1. ¹Divisione di Ematologia, Istituto Nazionale per lo Studio e la Cura dei Tumori, Università di Milano, Milano, Italy
2. ²Divisione di Ematologia, Università di Torino, Torino, Italy
3. ³Ufficio Operativo, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano, Italy
4. ⁴Divisione di Oncologia Medica 3, Istituto Nazionale per lo Studio e la Cura dei Tumori, Università di Milano, Milano, Italy
5. ⁵Divisione di Ematologia, Ospedali Riuniti, Bergamo, Italy

Correspondence: Professor P Corradini, Department of Hematology, Istituto Nazionale per lo Studio e la Cura dei Tumori, University of Milano, Via Venezian 1, Milano, Torino 20133, Italy. E-mail: paolo.corradini@istitutotumori.mi.it

Received 2 February 2006; Revised 23 April 2006; Accepted 31 May 2006; Published online 27 July 2006.

Abstract

We report the results of two prospective phase II studies investigating the role of high-dose sequential chemotherapy, followed by autologous stem cell transplantation (ASCT) in 62 patients with advanced stage peripheral T-cell lymphomas (PTCLs) at diagnosis. Conditioning regimen consisted of mitoxantrone (60 mg/m²) and melphalan (180 mg/m²) or carmustine, etoposide, Ara-C and melphalan followed by peripheral blood stem cell autografting. In an intent-to-treat analysis, 46 out of 62 patients (74%) completed the whole programme, whereas 16 patients did not undergo ASCT, mainly because of disease progression. At a median follow-up of 76 months, the estimated 12-year overall (OS), disease-free and event-free survival (EFS) were 34, 55 and 30%, respectively. OS and EFS were significantly better in patients with anaplastic lymphoma-kinase (ALK)-positive anaplastic large-cell lymphoma (ALCL), as compared with the remaining PTCL. Multivariate analysis showed that patients attaining complete remission (CR) before ASCT had a statistically significant benefit in terms of OS and EFS (P<0.0001). Overall treatment-related mortality rate was 4.8%. In conclusion, our findings indicate (1) up-front high-dose therapy and ASCT are feasible, but could induce a high rate of long-term CR only in patients with ALK-positive ALCL and (2) the achievement of CR before autografting is a strong predictor of better survival.