| Authors: |
Murthy, H. S.; Ahn, K. W.; Estrada-Merly, N.; Alkhateeb, H. B.; Bal, S.; Kharfan-Dabaja, M. A.; Dholaria, B.; Foss, F.; Gowda, L.; Jagadeesh, D.; Sauter, C.; Abid, M. B.; Aljurf, M.; Awan, F. T.; Bacher, U.; Badawy, S. M.; Battiwalla, M.; Bredeson, C.; Cerny, J.; Chhabra, S.; Deol, A.; Diaz, M. A.; Farhadfar, N.; Freytes, C.; Gajewski, J.; Gandhi, M. J.; Ganguly, S.; Grunwald, M. R.; Halter, J.; Hashmi, S.; Hildebrandt, G. C.; Inamoto, Y.; Jimenez-Jimenez, A. M.; Kalaycio, M.; Kamble, R.; Krem, M. M.; Lazarus, H. M.; Lazaryan, A.; Maakaron, J.; Munshi, P. N.; Munker, R.; Nazha, A.; Nishihori, T.; Oluwole, O. O.; Ortí, G.; Pan, D. C.; Patel, S. S.; Pawarode, A.; Rizzieri, D.; Saba, N. S.; Savani, B.; Seo, S.; Ustun, C.; van der Poel, M.; Verdonck, L. F.; Wagner, J. L.; Wirk, B.; Oran, B.; Nakamura, R.; Scott, B.; Saber, W. |
| Abstract: |
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 transplantation characteristics and outcomes after alloHCT are sparse. In this study, we evaluated outcomes of alloHCT in patients with T-PLL and attempted to identify predictors of post-transplantation relapse and survival. We conducted an analysis of data using the Center for International Blood and Marrow Transplant Research database on 266 patients with T-PLL who underwent alloHCT between 2008 and 2018. The 4-year rates of overall survival (OS), disease-free survival (DFS), relapse, and treatment-related mortality (TRM) were 30.0% (95% confidence interval [CI], 23.8% to 36.5%), 25.7% (95% CI, 20% to 32%), 41.9% (95% CI, 35.5% to 48.4%), and 32.4% (95% CI, 26.4% to 38.6%), respectively. In multivariable analyses, 3 variables were associated with inferior OS: receipt of a myeloablative conditioning (MAC) regimen (hazard ratio [HR], 2.18; P < .0001), age >60 years (HR, 1.61; P = .0053), and suboptimal performance status, defined by Karnofsky Performance Status (KPS) <90 (HR, 1.53; P = .0073). Receipt of an MAC regimen also was associated with increased TRM (HR, 3.31; P < .0001), an elevated cumulative incidence of grade II-IV acute graft-versus-host disease (HR, 2.94; P = .0011), and inferior DFS (HR, 1.86; P = .0004). Conditioning intensity was not associated with relapse; however, stable disease/progression was correlated with increased risk of relapse (HR, 2.13; P = .0072). Both in vivo T cell depletion (TCD) as part of conditioning and KPS <90 were associated with worse TRM and inferior DFS. Receipt of total body irradiation had no significant effect on OS, DFS, or TRM. Our data show that reduced-intensity conditioning without in vivo TCD (ie, without antithymocyte globulin or alemtuzumab) before alloHCT was associated with long-term DFS in patients with T-PLL who were age ≤60 years or who had a KPS >90 or chemosensitive disease. © 2022 The American Society for Transplantation and Cellular Therapy |
