Allogeneic Stem Cell Transplantation Effective for Angioimmunoblastic T-Cell Lymphoma

Posted on July 28th, 2009 by

Among patients with a type of T-cell non-Hodgkin’s lymphoma known as angioimmunoblastic T-cell lymphoma (AITL), treatment with allogeneic stem cell transplantation results in long-term disease-free survival in approximately 50% of patients. The results of this study were published in the Journal of Clinical Oncology.

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). Symptoms may include high fever, night sweats, weight loss, and skin rash. The disease is more common in males, and the median age at diagnosis is 65 years. Patients with AITL are often diagnosed at an advanced stage of the disease.

Currently, AITL is treated with anthracycline-containing chemotherapy regimens. Patients with AITL are considered candidates for stem cell transplantation.

Two newer drugs — pralatrexate and romidepsin – have shown significant activity in patients with PTCL, but results in the subset of patients with AITL have not been reported.

Autologous stem cell transplants (stem cell transplants that utilize the patient’s own stem cells) have been used as upfront therapy for patients with AITL, with 48% of patients remaining free of cancer progression at three years. Allogeneic stem cell transplants (stem cell transplants that utilize donor stem cells) have also been effective for PTCL patients who have failed chemotherapy.

To evaluate allogeneic stem cell transplantation in patients with AITL, researchers conducted a study among 45 patients. Thirty-four of the patients had already received two or more treatment regimens and 11 had experienced cancer progression following an autologous stem cell transplant.

  • Three-year survival without cancer progression was 54%.
  • Three-year overall survival was 64%.
  • Treatment-related mortality was 25%.
  • 20% of patients experienced a relapse during the first three years after treatment. Relapse rates were lower among patients who experienced chronic graft-versus-host disease and among patients who were not resistant to chemotherapy.

The results of this study suggest that a significant fraction of patients with AITL who fail conventional chemotherapy will respond to 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

Kyriakou C, Canals C, Finke J, 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 2009;early on-line publication on July 20.

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