ASCT Improved Overall Survival Among Older Patients With Peripheral T-Cell Lymphoma

In patients aged <65 years with advanced-stage ALK⁻ anaplastic large-cell lymphoma (ALCL), angioimmunoblastic T-cell lymphoma (AITL), or peripheral t-cell lymphoma (PTCL), the use of autologous stem cell transplantation (ASCT) consolidation was associated with improved overall survival (OS), according to a population-based cohort study published in Blood.

“Patients aged <65 years with PTCL are [typically] treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). Although the addition of etoposide (CHOEP) and consolidation with ASCT are preferred in some countries, randomized trials are lacking,” Mirian Brink, MD, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands, and coauthors wrote.

This nationwide study assessed the impact of etoposide and ASCT on OS among patients aged 18 to 64 years with stage 2 to 4 ALCL, AITL, or PTCL not otherwise specified, diagnosed between 1989 and 2018 using the Netherlands Cancer Registry. Patients were categorized into 2 calendar periods, representing pre- and post-eras of etoposide and ASCT, respectively. A total of 1427 patients were identified: 35% with ALCL, 21% with AITL, and 44% with PTCL not otherwise specified. The primary end point for the study was OS.

There was a significant increase of OS from 39% in the period from 1989 to 2009 to 49% in the period of 2009 to 2018 (P < .01). The 5-year OS was superior for patients treated with CHOEP vs CHOP (64% and 44%, respectively; P < .01). When adjusted for subtype, International Prognostic Index score, and ASCT, the risk of mortality was similar between the 2 groups, except for patients with ALK⁺ ALCL. In this population, the risk of mortality was 6.3 times higher when treated with CHOP vs CHOEP.

Patients undergoing consolidation with ASCT had superior 5-year OS of 81% compared with 39% for patients not undergoing ASCT (P < .01), regardless of whether complete remission was achieved.

“In patients aged <65 years with advanced-stage ALK⁻ ALCL, AITL, or PTCL, the use of ASCT consolidation, but not the addition of etoposide, was associated with improved OS,” Dr Brink and study coauthors concluded.

Source:

Brink M, Meeuwes FO, van der Poel MWM, et al. Impact of etoposide and ASCT on survival among patients aged <65 years with stage II to IV PTCL: a population-based cohort study. Blood. 2022;140(9):1009-1019. doi:10.1182/blood.2021015114