Outcomes of Allogeneic Hematopoietic Cell Transplantation in T-cell Prolymphocytic Leukemia: A Contemporary Analysis from the Center for International Blood and Marrow Transplant Research.
Publisher DOI
PubMed ID
35081472
Abstract
BACKGROUND
T-cell prolymphocytic leukemia (T-PLL) is a rare, aggressive malignancy with limited treatment options and poor long-term survival. Previous studies of allogeneic hematopoietic cell transplantation (alloHCT) for T-PLL are limited by small numbers, and descriptions of patient and transplant characteristics and outcomes after alloHCT are sparse.
OBJECTIVE
To describe outcomes of alloHCT in T-PLL and identify predictors of post-transplant relapse and survival.
STUDY DESIGN
We conducted an analysis of data using the Center for International Blood and Marrow Transplant Research (CIBMTR) database on 266 patients with T-PLL who underwent alloHCT during 2008-2018.
RESULTS
The 4-year rates of overall survival (OS), disease-free survival (DFS), relapse, and treatment-related mortality (TRM) were 30.0% (95% CI, 23.8-36.5%), 25.7% (95% CI, 20-32%), 41.9% (95% CI, 35.5-48.4%), and 32.4% (95% CI, 26.4-38.6%), respectively. In multivariable analyses, three variables were associated with inferior OS: myeloablative conditioning (MAC) (hazard ratio [HR] 2.18, p<0.0001); age older than 60 years (HR 1.61, p=0.0053); and suboptimal performance status defined by Karnofsky Performance Status (KPS) <90 (HR 1.53, p=0.0073). MAC also was associated with increased TRM (HR 3.31, p<0.0001), increased cumulative incidence of grade 2-4 acute graft-versus-host disease (GVHD) (HR 2.94, p=0.0011) and an inferior disease-free survival (HR 1.86, p=0.0004). Conditioning intensity was not associated with relapse; however stable disease/progression correlated with increased risk of relapse (HR 2.13, p=0.0072). Both in vivo T cell depletion (TCD) as part of conditioning and KPS <90 were associated with worse TRM and inferior DFS. Total Body Irradiation was not found to have any significant effect on OS, DFS or TRM.
CONCLUSION
Our data showed that reduced-intensity conditioning without in vivo T-cell depletion (that is, without ATG or alemtuzumab) prior to alloHCT was associated with long-term disease-free survival in patients with T-PLL who were 60 or younger or who had KPS >90 or had chemo-sensitive disease.
T-cell prolymphocytic leukemia (T-PLL) is a rare, aggressive malignancy with limited treatment options and poor long-term survival. Previous studies of allogeneic hematopoietic cell transplantation (alloHCT) for T-PLL are limited by small numbers, and descriptions of patient and transplant characteristics and outcomes after alloHCT are sparse.
OBJECTIVE
To describe outcomes of alloHCT in T-PLL and identify predictors of post-transplant relapse and survival.
STUDY DESIGN
We conducted an analysis of data using the Center for International Blood and Marrow Transplant Research (CIBMTR) database on 266 patients with T-PLL who underwent alloHCT during 2008-2018.
RESULTS
The 4-year rates of overall survival (OS), disease-free survival (DFS), relapse, and treatment-related mortality (TRM) were 30.0% (95% CI, 23.8-36.5%), 25.7% (95% CI, 20-32%), 41.9% (95% CI, 35.5-48.4%), and 32.4% (95% CI, 26.4-38.6%), respectively. In multivariable analyses, three variables were associated with inferior OS: myeloablative conditioning (MAC) (hazard ratio [HR] 2.18, p<0.0001); age older than 60 years (HR 1.61, p=0.0053); and suboptimal performance status defined by Karnofsky Performance Status (KPS) <90 (HR 1.53, p=0.0073). MAC also was associated with increased TRM (HR 3.31, p<0.0001), increased cumulative incidence of grade 2-4 acute graft-versus-host disease (GVHD) (HR 2.94, p=0.0011) and an inferior disease-free survival (HR 1.86, p=0.0004). Conditioning intensity was not associated with relapse; however stable disease/progression correlated with increased risk of relapse (HR 2.13, p=0.0072). Both in vivo T cell depletion (TCD) as part of conditioning and KPS <90 were associated with worse TRM and inferior DFS. Total Body Irradiation was not found to have any significant effect on OS, DFS or TRM.
CONCLUSION
Our data showed that reduced-intensity conditioning without in vivo T-cell depletion (that is, without ATG or alemtuzumab) prior to alloHCT was associated with long-term disease-free survival in patients with T-PLL who were 60 or younger or who had KPS >90 or had chemo-sensitive disease.
Date Issued
2022-04
Publication Type
Article
Subject(s)
Language(s)
en
Author(s)
Murthy, Hemant S | |
Ahn, Kwang Woo | |
Estrada-Merly, Noel | |
Alkhateeb, Hassan B | |
Bal, Susan | |
Kharfan-Dabaja, Mohamed A | |
Dholaria, Bhagirathbhai | |
Foss, Francine | |
Gowda, Lohith | |
Jagadeesh, Deepa | |
Sauter, Craig | |
Abid, Muhammad Bilal | |
Aljurf, Mahmoud | |
Awan, Farrukh T | |
Badawy, Sherif M | |
Battiwalla, Minoo | |
Bredeson, Chris | |
Cerny, Jan | |
Chhabra, Saurabh | |
Deol, Abhinav | |
Diaz, Miguel Angel | |
Farhadfar, Nosha | |
Freytes, César | |
Gajewski, James | |
Gandhi, Manish J | |
Ganguly, Siddhartha | |
Grunwald, Michael R | |
Halter, Joerg | |
Hashmi, Shahrukh | |
Hildebrandt, Gerhard C | |
Inamoto, Yoshihiro | |
Jimenez-Jimenez, Antonio Martin | |
Kalaycio, Matt | |
Kamble, Rammurti | |
Krem, Maxwell M | |
Lazarus, Hillard M | |
Lazaryan, Aleksandr | |
Maakaron, Joseph | |
Munshi, Pashna N | |
Munker, Reinhold | |
Nazha, Aziz | |
Nishihori, Taiga | |
OIuwole, Olalekan O | |
Ortí, Guillermo | |
Pan, Dorothy C | |
Patel, Sagar S | |
Pawarode, Attaphol | |
Rizzieri, David | |
Saba, Nakhle S | |
Savani, Bipin | |
Seo, Sachiko | |
Ustun, Celalettin | |
van der Poel, Marjolein | |
Verdonck, Leo F | |
Wagner, John L | |
Wirk, Baldeep | |
Oran, Betul | |
Nakamura, Ryotaro | |
Scott, Bart | |
Saber, Wael |
Additional Credits
Journal
Transplantation and cellular therapy
Publisher
Elsevier
ISSN
2666-6367
Access(Rights)
open.access