Results of conventional or high-dose chemotherapy for peripheral T-cell lymphoma (PTCL) are unsatisfactory, leaving a potential role for autologous or allogeneic stem cell transplantation. There are a number of retrospective studies and a few prospective studies on autologous transplantation for first-line PTCL treatment. Studies show that autologous transplant is feasible in relapsed and previously untreated patients, and efficacy is comparable to results in aggressive B-cell lymphomas. Allogeneic transplant may also have a role in relapsed PTCL, especially in the context of reduced-intensity conditioning, which has decreased nonrelapse mortality. However, it is unclear whether there is a role for allogeneic transplant as a frontline treatment option.
[Show abstract][Hide abstract] ABSTRACT: The International Peripheral T-cell Lymphoma Project is a collaborative effort to better understand peripheral T-cell lymphoma (PTCL). A total of 22 institutions submitted clinical and pathologic material on 1314 cases. One objective was to analyze the clinical and pathologic features of 340 cases of PTCL, not otherwise specified. The median age of the patients was 60 years, and the majority (69%) presented with advanced stage disease. Most patients (87%) presented with nodal disease, but extranodal disease was present in 62%. The 5-year overall survival was 32%, and the 5-year failure-free survival was only 20%. The majority of patients (80%) were treated with combination chemotherapy that included an anthracycline, but there was no survival advantage. The International Prognostic Index (IPI) was predictive of both overall survival and failure-free survival (P < .001). Multivariate analysis of clinical and pathologic prognostic factors, respectively, when controlling for the IPI, identified bulky disease (≥ 10 cm), thrombocytopenia (< 150 × 10(9)/L), and a high number of transformed tumor cells (> 70%) as adverse predictors of survival, but only the latter was significant in final analysis. Thus, the IPI and a single pathologic feature could be used to stratify patients with PTCL-not otherwise specified for novel and risk-adapted therapies.
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