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Autologous transplantation as consolidation for high risk aggressive T-cell non-Hodgkin lymphoma: a SWOG 9704 intergroup trial subgroup analysis
Al-Mansour, Z., Li, H., Cook, J. R., Constine, L. S., Couban, S., Stewart, D. A., Shea, T. C., Porcu, P., Winter, J. N., Kahl, B. S., et al
Leukemia & lymphoma. 2019;:1-8
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Abstract
Phase II data suggest a benefit to autotransplantation for aggressive T-cell non-Hodgkin lymphoma (T-NHL) in first remission; randomized trials have yet to validate this. We performed a retrospective analysis of aggressive T-NHL patients in the intergroup randomized consolidative autotransplant trial (SWOG 9704). Of the 370 enrolled, 40 had T-NHL: 12 were not randomized due to ineligibility (n = 1), choice (n = 2), or progression (n = 9), leaving 13 randomized to control and 15 to autologous stem cell transplantation (ASCT). Two ASCT patients refused transplant and one failed mobilization. The 5-year landmark PFS/OS estimates for ASCT vs. control groups were 40% vs. 38% (p = .56), and 40% vs. 45% (p = .98), respectively. No difference was seen based on IPI, or histologic subtype. Only 1/7 receiving BCNU-based therapy survived vs. 4/5 receiving TBI. Aggressive T-NHL autotransplanted in first remission did not appear to benefit from consolidative ASCT. This and the 30% who dropped out pre-randomization mostly to progression, suggests that improved induction regimens be developed.
PICO Summary
Population
Aggressive T-cell non-Hodgkin lymphoma patients, treated with five cycles of CHOP/CHOP-R administered every three weeks; those who achieved at least a partial response were eligible for randomization (n=28).
Intervention
One further cycle of CHOP/CHOP-R followed by autologous stem cell transplantation
Comparison
Three further cycles of CHOP/CHOP-R
Outcome
Aggressive T-NHL autotransplanted in first remission did not appear to benefit from consolidative ASCT. . The 5-year landmark PFS/OS estimates for ASCT vs. control groups were 40% vs. 38%, and 40% vs. 45%, respectively. No difference was seen based on IPI, or histologic subtype. Only 1/7 receiving BCNU-based therapy survived vs. 4/5 receiving TBI.