Effect of immune modulation in relapsed peripheral T-cell lymphomas after post-allogeneic stem cell transplantation: a study by the Société Française de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC).
Fiche publication
Date publication
mars 2016
Journal
Bone marrow transplantation
Auteurs
Membres identifiés du Cancéropôle Est :
Pr FORNECKER Luc-Matthieu
Tous les auteurs :
Mamez AC, Lévy V, Chevallier P, Blaise D, Vigouroux S, Xhaard A, Fegueux N, Contentin N, Beguin Y, Ifrah N, Bulabois CE, Suarez F, Yakoub-Agha I, Turlure P, Deconink E, Lamy T, Cahn JY, Huynh A, Maury S, Fornecker LM, Ouzegdouh M, Bay JO, Guillerm G, Maillard N, Michallet M, Malfuson JV, Bourhis JH, Rialland F, Oumedaly R, Jubert C, Leblond V, Boubaya M, Mohty M, Nguyen S
Lien Pubmed
Résumé
Peripheral T-cell lymphoma carries a poor prognosis. To document a possible graft-versus-lymphoma effect in this setting, we evaluated the impact of immunomodulation in 63 patients with peripheral T-cell lymphoma who relapsed after allogeneic transplant in 27 SFGM-TC centers. Relapse occurred after a median of 2.8 months. Patients were then treated with non-immunologic strategies (chemotherapy, radiotherapy) and/or immune modulation (donor lymphocyte infusions (DLI) and/or discontinuation of immunosuppressive therapy). Median overall survival (OS) after relapse was 6.1 months (DLI group: 23.6 months, non-DLI group: 3.6 months). Among the 14 patients who received DLI, 9 responded and 2 had stable disease. Among the remaining 49 patients, a complete response accompanied by extensive chronic GvHD was achieved in two patients after tapering of immunosuppressive drugs. Thirty patients received radio-chemotherapy, with an overall response rate of 50%. In multivariate analysis, chronic GvHD (odds ratio: 11.25 (2.68-48.21), P=0.0009) and skin relapse (odds ratio: 4.15 (1.04-16.50), P=0.043) were associated with a better response to treatment at relapse. In a time-dependent analysis, the only factor predictive of OS was the time from transplantation to relapse (hazards ratio: 0.33 (0.17-0.640), P=0.0009). This large series provides encouraging evidence of a true GvL effect in this disease.
Mots clés
Adult, Allografts, Chemoradiotherapy, Disease-Free Survival, Follow-Up Studies, Hematopoietic Stem Cell Transplantation, Humans, Immunosuppressive Agents, administration & dosage, Lymphocyte Transfusion, Lymphoma, T-Cell, Peripheral, mortality, Middle Aged, Retrospective Studies, Survival Rate
Référence
Bone Marrow Transplant.. 2016 Mar;51(3):358-64