180: A Successful Treatment Strategy for Patients with T-NHL: Allogeneic Transplantation after Beam-Alemtuzumab Conditioning

For patients with relapsed or refractory T-cell lymphomas the prognosis is grim and no standard treatment strategy exists. In addition, mature T/NK-cell-lymphomas are an infrequent and heterogeneous group of lymphoid tumors. Ten patients with relapsed T-cell Non-Hodgkin's lymphoma (NHL) were treated with allogeneic stem cell transplantation (SCT) after 1 to 2 cycles of CLAEG (cladribine, cytarabine, etoposide/etopophos and G-CSF) induction therapy immediately followed by conditioning with BEAM (carmustine, cytarabine, etoposid/etopophos, melphalan) combined with alemtuzumab (Campath-1H). The following subtypes were included: 5 peripheral T-cell lymphomas (not otherwise specified), 2 angioimmunoblastic, 1 ALK negative anaplastic large cell, 1 extranodal NK/nasal type and 1 enteropathy-type T-cell lymphoma. All patients had at least 2 different treatment regimens previously. After 1 to 2 cycles of induction chemotherapy with CLAEG, one patient achieved a CR, 6 patients a PR and 3 had SD. Conditioning with BEAM combined with alemtuzumab was well tolerated. Seven patients received peripheral blood stem cells (PBSC) from HLA-identical unrelated donors and 2 from matched sibling donors, 1 patient received bone marrow from an HLA one-allele mismatched unrelated donor. Engraftment was rapid and the treatment well tolerated. There were 4 cases of grade 4 mucositis, 2 cases of sepsis in neutropenia, and 1 case of grade IV liver toxicity. Prophylaxis for graft-versus-host disease (GvHD) consisted of cyclosporine A and MTX or mycophenolate mofetil. No grade III or IV acute GvHD was seen and only 3 patients presented with grade II GvHD. Two patients experienced limited chronic GvHD. Asymptomatic CMV reactivation was found in 4 cases and all were treated successfully. Late infections occurred in four patients, including CMV infection, viral enteritis, aspergillus pneumonia and streptococcal sepsis. All patients achieved a CR after allogeneic transplantation. Currently, 3 patients have relapsed. One patient died in CR on day 233 post transplantation due to aspiration pneumonia caused by non-malignant bowel stenosis. All other patients remained in CR for up to 26+ months. This treatment approach with CLAEG induction followed by conditioning with BEAM combined with alemtuzumab shows a surprisingly good outcome in a group of T-cell NHL patients with a very poor prognosis. Allogeneic SCT with this strategy seems to be a promising therapeutic option for these patients.