Hemant S Murthy, Kwang Woo Ahn, Noel Estrada-Merly, Hassan B Alkhateeb, Susan Bal, Mohamed A Kharfan-Dabaja, Bhagirathbhai Dholaria, Francine Foss, Lohith Gowda, Deepa Jagadeesh, Craig Sauter, Muhammad Bilal Abid, Mahmoud Aljurf, Farrukh T Awan, Ulrike Bacher, Sherif M Badawy, Minoo Battiwalla, Chris Bredeson, Jan Cerny, Saurabh Chhabra, Abhinav Deol, Miguel Angel Diaz, Nosha Farhadfar, César Freytes, James Gajewski, Manish J Gandhi, Siddhartha Ganguly, Michael R Grunwald, Joerg Halter, Shahrukh Hashmi, Gerhard C Hildebrandt, Yoshihiro Inamoto, Antonio Martin Jimenez-Jimenez, Matt Kalaycio, Rammurti Kamble, Maxwell M Krem, Hillard M Lazarus, Aleksandr Lazaryan, Joseph Maakaron, Pashna N Munshi, Reinhold Munker, Aziz Nazha, Taiga Nishihori, Olalekan O Oluwole, Guillermo Ortí, Dorothy C Pan, Sagar S Patel, Attaphol Pawarode, David Rizzieri, Nakhle S Saba, Bipin Savani, Sachiko Seo, Celalettin Ustun, Marjolein van der Poel, Leo F Verdonck, John L Wagner, Baldeep Wirk, Betul Oran, Ryotaro Nakamura, Bart Scott, Wael Saber
Transplantation and cellular therapy 28(4) 187.e1-187.e10 2022年4月
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.