Efficacy of High-Dose Therapy and Autologous Hematopoietic Cell Transplantation in Peripheral T Cell Lymphomas as Front-Line Consolidation or in the Relapsed/Refractory Setting: A Systematic Review/Meta-Analysis

Jessica El-Asmar; Tea Reljic; Ernesto Ayala; Mehdi Hamadani; Taiga Nishihori; Ambuj Kumar; Mohamed A Kharfan-Dabaja

doi:10.1016/j.bbmt.2015.12.004

Efficacy of High-Dose Therapy and Autologous Hematopoietic Cell Transplantation in Peripheral T Cell Lymphomas as Front-Line Consolidation or in the Relapsed/Refractory Setting: A Systematic Review/Meta-Analysis

Biol Blood Marrow Transplant. 2016 May;22(5):802-14. doi: 10.1016/j.bbmt.2015.12.004. Epub 2015 Dec 20.

Authors

Jessica El-Asmar¹, Tea Reljic², Ernesto Ayala³, Mehdi Hamadani⁴, Taiga Nishihori³, Ambuj Kumar², Mohamed A Kharfan-Dabaja⁵

Affiliations

¹ Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
² Center for Evidence-Based Medicine, University of South Florida, Tampa, Florida.
³ Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center, Tampa, Florida; Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida.
⁴ Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
⁵ Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center, Tampa, Florida; Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida. Electronic address: Mohamed.Kharfan-Dabaja@Moffitt.org.

PMID: 26713431
DOI: 10.1016/j.bbmt.2015.12.004

Abstract

To date, no prospective randomized trials exist comparing high-dose therapy (HDT) followed by autologous hematopoietic cell transplantation (auto-HCT) against conventional therapy for management of peripheral T cell lymphomas either as upfront consolidation or in the relapsed/refractory setting. Available data supporting this approach are limited to single-arm prospective or retrospective studies only. Accordingly, we performed a systematic review/meta-analysis of the published literature. Our search identified 1586 publications, but only 27 (n = 1368) met our inclusion criteria. In the front-line setting, pooled analysis of only prospective studies showed rates of progression-free survival (PFS) of 33% (95% confidence interval [CI], 14% to 56%), overall survival (OS) of 54% (95% CI, 32% to 75%), relapse/progression of 26% (95% CI, 20% to 33%), and transplantation-related mortality (TRM) of 2% (95% CI, 0% to 5%); for retrospective studies, rates of PFS, OS, relapse/progression, TRM, and secondary malignancies were 55% (95% CI, 40% to 69%), 68% (95% CI, 56% to 78%), 36% (95% CI, 24% to 48%), 6% (95% CI, 2% to 11%), and 7% (95% CI, 2% to 14%), respectively. On the other hand, pooled analysis of retrospective studies evaluating HDT/auto-HCT in the relapsed/refractory setting showed pooled rates of PFS, OS, relapse/progression, and TRM of 36% (95% CI, 32% to 40%), 47% (95% CI, 43% to 51%), 51% (95% CI, 39% to 62%), and 10% (95% CI, 5% to 17%), respectively. Among the various histologic subtypes, PFS and OS rates appear to be higher in anaplastic large cell lymphoma, regardless of disease stage. In the absence of a multicenter, randomized controlled trial comparing HDT/auto-HCT to a nontransplantation strategy, the findings of this systematic review/meta-analysis may represent the best evidence supporting the role of HDT/auto-HCT for treatment of peripheral T cell lymphomas as front-line consolidation or in the relapsed/refractory setting.

Keywords: Autologous hematopoietic cell transplantation; High-dose therapy; Peripheral T cell lymphomas.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Autografts
Disease-Free Survival
Female
Hematopoietic Stem Cell Transplantation / methods*
Humans
Lymphoma, T-Cell, Peripheral / mortality
Lymphoma, T-Cell, Peripheral / therapy*
Male
Survival Rate