Auto vs. Allo HCT for poor-risk peripheral T-NHL

The following content was featured in a recent Abstracts newsletter distributed by ASTCT. The Abstracts newsletter highlights the latest research in the clinical research and translational science studies aspects of transplantation and cellular therapy. 

Schmitz N, Truemper LH, Bouabdallah K, et al. A Randomized Phase 3 Trial of Auto vs. Allo Transplantation as Part of First-Line Therapy in Poor-Risk Peripheral T-NHL. Blood. 2021; (doi: 10.1182/blood.2020008825).

Chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or CHOP plus etoposide (CHOEP) followed by autologous stem cell transplantation (AutoSCT) continues to be the preferred treatment option for transplant-eligible patients with T-cell lymphoma, new research concludes. The preferred treatment for relapsing patients after AutoSCT is consolidative allogeneic transplantation (AlloSCT), according to the study. Researchers randomized 104 adult patients with nodal peripheral T-cell lymphoma except anaplastic lymphoma kinase (ALK)-positive anaplastic large cell lymphoma (ALK+ ALCL) to receive four courses of CHOEP and one course of DHAP followed by high-dose therapy and AutoSCT or myeloablative conditioning and AlloSCT. After a median follow-up of 42 months, the primary objective—event-free survival at three years—was 43% for AlloSCT patients and 38% for AutoSCT patients. Overall survival at three years in the two groups was 57% and 70%, respectively. There were no relapses among the 21 responding patients proceeding to AlloSCT, while 13 of 36 patients (36%) proceeding to AutoSCT experienced relapse. Deaths from transplant-related toxicity occurred in 8 of 26 patients (31%) after AlloSCT and none of those undergoing AutoSCT. Additionally, transplant-related mortality counterbalanced the strong post-AlloSCT graft-versus-lymphoma effect.

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Tags: HCT, Risk, Peripheral