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FIRST‐LINE THERAPY OF T‐CELL LYMPHOMA: ALLOGENEIC OR AUTOLOGOUS TRANSPLANTATION FOR CONSOLIDATION ‐ FINAL RESULTS OF THE AATT STUDY

2019; Wiley; Volume: 37; Issue: S2 Linguagem: Inglês

10.1002/hon.64_2629

1099-1069

Olivier Tournilhac, Lorenz Truemper, Marita Ziepert, Krimo Bouabdallah, Maike Nickelsen, Sébastien Maury, Peter Reimer, Arnaud Jaccard, W. Herr, Mathias Wilhelm, Guillaume Cartron, Gerald Wulf, Laurence Sanhès, Peter Dreger, Thierry Lamy, Frank Kroschinsky, H. Lindemann, Murielle Roussel, Andreas Viardot, David Sibon, Alain Delmer, Laurence de Leval, Gandhi Damaj, C Gisselbrecht, Philippe Gaulard, Andreas Rosenwald, B. Friedrichs, Bettina Altmann, N. Schmitz,

Viral-associated cancers and disorders

Background: In patients (pts) with peripheral T-cell lymphoma (PTCL) results of first-line therapy remain poor; guidelines recommend consolidation with autologous transplantation (autoSCT) in transplant-eligible pts. AATT (Autologous or AllogeneicTransplantation in T-cell lymphoma) sought to improve first-line therapy and compared alloSCT with autoSCT. Methods: This was a prospective randomized trial comparing autoSCT with alloSCT in younger pts (18-60 yrs) with newly diagnosed PTCL who had achieved CR, PR, or SD after 4 courses of CHOEP and 1 course of DHAP. Pts were to receive BEAM followed by autoSCT or myeloablative conditioning (fludarabine, busulfan, cyclophosphamide) followed by alloSCT from a matched related or unrelated donor. Primary endpoint was 3-year event-free survival (EFS). The study was stopped prematurely after a pre-planned interim analysis (JCO 33, 2015, suppl 8507a) Results: 103 pts randomized upfront to autoSCT (n = 54) or alloSCT (n = 49) formed the full analysis set. Median age was 50 years, 63% were male. 36 pts (35%) could not proceed to transplantation mostly due to early progression. Median observation time for EFS was 42 months. 3-year EFS and overall survival (OS) did not significantly differ between alloSCT and autoSCT (EFS: 43% (95% CI29-57%) vs. 38% (25-52%), p = 0.58, OS: 57% (43-71%) vs. 70% (57-82%)(p = 0.41). Comparing pts who actually received autoSCT (n = 41) or alloSCT (n = 26) EFS, PFS, and OS also showed no significant difference. No patient relapsed but eight pts (31%) died of treatment-related mortality (TRM) after alloSCT compared to 13 relapses (36%) but no TRM observed after autoSCT. Comparison of pts with aaIPI 2/3 vs. 0/1 showed significant differences for all endpoints. Conclusions: AlloSCT or autoSCT given to consolidate response in pts with PTCL showed no significant survival differences. While exerting a strong GvL-effect alloSCT resulted in substantial TRM. For younger pts with PTCL autoSCT remains the preferred consolidation, in particular, because pts relapsing after autoSCT can be successfully salvaged with alloSCT. Keywords: allogeneic stem cell transplant (alloSCT); autologous stem cell transplantation (ASCT); T-cell lymphoma (TCL). Disclosures: Tournilhac, O: Consultant Advisory Role: Roche, Abbvie, Janssen-Cilag, Takeda; Honoraria: Roche, Celgene, Roche, Abbvie, Janssen, Gilead Science; Research Funding: Amgen. Nickelsen, M: Consultant Advisory Role: Roche; Celgene; Janssen China R&D; Honoraria: Roche; Celgene; MSD Oncology; Roche; Celgene; MSD Oncology; Other Remuneration: Travel, accommodations, expenses: Roche; Celgene; Janssen China R&D. Maury, S: Consultant Advisory Role: Pfizer; Amgen; Miltenyi Biotec; Other Remuneration: Patents, Royalties, other intellectual Property: Inserm. Reimer, P: Consultant Advisory Role: Takeda; Honoraria: Pfizer; Roche; Other Remuneration: Travel, accommodations, expenses: Gilead Sciences, Takeda, Abbvie, Bristol-Myers Squibb. Jaccard, A: Honoraria: Amgen; Celgene; Janssen China R&D; Research Funding: Celgene; Janssen China R&D; Other Remuneration: travel, accomodations, expenses: Celgene, Amgen, Janssen China R&D. Cartron, G: Consultant Advisory Role: Celgene; Roche; Honoraria: Gilead Sciences; Sanofi; Roche; Celgene; Janssen China R&D. Wulf, G: Consultant Advisory Role: Kite Gilead; Novartis; Other Remuneration: Speaker's Bureau: Novartis. Sanhes, L: Consultant Advisory Role: Biogaran, Celgene, Novartis. De Leval, L: Consultant Advisory Role: Abbvie; Honoraria: Roche; Other Remuneration: Travel, accommodations, expenses: MSD. Damaj, G: Consultant Advisory Role: Roche, Takeda, Novartis; Honoraria: Roche, Takeda, Novartis; Research Funding: Takeda, Roche; Other Remuneration: Travel Roche, Pfizer. Gisselbrecht, C: Research Funding: Roche/Genentech; JHL Biotech; Other Remuneration: Speakers' Bureau: Roche/Genentech. Gaulard, P: Consultant Advisory Role: Takeda; Research Funding: Takeda; Other Remuneration: Travel, accommodations, expenses: Roche; Takeda. Schmitz, N: Consultant Advisory Role: Riemser; Stock Ownership: Celgene; Honoraria: Takeda; Gilead sciences; Riemser; Janssen China R&D; Research Funding: Janssen China R&D; Other Remuneration: Travel, accommodations, expenses: Takeda; Gilead sciences; Riemser; Janssen China R&D.