Outcomes of Allogeneic Hematopoietic Cell Transplantation in T Cell Prolymphocytic Leukemia: A Contemporary Analysis from the Center for International Blood and Marrow Transplant Research
Hemant S. Murthy, Kwang Woo Ahn, Noel Estrada‐Merly, Hassan B. Alkhateeb, Susan Bal, Mohamed A. Kharfan‐Dabaja, Bhagirathbhai Dholaria, Francine M. Foss, Lohith Gowda, Deepa Jagadeesh, Craig S. Sauter, Muhammad Bilal Abid, Mahmoud Aljurf, Farrukh T. Awan, Ulrike Bacher, Sherif M. Badawy, Minoo Battiwalla, Christopher Bredeson, Jan Černý, Saurabh Chhabra, Abhinav Deol, Miguel Ángel Díaz, Nosha Farhadfar, César O. Freytes, James Gajewski, Manish J. Gandhi, Siddhartha Ganguly, Michael R. Grunwald, Joerg Halter, Shahrukh K. Hashmi, Gerhard Hildebrandt, Yoshihiro Inamoto, Antonio Jiménez, Matt Kalaycio, Rammurti T. 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 A. Rizzieri, Nakhle S. Saba, Bipin N. Savani, Sachiko Seo, Celalettin Üstün, Marjolein van der Poel, Leo F. Verdonck, John L. Wagner, Baldeep Wirk, Betül Oran, Ryotaro Nakamura, Bart L. Scott, Wael Saber
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.