Originally published as JCO Early Release 10.1200/JCO.2008.12.6219 on December 10 2007

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High-Dose Therapy and Autologous Stem-Cell Transplantation in Angioimmunoblastic Lymphoma: Complete Remission at Transplantation Is the Major Determinant of Outcome—Lymphoma Working Party of the European Group for Blood and Marrow Transplantation

Charalampia Kyriakou, Carmen Canals, Anthony Goldstone, Dolores Caballero, Bernd Metzner, Guido Kobbe, Hans-Jochem Kolb, Joachim Kienast, Peter Reimer, Jurgen Finke, Gunnar Oberg, Ann Hunter, Niklas Theorin, Anna Sureda, Norbert Schmitz

From the University College London; European Bone Marrow Transplantation Group, London; and Leicester Royal Infirmary, Leicester, United Kingdom; Hospital Clínico Servicio de Hematología, Salamanca; and Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; University Hospital, Dept. of Hematology; and University Hospital, Department of Medicine, Uppsala, Sweden; University of Freiburg, Department of Medicine -Hematology, Oncology, Freiburg; Medical Klinik, Wurzburg; University of Münster, Department of Hematology/Oncology, Münster; Klinikum Grosshadern, Munich; Heinrich Heine Universität, Düsseldorf; and Klinikum Oldenburg, Abt Onkologie/Hämatologie, Oldenburg, Germany

Corresponding author: Charalampia Kyriakou, MD, University College London, 4 Sentis Court, 8 Carew Rd, Northwood, Middlesex, United Kingdom HA6 3NG; e-mail: c.kyriakou{at}btinternet.com

Purpose Patients with angioimmunoblastic T-cell lymphoma (AITL) have poor prognoses with current conventional chemotherapy. The aim of this study was to evaluate the effect of high-dose therapy (HDT) followed by autologous stem-cell transplantation (ASCT) on patients with AITL.

Patients and Methods We report a retrospective, multicenter study of 146 patients with AITL who received ASCT. The source of the stem cells was peripheral blood in 143 patients. The conditioning regimen varied, and 74% of the patients received carmustine and 1,3-bis(2-chloroethyl)-1-nitrosourea; etoposide; ara-C; and melphalan chemotherapy.

Results After a median follow-up of 31 months (range, 3 to 174 months), 95 patients (65%) remained alive, and 51 patients (35%) died. Forty-two patients died as a result of disease progression, and nine died as a result of regimen-related toxicity. The cumulative incidence of nonrelapse mortality was 5% and 7% at 12 and 24 months, respectively. The actuarial overall survival (OS) was 67% at 24 months and 59% at 48 months. The cumulative incidence of relapse was estimated at 40% and 51% at 24 and 48 months, respectively. Disease status at transplantation was the major factor that impacted outcome. Patients who received a transplant during first complete remission (CR) had significantly superior progression-free survival and OS. The estimated PFS rates for patients who received their transplants in CR were 70% and 56% at 24 and 48 months, respectively; 42% and 30% for patients with chemotherapy-sensitive disease at those time points, respectively; and 23% at both time points for patients with chemotherapy-refractory disease.

Conclusion This study shows that HDT and ASCT offers the possibility of long-term disease-free survival to patients with AITL. Early transplantation is necessary to achieve optimal results.

published online ahead of print at www.jco.org on December 10, 2007.

C.K., A.S., and N.S. shared primary responsibility for drafting the manuscript. C.C. performed the statistical analyses; all authors contributed data and discussed the final manuscript.

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

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