Up-Front Autologous Stem-Cell Transplantation in Peripheral T-Cell Lymphoma: NLG-T-01
Up-Front Autologous Stem-Cell Transplantation in Peripheral T-Cell Lymphoma: NLG-T-01
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DOI：
10.1200/jco.2011.40.2719
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发表时间：
2012-09-01
影响因子：
45.3
通讯作者：
Toldbod, Helle E.
中科院分区：
文献类型：
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作者：
d'Amore, Francesco;Relander, Thomas;Toldbod, Helle E.
目的系统性外周T细胞淋巴瘤（Systemic peripheral T-cell lymphomas，PTCL）对常规治疗反应较差。为了评价由前期高剂量化疗（HDT）和自体干细胞移植（ASCT）巩固的剂量密集方法在PTCL中的疗效，北欧淋巴瘤组（NLG）在未经治疗的系统性PTCL中进行了一项大型前瞻性II期研究。这是最终的报告，与5年的中位数随访，NLG-T-01 study.Patients和MethodsTreatment-naive PTCL患者年龄18至67岁（中位数，57岁）被纳入。排除间变性淋巴瘤激酶（ALK）阳性间变性大细胞淋巴瘤（ALCL）。给予6个周期的诱导方案，每两周一次CHOEP（环磷酰胺、多柔比星、长春新碱、依托泊苷和泼尼松）（年龄> 60岁的患者省略依托泊苷）。如果在完全或部分缓解，患者进行巩固HDT/ASCT.ResultsOf 166例入组患者，160例组织病理学证实PTCL。大多数表现为晚期疾病、B症状和血清乳酸脱氢酶升高。共有115例接受了HDT/ASCT，其中90例在移植后3个月完全缓解。早期失败发生在26%。治疗相关死亡率为4%。在中位随访60.5个月时，83例患者存活。合并的5年总体和无进展生存期（PFS）分别为51%（95% CI，43%至59%）和44%（95% CI，36%至52%）。ALK阴性ALCL.ConclusionDose-dense诱导后HDT/ASCT耐受性良好，导致44%的PTCL初治患者长期PFS。这是一个令人鼓舞的结果，特别是考虑到研究人群的中位年龄和不良风险特征。因此，剂量密集诱导和HDT/ASCT是适合移植的PTCL患者的合理前期策略。J Clin Oncol 30：3093-3099. (C)2012年美国临床肿瘤学会
PurposeSystemic peripheral T-cell lymphomas (PTCLs) respond poorly to conventional therapy. To evaluate the efficacy of a dose-dense approach consolidated by up-front high-dose chemotherapy (HDT) and autologous stem-cell transplantation (ASCT) in PTCL, the Nordic Lymphoma Group (NLG) conducted a large prospective phase II study in untreated systemic PTCL. This is the final report, with a 5-year median follow-up, of the NLG-T-01 study.Patients and MethodsTreatment-naive patients with PTCL age 18 to 67 years (median, 57 years) were included. Anaplastic lymphoma kinase (ALK) -positive anaplastic large-cell lymphoma (ALCL) was excluded. An induction regimen of six cycles of biweekly CHOEP (cyclophosphamide, doxorubicin, vincristine, etoposide, and prednisone) was administered (in patients age > 60 years, etoposide was omitted). If in complete or partial remission, patients proceeded to consolidation with HDT/ASCT.ResultsOf 166 enrolled patients, 160 had histopathologically confirmed PTCL. The majority presented with advanced-stage disease, B symptoms, and elevated serum lactate dehydrogenase. A total of 115 underwent HDT/ASCT, with 90 in complete remission at 3 months post-transplantation. Early failures occurred in 26%. Treatment-related mortality was 4%. At 60.5 months of median follow-up, 83 patients were alive. Consolidated 5-year overall and progression-free survival (PFS) were 51% (95% CI, 43% to 59%) and 44% (95% CI, 36% to 52%), respectively. Best results were obtained in ALK-negative ALCL.ConclusionDose-dense induction followed by HDT/ASCT was well tolerated and led to long-term PFS in 44% of treatment-naive patients with PTCL. This represents an encouraging outcome, particularly considering the high median age and adverse risk profile of the study population. Therefore, dose-dense induction and HDT/ASCT are a rational up-front strategy in transplantation-eligible patients with PTCL. J Clin Oncol 30: 3093-3099. (C) 2012 by American Society of Clinical Oncology