指 PTCL 的结外侵袭性大 B 细胞淋巴瘤。83 例患者未行 ASCT，36 例患者在 CR1 期行巩固性 ASCT。中位随访 2.8 年，行 ASCT 患者的总生存期尚未达到，而未行 ASCT 患者的总生存期为 57.6 个月（P =.06）。ASCT 可改善晚期疾病或中高危国际预后指数评分患者的生存。ASCT 显著改善 AITL 患者的总生存和无进展生存，但对其他 PTCL 亚型患者无此获益。多变量分析显示，ASCT 与改善生存相关（风险比，0.37；95%置信区间，0.15-0.89）。
这是第一项直接比较 CR1 期结外 PTCL 患者接受或不接受巩固性 ASCT 的生存结局的大型前瞻性队列研究。ASCT 可能在特定临床情况下有益，但应在前瞻性随机试验中确定其更广泛的适用性。这些结果为设计新诊断 PTCL 的未来研究提供了平台。
