Can autologous hematopoietic stem cell transplantation after first-line therapy prolong the survival of patients with stage II-IV peripheral T-cell lymphoma < 65 years of age?

• A analysis: comparison of pre- and post-survival of etoposide and ASCT

A total of 1427 patients with advanced PTCL aged < 65 years were included in the analysis, including ALCL 504 (35%), AITL 294 (21%), and PTCL NOS 629 (44%)<b10>.
Baseline characteristics of patients are shown in Table 1, with males being more numerous (62%) and a median age of 52 years (range, 18-64 years)
for all patients.
The proportion of patients receiving chemotherapy alone (without ASCT) decreased in 2009–2018 compared with 1989–2008 (75 versus 57 percent
).
This suggests that the combination of chemotherapy + ASCT is increasingly used in first-line treatment of PTCL (5 versus 31 percent; P＜0.
01）
。

Table 1

The 5-year OS rate across the cohort was 43% (range, 41%-46%) with a median follow-up of 28.
9 months (range, 0.
03-383 months).

The five-year OS rate in patients before and after etoposide and ASCT increased significantly from 39% (95% CI, 35% to 42%) to 49% (95% CI, 45% to 53%); P<0.
001) (Figure 1A).
<b11> Patients with ALK+ALCL have a higher
5-year OS rate.
The 5-year OS rates of ALK+ALCL, ALK-ALCL, ALCL NOS, AITL, and PTCL NOS were 72%, 52%, 49%, 44%, and 32%, respectively (Figure 1B).

Figure 1

• B analysis: effect of etoposide on patient survival

To analyze the effect of etoposide on patient survival, in the B analysis, the investigators compared
CHOEP and CHOP treatment regimens using data from patients diagnosed between 2014 and 2018.
Table 2 lists the baseline characteristics
of patients included in Analysis B.
There were no significant differences
in sex, median age, or other clinical variables between patients treated with ALK+ALCL, ALK-ALCL, AITL, or PTCL NOS treated with CHOP or CHOEP.

Table 2

Patients with ALK+ALCL treated with CHOEP had significantly higher rates of CR than those treated with CHOP (86 versus 61 percent; P=0.
03) (Figure 2A).

Patients treated with ALK-ALCL, AITL, or PTCL NOS who received the CHOEP regimen also had significantly higher rates of CR than those treated with the CHOP regimen (60 versus 49 percent; P=0.
06) (Figure 2B).

Figure 2

Patients with ALK+ALCL treated with CHOEP had significantly higher OS rates at 5 years than those treated with CHOP (90% [95% CI, 72% to 97%] vs 61% [95% CI, 40% to 76%]; P<0.
01) (Figure 3A).
<b10> When the age and international prognostic index (IPI) score of the patient at the time of diagnosis were adjusted at the same time, the risk of death was higher in patients treated with ALK+ALCL with CHOP than in those treated with CHOP (HR, 6.
33; 95% CI, 1.
65-24.
30; P<0.
01) (Figure 3B).
<b11> 。 Patients with ALK-ALCL, AITL, or PTCL NOS treated with CHOP had a better five-year OS rate than those treated with CHOP (59% [95% CI, 50% to 67%] versus 38% [95% CI, 27% to 49%]; P<0.
01) (Figure 3C).
<b12> After adjustment for PTCL subtype, IPI score, and ASCT, the risk of death was similar for both regimens (HR, 0.
95; 95% CI, 0.
64-1.
42; P = 0.
81) (Figure 3D).

Figure 3

• C analysis: effect of ASCT on patient survival

In the C analysis, the investigators assessed the effect of
ASCT on the survival of patients diagnosed between 2014 and 2018.
ASCT
was performed in 117 of 213 patients (52%).
Patient baseline characteristics are shown
in Table 3.
Compared with those who did not have ASCT, ASCT had fewer men, lower IPI scores, and higher ALK-ALCL
ratios.

Table 3

Patients receiving consolidation therapy with ASCT had a better five-year OS rate than those receiving induction chemotherapy alone (78 versus 45 percent; P<0.
01) (Figure 4A).
<b10> In sensitivity analyses, the investigators assessed the estimated OS of patients with or without CR acceptance/ASCT and showed that 5-year OS rates were better in patients receiving ASCT consolidation therapy than those who did not (82 versus 47 percent; P<0.
01) (Figure 4B).
<b11>

Figure 4