Allogeneic Stem Cell Transplantation Effective for Angioimmunoblastic T-cell Lymphoma

Researchers affiliated with the European Working Party of the European Group for Blood and Marrow Transplantation have reported that allogeneic stem cell transplantation results in long-term disease-free survival in approximately 50% of patients with angioimmunoblastic T-cell lymphoma (AITL). The details of this study appeared in an early online publication on July 20, 2009 in the Journal of Clinical Oncology.[1]

T-cell lymphomas are a relatively uncommon form of non-Hodgkin’s lymphoma (NHL) that generally do not respond as well to treatment as B-cell NHL. AITL is considered a subtype of peripheral T-cell lymphoma (PTCL) and in some studies, makes up half of this population. AITL is clinically characterized by high fever, night sweats, weight loss, skin rash, a positive Coomb’s test, polyclonal hypergammaglobulinemia, and generalized lymphadenopathy. Other clinical features include skin rash, edema, ascites, pleural effusions, and arthritis. The median age for this disease is approximately 65 years (40-90) and is more frequent in males. Patients with this disease usually present at an advanced stage and show systemic involvement.

Currently, AITL is treated like PTCL, using anthracycline-containing chemotherapy regimens; these patients are considered candidates for stem cell transplantation. Recent studies suggest that two new agents, pralatrexate and romidepsin, have significant activity in patients with PTCL, but response to AITL has not been specifically reported. Autologous stem cell transplants have been used as upfront therapy for patients with AITL with a reported 48% three-year progression-free survival.[2] Allogeneic stem cell transplants have also been effective for patients with PTCL who have failed chemotherapy.

The current study included 45 patients with AITL. Thirty-four patients had received two or more treatment regimens, and 11 had failed an autologous stem cell transplant. The median age was 48 years, and the oldest patient was 68 years old. Twenty-seven patients were considered to have chemosensitive disease, and 18 to have chemoresistant disease. Twenty-five patients underwent a myeloablative transplant and 20 a reduced-intensity transplant. Treatment-related mortality was 25%, and the relapse rate was 20%. However, the relapse rate was 57% for those without chronic graft-versus host disease and 0% for those with chronic graft-versus host disease. Relapse rates were higher in refractory patients compared with chemoresponsive patients. There were no differences in the relapse rates between patients receiving myeloablative regimens and those receiving reduced-intensity regimens. The three-year progression-free survival was 54%, and the overall survival rate was 64%.

Comment: These data show that a significant fraction of patients with AITL who fail conventional chemotherapy can be salvaged with an allogeneic stem cell transplant. This study also suggests that patients should receive an allogeneic stem cell transplant before the development of chemotherapy resistance.

Reference:

[1] Kyriakou C, Canals C, Finke, et al. Allogeneic stem cell transplantation is able to induce long-term remissions in angioimmunoblastic T-cell lymphoma: A retrospective study from the Lymphoma Working Party of the European Group for Blood and Marrow Transplantation. Journal of Clinical Oncology [early online publication]. July 20, 2009.

[2] Reimer P, Rudiger T, Geissinger E, et al. Autologous stem-cell transplantation as first-line therapy in peripheral T-cell lymphomas: results of a prospective multicenter study. Journal of Clinical Oncology. 2009;27:106-113.


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