Allogeneic hematopoietic stem cell transplantation (allo-HSCT) may be a curative option for some patients with relapsed / refractory T-cell lymphoma (TCL), according to results of a retrospective study presented at the virtual 62nd American Society of Hematology (ASH) Annual Meeting and Exposition .
Results from previous registry studies suggest that only about one third of patients with recurrent TCA are disease-free 3 years after allo-HSCT, including a previous study by the same group of investigators, which found that 2-year PFS and OS were 48.9%, respectively. and 61.7%.
The group conducted the current study “to better understand the dynamics of allogeneic transplantation in T-cell lymphoma and with longer follow-up,” Neha Mehta-Shah, MD, of Washington University School of Medicine in St. Louis, Missouri, and presenter of the study, said.
The retrospective study included 508 consecutive patients with TCL who underwent allo-HSCT between 2000 and 2019 in 12 academic settings. The median age of the patients in the cohort was 51 years and at the time of transplantation was 54.4% in complete remission (CR), 37.2% in partial remission (PR), 5% had stable disease and 3.2% % had progressive disease. There were 15.5% of patients who had previously undergone an autologous transplant. The pre-transplant conditioning regimens were myeloablative in 35.4%, reduced intensity / non-myeloablative in 63.6%, and unknown in less than 1% of patients.
After allo-HSCT, the rates of progression-free survival (PFS) at 2 and 5 years were 45.8% and 39.4%, respectively.
The time from relapse to death after allo-HSCT averaged 10.2 months. The 2- and 5-year overall survival (OS) was 59.1% and 50.8%, respectively. Of the 261 deaths recorded, 31% were transplant-related, 26.4% were due to progressive disease, and 42.5% were non-relapse-related and / or unknown.
PFS was comparable in patients with the angioimmunoblastic, not otherwise specified, and ALK positive or negative anaplastic large cell subtypes. Although PFS outcomes were worse for patients with cutaneous TCL (P. = .0008), the OS results were not significantly different from other TCA subtypes (44% for cutaneous TCA versus 53.1% for others; P. = .4573).
CR at the time of transplantation was associated with longer median PFS and OS, with progressive disease associated with the shortest PFS and OS.
Dr. Mehta-Shah concluded that “in the largest series of allogeneic transplants to date, allogeneic transplantation for patients with TCA can lead to durable remissions in patients with otherwise poor outcomes.”
Disclosures: Some presenters disclosed financial relationships with the pharmaceutical and / or medical device industries. Refer to the summary of the presentation for a full list of explanations.
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Mehta-Shah N, Kommalapati A, Teja S, et al. Successful treatment of adult T cell lymphoma with allogeneic stem cell transplantation: the largest multicentre retrospective analysis. Presented at: 62nd American Society of Hematology (ASH) Annual Meeting and Exposition; virtual; December 5-9, 2020. Summary 41.