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DexaBEAM versus ICE salvage regimen prior to autologous transplantation for relapsed or refractory aggressive peripheral T cell lymphoma: a retrospective evaluation of parallel patient cohorts of one center

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Abstract

High-dose chemotherapy (HDT) followed by autologous stem cell transplantation (ASCT) is considered standard in the treatment of patients with relapsed or refractory aggressive peripheral T cell lymphoma (PTCL). However, the optimal salvage regimen before ASCT has not yet been established. We retrospectively analyzed 31 patients with relapsed or refractory aggressive PTCL after anthracycline-based first-line chemotherapy who received either DexaBEAM (dexamethasone, carmustine, etoposide, cytarabine, and melphalan; n = 16) or ICE (ifosfamide, carboplatin, and etoposide; n = 15) regimen as first salvage chemotherapy followed by HDT/ASCT. The overall response rate (OR) was significantly higher for patients treated with DexaBEAM (69 %; 95 % confidence interval 46.0–91.5 %) as compared to the ICE group (20 %; 95 % confidence interval −0.2–40.2 %; P = 0.01), with higher complete response (CR; 38 %; 95 % confidence interval 13.8–61.2 %; vs. 7 %; 95 % confidence interval −6.0–19.6 %) as well as partial response (PR; 31 vs. 13 %) rate. Changing regimen due to failure of first salvage therapy, 12 patients initially receiving ICE still achieved an OR of 58 % (33 % CR, 25 % PR) with DexaBEAM as second salvage therapy, whereas in three patients receiving ICE after DexaBEAM failure, only one achieved an OR (1 PR). Median progression-free survival was significantly higher in the DexaBEAM group (6.4 vs. 2 months; P = 0.01). Major adverse event in both groups was myelosuppression with higher but tolerable treatment-related toxicity for patients in the DexaBEAM group. For all patients proceeding to HDT/ASCT, a 3-year overall survival was 50 %. Together, considering the limitations of the retrospective design of the evaluation and the small sample size, our data suggest that DexaBEAM salvage chemotherapy is superior to ICE for patients with relapsed or refractory aggressive PTCL for remission induction prior to autologous transplantation, with higher but manageable treatment-related toxicity.

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The authors have declared no potential conflicts of interest.

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Authors and Affiliations

  1. Department of Medicine, Hematology and Oncology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany

    Jan-Henrik Mikesch, Mareike Kuhlmann, Angela Demant, Utz Krug, Gabriela B. Thoennissen, Eva Schmidt, Torsten Kessler, Christoph Schliemann, Michele Pohlen, Michael Mohr, Georg Evers, Rolf Mesters, Carsten Müller-Tidow, Wolfgang E. Berdel & Nils H. Thoennissen

  2. Department of Pathology, University Hospital of Muenster, Muenster, Germany

    Gabriele Köhler

  3. Department of Radiology, University Hospital of Muenster, Muenster, Germany

    Johannes Wessling

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Correspondence to Nils H. Thoennissen.

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J.H.M. and M.K. contributed equally to the manuscript and share the first authorship. N.H.T. and W.E.B. contributed equally to the manuscript and share senior authorship.

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Mikesch, JH., Kuhlmann, M., Demant, A. et al. DexaBEAM versus ICE salvage regimen prior to autologous transplantation for relapsed or refractory aggressive peripheral T cell lymphoma: a retrospective evaluation of parallel patient cohorts of one center. Ann Hematol 92, 1041–1048 (2013). https://doi.org/10.1007/s00277-013-1738-9

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