Role of up-front autologous stem cell transplantation in peripheral T-cell lymphoma for patients in response after induction: An analysis of patients from LYSA centers

Abstract

Background

Peripheral T-cell lymphoma (PTCL) remains a therapeutic challenge. Due to the rarity and the heterogeneity of PTCL, no consensus has been achieved regarding even the type of first-line treatment. The benefit of autologous stem cell transplant (ASCT) is, therefore, still intensely debated.

Patients and methods

In the absence of randomized trials addressing the role of ASCT, we performed a large multicentric retrospective study and used both a multivariate proportional hazard model and a propensity score matching approach to correct for sample selection bias between patients allocated or not to ASCT in intention-to-treat (ITT).

Results

Among 527 patients screened from 14 centers in France, Belgium, and Portugal, a final cohort of 269 patients ≤ 65 years old with PTCL-NOS (N=78, 29%), AITL (N=123, 46%) and ALK-ALCL (N=68, 25%) with partial (N=52, 19%) or complete responses (N=217, 81%) after induction was identified and information about treatment allocation was carefully collected before therapy initiation from medical records. One hundred and thirty-four patients were allocated to ASCT in ITT and 135 were not. Neither the Cox multivariate model (HR = 1.02; 95% CI 0.69-1.50 for PFS and HR = 1.08; 95% CI 0.68-1.69 for OS) nor the propensity score analysis after stringent matching for potential confounding factors (logrank P=0.90 and 0.66 for PFS and OS respectively) found a survival advantage in favor of ASCT as a consolidation procedure for patients in response after induction. Subgroup analyses did not reveal any further difference for patients according to response status, stage disease or risk category.

Conclusions

The present data do not support the use of ASCT for up-front consolidation for all patients with PTCL-NOS, AITL or ALK- ALCL with partial or complete response after induction.