Role of up-front autologous stem-cell transplantation in peripheral T-cell lymphoma for patients in response after induction: an analysis of patients from LYSA centers

G Fossard (1) , F Broussais (2) , I Coelho , S Bailly (3) , E Nicolas-Virelizier (4) , E Toussaint (5) , C Lancesseur , F Le Bras (6) , E Willems , E. Tchernonog (7) , T Chalopin (8) , R Delarue (9) , R Gressin (10) , A Chauchet (11) , E. Gyan (8) , G Cartron , C Bonnet , C Haioun (6) , G. Damaj , P Gaulard , L Fornecker , H Ghesquières , O Tournilhac (12) , M G da Silva , R. Bouabdallah (13) , G Salles (1) , E. Bachy (1)

1 UNICANCER/CRCL - Centre de Recherche en Cancérologie de Lyon
2 CHLS - Centre Hospitalier Lyon Sud [CHU - HCL]
3 UCA [2017-2020] - Université Clermont Auvergne [2017-2020]
4 Centre Léon Bérard [Lyon]
5 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
6 CHU Henri Mondor [Créteil]
7 Département d'hématologie biologique[Montpellier]
8 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
9 Hôpital Necker - Enfants Malades [AP-HP]
10 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
11 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
12 CHELTER - Role of intra-Clonal Heterogeneity and Leukemic environment in ThErapy Resistance of chronic leukemias
13 IPC - Institut Paoli-Calmettes

Background: Peripheral T-cell lymphoma (PTCL) remains a therapeutic challenge. Due to the rarity and the heterogeneity of PTCL, no consensus has been achieved regarding even the type of first-line treatment. The benefit of autologous stem-cell transplantation (ASCT) is, therefore, still intensely debated. Patients and methods: In the absence of randomized trials addressing the role of ASCT, we performed a large multicentric retrospective study and used both a multivariate proportional hazard model and a propensity score matching approach to correct for sample selection bias between patients allocated or not to ASCT in intention-to-treat (ITT). Results: Among 527 patients screened from 14 centers in France, Belgium and Portugal, a final cohort of 269 patients 65 years old with PTCL-not otherwise specified (NOS) (N ¼ 78, 29%), angioimmunoblastic T-cell lymphoma (AITL) (N ¼ 123, 46%) and anaplastic lymphoma kinase-positive anaplastic large cell lymphoma (ALK-ALCL) (N ¼ 68, 25%) with partial (N ¼ 52, 19%) or complete responses (N ¼ 217, 81%) after induction was identified and information about treatment allocation was carefully collected before therapy initiation from medical records. One hundred and thirty-four patients were allocated to ASCT in ITT and 135 were not. Neither the Cox multivariate model (HR ¼ 1.02; 95% CI: 0.69-1.50 for PFS and HR ¼ 1.08; 95% CI: 0.68-1.69 for OS) nor the propensity score analysis after stringent matching for potential confounding factors (logrank P ¼ 0.90 and 0.66 for PFS and OS, respectively) found a survival advantage in favor of ASCT as a consolidation procedure for patients in response after induction. Subgroup analyses did not reveal any further difference for patients according to response status, stage disease or risk category. Conclusions: The present data do not support the use of ASCT for up-front consolidation for all patients with PTCL-NOS, AITL, or ALK-ALCL with partial or complete response after induction.

Mots clés: peripheral T-cell lymphoma; autologous stem-cell transplantation; propensity score matching; complete response; partial response; first line

Domaines: Cancer; Hématologie

G Fossard, F Broussais, I Coelho, S Bailly, E Nicolas-Virelizier, et al.. Role of up-front autologous stem-cell transplantation in peripheral T-cell lymphoma for patients in response after induction: an analysis of patients from LYSA centers. Annals of Oncology, 2018, 29 (3), pp.715 - 723. ⟨10.1093/annonc/mdx787⟩. ⟨hal-01759926⟩