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

2020; Elsevier BV; Linguagem: Inglês

10.1182/blood.2020008825

1528-0020

Norbert Schmitz, Lorenz Truemper, Krimo Bouabdallah, Marita Ziepert, Mathieu Leclerc, Guillaume Cartron, Arnaud Jaccard, Peter Reimer, Eva Wagner-Drouet, Martin Wilhelm, Laurence Sanhès, Thierry Lamy, Laurence de Leval, Andreas Rosenwald, Murielle Roussel, Frank Kroschinsky, Walter Lindemann, Peter Dreger, Andreas Viardot, Nöel Milpied, Christian Gisselbrecht, Gerald Wulf, Emmanuel Gyan, Philippe Gaulard, Jacques‐Olivier Bay, Bertram Glaß, Viola Poeschel, Gandhi Damaj, David Sibon, Alain Delmer, Karin Bilger, Anne Banos, Mathias Haenel, Martin Dreyling, Bernd Metzner, Ulrich Keller, Friederike Braulke, Birte Friedrichs, Maike Nickelsen, Bettina Altmann, Olivier Tournilhac,

Chronic Myeloid Leukemia Treatments

Standard first-line therapy for younger patients with peripheral T-cell lymphoma consists of six courses of CHOP or CHOEP consolidated by high-dose therapy and autologous stem cell transplantation (AutoSCT). We hypothesized that consolidative allogeneic transplantation (AlloSCT) could improve outcome. 104 patients with nodal peripheral T-cell lymphoma except ALK+ ALCL, 18 to 60 years of age, all stages and IPI scores except stage 1 and aaIPI 0, were randomized to receive 4 x CHOEP and 1 x DHAP followed by high-dose therapy and AutoSCT or myeloablative conditioning and AlloSCT. The primary endpoint was event-free survival (EFS) at three years. After a median follow-up of 42 months, 3-year EFS of patients undergoing AlloSCT was 43% (95% confidence interval [CI]: 29%; 57%) as compared to 38% (95% CI: 25%; 52%) after AutoSCT. Overall survival at 3 years was 57% (95% CI: 43%; 71%) versus 70% (95% CI: 57%; 82%) after AlloSCT or AutoSCT, without significant differences between treatment arms. None of 21 responding patients proceeding to AlloSCT as opposed to 13 of 36 patients (36%) proceeding to AutoSCT relapsed. Eight of 26 patients (31%) and none of 41 patients died due to transplant-related toxicity after allogeneic and autologous transplantation, respectively. In younger patients with T-cell lymphoma standard chemotherapy consolidated by autologous or allogeneic transplantation results in comparable survival. The strong graft-versus-lymphoma effect after AlloSCT was counterbalanced by transplant-related mortality. CHO(E)P followed by AutoSCT remains the preferred treatment option for transplant-eligible patients. AlloSCT is the treatment of choice for relapsing patients also after AutoSCT.