Reduced Intensity Allogeneic Hematopoietic Cell Transplantation using Fludarabine-Melphalan conditioning for Treatment of Mature T-cell Lymphomas

Among non-Hodgkin lymphoma subtypes, T-cell phenotype confers a poor clinical prognosis. For more aggressive histologies, patients frequently present with advanced disease that is inherently chemoresistant. For cutaneous histologies, disease progresses less rapidly, but is debilitating and often incurable long term. Here we report the retrospective analysis of data from 27 patients with mature T-cell lymphoma treated with salvage allo-HCT at the City of Hope using a reduced-intensity fludarabine/melphalan conditioning regimen between the years 2001 and 2008. Eleven of the twenty-seven patients had cutaneous T-cell lymphoma (CTCL). The majority of patients had advanced disease at the time of transplant (17/27 or 63%). Median followup was 36 months. We observed 2-year overall survival (OS) of 55%, progression-free survival (PFS) of 47%, and cumulative incidence of relapse/progression and non-relapse mortality (NRM) of 30% and 22%, respectively. For CTCL, patients had a 2-yr PFS of 45% and NRM of 27% compared to patients with other histologies, who had PFS of 62% and NRM of 19%. Overall, our results suggest that meaningful long term survival rates and disease control can be achieved with acceptable non-relapse mortality in patients with mature T-cell lymphomas, including CTCL using reduced intensity conditioning with melphalan and fludarabine.