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Graft-versus-T-cell lymphoma effect: a sustained CR after tapering immunosuppressive drugs in a patient with angioimmunoblastic T-cell lymphoma in relapse after allogeneic transplantation

Bone Marrow Transplantation volume 50, pages 304–306 (2015)Cite this article

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Peripheral T-cell lymphomas form a heterogeneous group of poor-prognosis hematological malignancies representing 10–15% of all lymphomas. Angioimmunoblastic T-cell lymphoma (AITL) is a subtype defined by follicular helper T-cell proliferation. AITL carries a particularly poor prognosis. Chemotherapy-based treatment (usually a CHOP-like regimen) yields a response rate of ~60%, but long-term disease-free survival (DFS) only reaches ~20%. Kyriakou et al.1 reported a series of 146 AITL patients treated with autologous hematopoietic SCT (HSCT): the OS rate at 4 years was 59% but the 2-year cumulative incidence of relapse was 40%. Indirect evidence points to a graft-versus-lymphoma (GVL) effect after allo-HSCT for peripheral T-cell lymphoma (PTCL; summarized in Table 1). Most chemoresistant patients relapse after auto-SCT, whereas allo-SCT can provide long-term DFS in a substantial number of cases. In a recent large study,2 13 patients with stable disease, progressive disease (PD) or refractory disease before allo-transplantation had a CR after allo-HSCT with myeloablative conditioning, with a median 5-year OS of 29%. Similar results were obtained after reduced-intensity conditioning allo-SCT in 17 patients who were allografted for relapsed or refractory PTCL.3 Another argument in favor of a GVL effect is the poor efficacy of T-depleted transplantation: Duarte et al.4 reported 2-year PFS rates of 17% after ex vivo T-cell-depleted allo-HSCT and 39% after T-cell-repleted allo-HSCT.

Table 1 Allogeneic transplantation for T-cell lymphoma: results of recent studies
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Interestingly, the occurrence of GVHD was also associated with a better outcome.5, 6

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Acknowledgements

Written informed consent (copy available on demand) was obtained from the patient for publication of this case report and accompanying images.

Author Contributions

A-CM collected the data and wrote the manuscript. LS, DR-W, MU, CA and VL were responsible for patient care. ALB performed and analyzed the radiological tests. SN was responsible for data collection, review and manuscript preparation. All the authors read and approved the final manuscript.

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  1. Service d’Hématologie, Hôpital Pitié Salpêtrière, Paris, France

    A C Mamez, L Souchet, D Roos-Weil, M Uzunov, C Algrin, V Leblond & S Nguyen

  2. Service de Radiologie, Hôpital Pitié Salpêtrière, Paris, France

    A L Brun

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Mamez, A., Souchet, L., Roos-Weil, D. et al. Graft-versus-T-cell lymphoma effect: a sustained CR after tapering immunosuppressive drugs in a patient with angioimmunoblastic T-cell lymphoma in relapse after allogeneic transplantation. Bone Marrow Transplant 50, 304–306 (2015). https://doi.org/10.1038/bmt.2014.243

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