Based! on! this! study,! allo>SCT! could! not! be! recommended! as! a! standard! therapy! for! PTCL!
patients!in!first!response.!
Though! allo>SCT! is! a! good! option! for! patients! in! the! relapse! or! refractory! setting.! As!
mentioned! before,! data! from! retrospective! and! prospective! studies! showed! an! excellent!
long!term!disease!control.!
One!of!the!major!issues!when!considering!alloSCT!for!PTCL!patients,!whose!median!age!at!
diagnosis!is!50!years!or!more,!is!the!toxicities!of!such!procedure.!The!TRM!varied!between!
studies! and! ranging! from! 8%! for! reduced! intensity! regimen! (RIC)! to! as! high! as! 30! to! 35! %!
with!myeloablative!regimen!(MAC).!Furthermore,!the!use!of!RIC!was!associated!with!more!
relapses.!Though,!the!choice!between!RIC!and!MAC!conditioning!regimen!is!to!be!tailored,!in!
the! absence! of! prospective! and! controlled! studies,! according! to! the! disease! status! before!
allo>SCT!and!patients’!characteristics.!
!
Another!major!issue,!when!allo>SCT!is!considered!in!the!management!of!PTCL!patients,!is!the!
disease!status!before!allo>transplant.!Patients!who!are!transplanted!in!CR!or!PR!have!better!
outcome! than! patients! who! have! progressive! disease! before! allo>SCT.! The! outcome! of!
patient!with!second!CR!or!PR!does!not!seem!different!from!that!of!patients!in!CR1!or!PR1.!
However!the!toxicity!is!slightly!higher!in!the!relapse!setting!than!in!front!line!according!to!
some!studies!(Mamez!et!al,!2020)!
Being!in!PR!before!transplant!seems!do!not!influence!the!outcome!in!the!majority!of!studies.!
Som!However,!some!studies!reported!better!outcome!for!patient!in!CR!over!PR.!
The!dogma!to!not!transplant!patients!with!progressive!or!refractory!disease!at!the!time!of!
allo>SCT!have!been!challenged!in!PTCL.!The!long!term!OS!for!patients!who!are!transplanted!
in!progressive!disease!is!quite!good!between!30%!and!35%!(Le!Gouill!et!al,!2008;!Mamez!et!
al! 2020)! in! the! context! of! the! disease! with! an! estimated! median! OS! for! patients! in! this!
category!of!less!than!6!months.!
In! conclusion,! allo>SCT! remains! a! curative! option! for! patients! with! PTCL.! It! should! be!
considered!rapidly!in!the!course!of!the!disease.!Patients!who!obtained!less!than!CR!prior!to!
allogeneic! transplant! should! not! be! excluded! from! the! procedure,! in! the! absence! of! new!
efficacious!drugs.!
!!!
!