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Autologous Stem Cell Transplantation as First-Line Therapy in Peripheral T-Cell Lymphomas

Author(s): Peter Reimer

Journal: European Journal of Clinical & Medical Oncology
ISSN 1759-8958

Volume: 2;
Issue: 2;
Start page: 121;
Date: 2010;
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Keywords: peripheral T-cell lymphoma | autologous stem cell transplantation | high-dose therapy

Peripheral T/NK-cell lymphomas (PTCL) comprise a rare and heterogeneous group of malignancies that are characterized by an aggressive course. So far, no standard therapy has been defined. With the exception of anaplastic large cell lymphoma (ALCL) expressing the anaplastic lymphoma kinase (ALK), conventional (anthracycline-based) polychemotherapy leads to dismal outcome, with sustaining complete remissions achievable in only a minority of patients. High-dose therapy supported by autologous stem cell transplantation (HDT-ASCT) is a well-defined and widely used therapeutic approach in different hematological malignancies (e.g., relapsed aggressive B-cell lymphomas, relapsed Hodgkin’s disease, multiple myeloma), and has also shown efficacy in relapsed PTCL. However, on account of the lack of randomized PTCL-restricted studies, the impact of HDT-ASCT as first-line therapy in PTCL is unclear. Retrospective studies in this setting have shown good feasibility with a low therapy-associated morbidity and mortality not exceeding toxicity in high-dose studies on aggressive B-cell lymphomas. To date, five larger prospective PTCL-restricted trials have addressed this strategy, varying in terms of inclusion criteria, induction therapy, high-dose protocols, etc. The outcome shows promising results with an overall survival of about 50% at 3 years. Patients achieving complete remission (CR) at transplantation seem to benefit most from this strategy. Therefore, induction therapy needs to be further improved to increase the transplantation rate. With the limited data available, upfront HDT-ASCT seems a reasonable approach in eligible patients, especially in patients achieving CR after induction therapy. This approach should be urgently evaluated in randomized trials, as planned by the German High-Grade Non-Hodgkin Lymphoma Study Group.
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