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Kuittinen T, Wiklund T, Remes K, Elonen E, Lehtinen T, Kuittinen O, Leppä S, Putkonen M, Räty R, Turpeenniemi-Hujanen T, Nousiainen T, Jantunen E. Outcome of progressive disease after autologous stem cell transplantation in patients with non-Hodgkin's lymphoma: a nation-wide survey. Eur J Haematol 2005: 75: 199–205. © Blackwell Munksgaard 2005. Objectives: To analyse outcome and prognostic factors in non-Hodgkin's lymphoma (NHL) patients who progress after autologous stem cell transplantation (ASCT). Patients: Altogether 115 consecutive NHL patients transplanted in 1991–2000 were studied. Histology included diffuse large B cell ( n = 52), follicular ( n = 26), mantle cell ( n = 15), T cell ( n = 16) and other subtypes ( n = 6). The median time from ASCT to the progression was 7 months. Ninety-six patients (83%) received salvage treatment. Results: Twenty-four patients (25%) achieved complete remission and 30 (31%) partial remission. The median overall survival was 8 months (range 0–98+) and the projected 4-year survival 21%. In multivariate analysis factors predicting treatment response after the progression included the use of rituximab ( P = 0.036), histology other than diffuse large B cell ( P = 0.001) and International Prognostic Index ≤2 at progression ( P < 0.001). Normal lactate dehydrogenase (LDH) at progression ( P = 0.002), response to salvage treatment ( P < 0.001) and time from ASCT to progression ≥7 months ( P = 0.022) were predictors for overall survival. Conclusions: Although the prognosis of patients who progress after ASCT is generally poor, many patients will respond to current therapies, and some may experience prolonged survival. Normal LDH at time of disease progression and longer time to progression after ASCT were the most powerful predictors for a promising outcome. [ABSTRACT FROM AUTHOR]

Summary:Limited experience is available on the feasibility and efficacy of high-dose therapy (HDT) supported by autologous stem cell transplantation (ASCT) in patients with peripheral T-cell lymphoma (PTCL). Therefore, a nation-wide survey was conducted in adult patients transplanted for PTCL in Finland during 1990-2001. After histopathology review, 37 patients were identified. The median age was 46 years (16-68) at the time of ASCT. Histology included PTCL not otherwise specified in 14 patients, anaplastic large cell lymphoma (ALCL) in 14 patients, and other in nine patients. Disease status at the time of ASCT was CR/PR1 in 18 patients; CR/PR2 in 14 patients, and other in five patients. HDT consisted of either BEAC (N=22) or BEAM (N=15), supported by blood stem cells in 34 patients (92%). Early transplant-related mortality was 11%. With a median follow-up of 24 months from HDT, 16 patients (43%) have relapsed or progressed. The estimated 5-year overall survival (OS) was 54%. Patients with ALCL had superior OS when compared with other subtypes (85 vs 35%, P=0.007). OS at 5 years was 63% in patients transplanted in CR/PR1 vs 45% in those transplanted in other disease status (P=NS). Prospective studies are needed to define the role of ASCT in this lymphoma type.Bone Marrow Transplantation (2004) 33, 405-410. doi:10.1038/sj.bmt.1704367 Published online 15 December 2003 [ABSTRACT FROM AUTHOR]

Discusses the treatment of enteropathy-associated T-cell lymphoma. Efficacy of high-dose therapy supported by autologous stem cell transplantation; Median time to reach ideal neutrophil and platelet cell counts; Treatment complications; Incidence of disease relapse or progression.