Cancer Res Treat.  2017 Jan;49(1):92-103. 10.4143/crt.2015.476.

Comparison of Total Body Irradiation (TBI) Conditioning with Non-TBI for Autologous Stem Cell Transplantation in Newly Diagnosed or Relapsed Mature T- and NK-Cell Non-Hodgkin Lymphoma

• Maeng CH
• Ko YH
• Lim DH
• Kang ES
• Choi JY
• Kim WS
• Kim SJ

• KMID: 2367507
• DOI: http://doi.org/10.4143/crt.2015.476

Abstract

PURPOSE
This retrospective study was conducted for comparison of survival outcomes and toxicities of autologous stem cell transplantation (ASCT) based on the use of total body irradiation (TBI) as a part of the conditioning regimen in patients with mature T- and natural killer (NK)-cell lymphomas.
MATERIALS AND METHODS
Patients who underwent ASCT in the upfront or salvage setting between January 2000 and December 2013 were analyzed. Patients were dichotomized according to the TBI group (n=38) and non-TBI group (n=60) based on the type of conditioning regimen for ASCT.
RESULTS
Patients with responsive disease underwent upfront ASCT (TBI, n=16; non-TBI, n=29) whereas patients with refractory disease (TBI, n=9; non-TBI, n=12) or relapsed disease (TBI, n=13; non-TBI, n=19) underwent ASCT after salvage treatment. Hematologic and non-hematologic toxicities were manageable, and the median cumulative toxicity score according to Seattle criteria was estimated as 2 (range, 0 to 7) in both groups. No significant difference in 100-day mortality was observed between the TBI (13%, 5/38) and non-TBI (12%, 12/60) groups, and most deaths were related to disease progression. There was no difference in overall and progression-free survival; however, the TBI group showed a trend of better survival in upfront and salvage ASCT than the non-TBI group. However, patients with refractory disease showed the worst outcome regardless of the use of TBI. Patients who showed complete response before ASCT showed better progression-free survival than thosewho showed partial response.
CONCLUSION
TBI could be used as an effective part of conditioning for ASCT in patients with mature T- and NK-cell lymphomas.

Keyword

T-lymphocytes; Nutural killer cells; Lymphoma; Stem cell transplantation; Whole-body irradiation

MeSH Terms

Disease Progression
Disease-Free Survival
Humans
Lymphoma
Lymphoma, Non-Hodgkin*
Mortality
Retrospective Studies
Salvage Therapy
Stem Cell Transplantation*
Stem Cells*
T-Lymphocytes
Whole-Body Irradiation*

Figure

• 

  Fig. 1. Classification of patients according to response to induction treatment and time of autologous stem cell transplantation. CR, complete response; PR, partial response; PD, progressive disease; TBI, total body irradiation; ASCT, autologous stem cell transplantation; PTCL, peripheral T-cell lymphoma; AITL, angioimmunoblastic T-cell lymphoma; ALCL, anaplastic large cell lymphoma; ENKTL, extranodal natural killer/T-cell lymphoma.

• 

  Fig. 2. (A, B) Comparison of overall and progression-free survival according to the use of total body irradiation (TBI). (C, D) Comparison of progression-free survival between TBI and non-TBI group in upfront and salvage autologous stem cell transplantation. (E, F) Comparison of progression-free survival between TBI and non-TBI group in T-cell lymphomas and extranodal natural killer (NK)/T-cell lymphoma.

• 

  Fig. 3. (A, B) Comparison of progression-free survival between patients with pre-transplantation complete response (CR) and partial response (PR) in the total body irradiation (TBI) and non-TBI group. (C, D) Association of pre-transplantation CR assessed by positron emission tomography (PET) computed tomography and progression-free survival in the TBI and non-TBI group. (E, F) Comparison of progression-free survival according to the response to induction treatment in the TBI and non-TBI group.

• 

  Fig. 4. (A-C) Comparison of progression-free survival of patients with responsive, refractory, and relapsed disease between the total body irradiation (TBI) and non-TBI groups. (D, E) The TBI group showed a trend of better progression-free survival than the non-TBI group in extranodal natural killer (NK)/T-cell lymphoma with responsive disease and T-cell lymphoma with relapsed disease. (F) No difference in progression-free survival of refractory disease was observed in patients with extranodal NK/T-cell lymphoma.

Reference

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