Consolidation with AHSCT Key to Increase in Survival in Peripheral T-Cell Lymphomas

The use of autologous hematopoietic stem cell transplantation (AHSCT), but not the addition of etoposide, improved survival outcomes for patients aged younger than 65 years with certain advanced-stage T-cell lymphomas, according to a recent study.

“The cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) regimen has been the standard of care for the majority of T-cell non-Hodgkin lymphoma (NHL) subtypes for decades,” study researchers from the Netherlands wrote. However, patients who progress or relapse have an estimated three-year overall survival (OS) of less than 10%.

Etoposide plus CHOP is used in some countries, including the Netherlands, for second-line treatment of these patients, but its effect on OS is unclear. Consolidation in first remission with myeloablative AHSCT is performed in young and fit patients; however, there is a lack of randomized trials examining this treatment.

In this study, researchers evaluated the effect of etoposide and AHSCT on OS in patients aged younger than 65 years with one of the three peripheral T-cell NHLs:

• anaplastic large cell lymphoma (ALCL)
• angioimmunoblastic T-cell lymphoma (AITL)
• peripheral T-cell lymphoma not otherwise specified (PTCL NOS)

Patients were grouped into two categories: pre-etoposide/AHSCT era and post-etoposide/AHSCT era.

OS increased from 39% in the pre-era to 49% in the post-era (P<.01). Five-year OS was superior for patients treated with etoposide plus CHOP compared with CHOP alone (64% vs 44%; P<.01). However, when adjusted for subtype, International Prognostic Index score, and AHSCT, the risk for mortality was similar between the pre- and post-era groups, except for anaplastic lymphoma kinase (ALK)-positive ALCL. In these patients, the risk for mortality was 6.3 times higher when treated with CHOP compared with etoposide plus CHOP.

Patients who underwent consolidation with AHSCT had significantly improved OS compared with patients not receiving AHSCT (81% vs 39%; P<.01), regardless of whether disease was in complete remission.

“Our data support the use of consolidation with AHSCT in first-line treatment for patients with ALK-[positive] ALCL, AITL, and PTCL NOS,” the researchers concluded.

Brink M, Meeuwes FO, van der Poel MWM, et al. Impact of etoposide and ASCT on survival among patients <65 years with stage II-IV PTCL; a population-based cohort study. Blood. 2022. doi:10.1182/blood.2021015114