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Graft-Versus-Lymphoma Effect in Relapsed Peripheral T-Cell Non-Hodgkin's Lymphomas After Reduced-Intensity Conditioning Followed by Allogeneic Transplantation of Hematopoietic Cells

From the Divisions of Hematology and Medical Oncology, Istituto Nazionale Tumori, University of Milano, and the Department of Hematology, H.S. Raffaele, Milan; the Department of Hematology, University of Torino, Torino; the Department of Hematology, Ospedale Regionale, Bolzano; the Department of Hematology, University of Modena, Modena; the Department of Hematology, University of Udine, Udine; the Department of Hematology, University of Verona, Verona; and the Department of Hematology, Ospedali Riuniti Bergamo, Bergamo, Italy

Address reprint requests to Paolo Corradini, MD, Division of Hematology-Bone Marrow Transplantation, Istituto Nazionale per lo Studio e la Cura dei Tumori, Via Venezian, 1, 20133 Milano, Italy; e-mail: paolo.corradini{at}unimi.it

PURPOSE: Peripheral T-cell lymphomas (PTCLs) are a heterogeneous group of malignancies characterized by a poor prognosis. We performed a pilot study to investigate the role of reduced-intensity conditioning (RIC) followed by allogeneic stem-cell transplantation in relapsed or refractory PTCLs.

PATIENTS AND METHODS: We have conducted a phase II trial on 17 patients receiving salvage chemotherapy followed by RIC and allogeneic transplantation of hematopoietic cells. The RIC regimen consisted of thiotepa, fludarabine, and cyclophosphamide. The acute graft-versus-host disease prophylaxis consisted of cyslosporine and short course methotrexate.

RESULTS: Patients had a median age of 41 years (range, 23 to 60 years). Two patients were primary chemorefractory, and 15 had relapsed disease; eight patients (47%) had a disease relapse after an autologous transplantation. After a median follow-up of 28 months from the day of study entry (range, 3 to 57 months), 14 of 17 patients were alive (12 in complete remission, one in partial remission, and one with stable disease), two died as a result of progressive disease, and one died as a result of sepsis concomitant to acute graft-versus-host disease. The estimated 3-year overall and progression-free survival rates were 81% (95% CI, 62% to 100%) and 64% (95% CI, 39% to 89%), respectively. The estimated probability of nonrelapse mortality at 2 years was 6% (95% CI, 1% to 17%). Donor lymphocyte infusions induced a response in two patients progressing after allografting.

CONCLUSION: RIC followed by allogeneic stem-cell transplantation is feasible, has a low treatment-related mortality, and seems to be a promising salvage treatment for relapsed PTCL. These findings suggest that the existence of a graft-versus-T-cell lymphoma effect.

Supported in part by grants from the Associazione Italiana Ricerca sul Cancro (AIRC); Compagnia di San Paolo, Programma Oncologia; and Fondazione Michelangelo.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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