Impact of high-dose chemotherapy on peripheral T-cell lymphomas

Purpose : To evaluate the outcome of high-dose chemotherapy (HDCT) and auto logous or allogeneic hematopoietic transplantation in patients with periphe ral T-cell lymphoma (PTCL) who experienced disease recurrence after prior c onventional chemotherapy. Patients and Methods: We performed a retrospective analysis of 36 PTCL pati ents from the University of Texas M.D. Anderson Cancer Center treated betwe en 1989 and 1998 with HDCT and autologous or allogeneic hematopoietic trans plantation. Results: A total of 36 patients were studied (29 received autologous transp lantation, and seven received allogeneic transplantation). The overall surv ival rate at 3 years was 36% (95% confidence interval [CI], 23% to 59%), an d the progression-free survival (PFS) rate was 28% (95% CI, 16% to 49%). Th e pretransplant serum lactate dehydrogenase level was the most important pr ognostic factor for both survival and PFS rates (P < .001). A Pretransplant International Prognostic Index score of less than or equal to 1 indicated a superior survival rate (P = .036) but not an improved PFS rate. A median follow-up of 43 months (range, 13 to 126 months) showed 13 patients (36%) w ere still alive with no evidence of disease. Conclusion: Our results are comparable to the published data on HDCT in B-c ell non-Hodgkin's lymphoma (NHL) patients despite the fact that patients wi th PTCL are known to have a worse outcome compared with B-cell NHL patients . Considering the dismal outcome of conventional chemotherapy in PTCL patie nts, these data suggest the hypothesis that the poor prognostic implication of T-cell phenotyping in NHL might be overcome by frontline HDCT and trans plantation.