Stem cell transplantation as a biological therapy for peripheral T-cell lymphomas

Optimal disease surveillance strategies in non-Hodgkin lymphoma

Given the paucity of randomized controlled trial data, defining the ideal strategy for surveillance imaging in patients with non-Hodgkin lymphoma (NHL) has become increasingly challenging. The routine use of frequent surveillance scans has been a common component of patient care. Emerging data from prospective and retrospective observational studies and modeling approaches have highlighted the performance characteristics of imaging modalities and the challenges with this form of secondary screening. The majority of patients with relapsed lymphoma have clinical signs or symptoms that prompt further evaluation, and only a small proportion of patients experience relapse detected on a routine scan while being otherwise asymptomatic. Surveillance imaging is costly, may expose patients to minimal risks of mortality due to radiation-related secondary malignancies, and can lead to false-positive findings, leading to unnecessary biopsies. In addition, no prospective study has demonstrated a significant improvement in overall survival for those patients whose disease is discovered on a routine scan versus those who present with clinical symptoms. In this chapter, we examine the baseline risks of relapse for various NHL subtypes that provide the context for surveillance, review the data on imaging modalities, and establish a framework for discussing optimal surveillance strategies with individual patients. Patients should be counseled on the risks and benefits of routine surveillance imaging and decisions regarding surveillance should be made on an individual basis using patient-specific risk factors, response to induction therapy, and patient preferences with a bias toward using surveillance imaging in the 2 years after treatment only in those NHL patients with the greatest likelihood of benefit.

Allogeneic stem-cell transplantation for peripheral T-cell lymphoma: a systemic review and meta-analysis

Peripheral T-cell lymphoma (PTCL) comprises a heterogeneous group of mature T-cell tumors with a poor prognosis; allogeneic stem cell transplantation (allo-SCT) may offer a potential way of cure for these patients though the optimal type and timing of transplantation remain to be defined. We performed a systemic review and meta-analysis examining the efficacy and safety of allo-SCT for PTCL. The pooled 3-year overall survival (OS) of PTCL patients treated with allo-SCT was 49.6% (95% confidence interval, CI: 41.7-57.5%). A meta-analysis of 3-year OS in allo-SCT and autologous SCT (auto-SCT) showed no statistical difference. The rates of pooled acute graft-versus-host disease (GVHD; grade 2/4) and chronic GVHD were 26.7% (95% CI: 21.4-32.9%) and 29.9% (95% CI: 24.3-36.1%), respectively. The pooled 100-day treatment-related mortality was 24.2% (95% CI: 17.2-33.0%). Of the total study patients (n = 299), 48.5% were reported dead after allo-hematopoietic SCT, with disease progression as the first cause of death in PTCL patients. Although most studies included were retrospective and their sample size was small, existing data suggested that the group of PTCL patients receiving allo-SCT was to a great degree homogeneous regarding OS, mortality without relapse, death rate and the incidence of GVHD. The most common cause of death was disease progression. The present data did not show a difference in OS between allo- and auto-SCT in PTCL patients, but large prospective studies are needed to provide a more comprehensive understanding of the role of allo-SCT in the treatment of PTCL patients.