PracticeUpdate: Oncology - Winter 2018

EHA 2018 31

Neither Myeloablative nor Reduced- Intensity Conditioning Impact Overall Survival in T-Cell Lymphoma Largest cohort of allo-hematopoietic stem cell transplantation patients for T-cell lymphoma provides encouraging results E ncouraging results have been found in both myeloablative conditioning (MAC) and reduced-intensity con- most serious illnesses, as the Karnofsky score declines, the likelihood of survival decreases.

ditioning (RIC) in what is believed to be the largest cohort of allo-hematopoietic stem cell transplantation (HSCT) patients for T-cell lymphoma, according to new research presented at EHA 2018. The aim of the study, led by Anne-Claire Mamez, MD, with the Department of Inter- nal Medicine Specialties at the University of Geneva, Switzerland, was to analyze the outcomes in a cohort of nearly 300 patients who had undergone an allo-HSCT for peripheral T-cell lymphoma. Three out- comes were measured: overall survival (OS), relapse/progression, and non-relapse mortality. Using clinical files and data from the Société Francophone De Greffe De Moelle Et De Thérapie Cellulaire database, which has more than 400 members engaged in stem cell transplantation research, the study investigators conducted a retro- spective analysis of adult patients who underwent an allo-stem cell transplant for non-cutaneous peripheral T-cell lymphoma (PTCL) in 34 centers between 2006 and 2014. Primary cutaneous T-cell lymphomas were excluded. According to the abstract, a total of 284 patients with PTCL were allo-transplanted in a median time of 12.6 months after diag- nosis (3–322 months). This comprised 39% NOS-T cell lymphomas, 29% angioimmuno- blastic T lymphomas, 15% anaplastic T-cell lymphomas, 17% in other categories. The median age at transplant was 50 years (15 to 60 years) and 67% were males. At the time of transplant, 62% were in complete remission (CR), 27% in partial response (PR) and 11% in progressive disease (PD). Twenty-eight percent were transplanted in frontline treatment, 36% after 2 lines of treatment, and 35% after 3 or more lines of treatment. After the first autologous HSCT, 23% of patients had relapsed and the Kar- nofsky Performance Status Scale Index was up to 80% in 94% of the patients. The Index is a widely used assessment tool to meas- ure functional impairment. It can be used to compare the effectiveness of different therapies as well as to evaluate the prog- nosis in individual patients. Generally, for

Donors were matched related in 45% of cases, matched unrelated in 36%, and alter- native in 19% (haplo-identical n=7, cord blood n=33, mismatched 9/10 n=13) and the stem cell source was peripheral blood in 71% of the patients. A reduced-intensity regiment was given in 147 patients (52%), myeloab- lative in 106 (38%), and nonmyeloablative in 27 (10%). Half of all patients received an ex-vivo T cell depletion; only 1% had an ex vivo T depletion. Fourteen patients (14%) developed grade III–IV acute graft versus host disease (GvHD), and 34% developed chronic GvHD (extensive for 13%). The median follow-up was 33 months. The 1- and 2-year OS were 68% (95% CI 0.62–0.73) and 64% (95% CI 0.58–07), respectively. The cumulative incidence of relapse was 18% after the first year and 22% at 2 years. The median time from trans- plant to relapse was 94 days and only 10% of the relapse occurred after the first year post-transplant. Non-relapse mortality was 22% at 1 year and 24% at 2 years. The main causes of death were relapse (35%), infec- tion (27%) or GvHD (22%). A multivariate analysis conducted by the research team found that at year 5 OS was significantly adversely influenced by the occurrence of grade III–IV GvHD (HR 2.52 [1.52–4.19], P < .01), low Karnofsky score at the time of transplant (HR 2.22 [1.32–3.71], P = .002), and cord blood transplant com- pared to bone marrow (HR 2.01 [1.00–4.01], P = .049). The main factors associated with non-relapse mortality were as follows: • patient’s age (HR 1.02, P = .084 [MTR3]) • a low Karnofsky score (HR 2.03 [1.08– 3.83], P = .029) • female donor to male recipient (HR 1.87 [1.07–3.28], P = .027). “The conditioning regimen intensity (RIC or MAC) was not found to have impact on OS,” the researchers stated in their abstract. Among 30 patients transplanted in PD, 50% reached complete remission after allo-HSCT and 2 year-OS was 51% in this subgroup. www.practiceupdate.com/c/69753

" …treatment with G-Clb

(n=238) was associated with improved outcomes compared with Clb alone (n=118). "

After a median observation time of 62.5 months, treatment with G-Clb (n=238) was associated with improved outcomes compared with Clb alone (n=118). After a median observation time of 59.4 months, G-Clb (n=333) also demonstrated a clinically meaningful improvement in outcomes compared with R-Clb (n=330). Notably, G-Clb also provided a clinically meaningful improvement in overall sur- vival compared with R-Clb. Two- and five-year survival rates were 91% vs 84% and 66% vs 57% for G-Clb vs R-Clb, respectively. Overall, the study found that fewer patients died in the G-Clb arm (37%) than in the R-Clb arm (45%). During the survival follow-up period, the most common cause of death was disease progression (G-Clb, 10%; R-Clb, 15%). www.practiceupdate.com/c/69754

VOL. 2 • NO. 3 • 2018