Outcome of Stem Cell Transplantation in HTLV-1-Associated North American Adult T-Cell Leukemia/Lymphoma.
- Bazarbachi, Abdul-Hamid;
- Reef, Daniel;
- Narvel, Hiba;
- Patel, Riya;
- Al Hamed, Rama;
- Vikash, Sindhu;
- Neupane, Karun;
- Atalla, Eleftheria;
- Thakkar, Astha;
- Rahman, Shafia;
- Shah, Urvi;
- Adrianzen-Herrera, Diego;
- Quinn, Ryann;
- Zareef, Sumaira;
- Rabinovich, Emma;
- De Castro, Alyssa;
- Joseph, Felisha;
- Gillick, Kailyn;
- Mustafa, Jennat;
- Khatun, Fariha;
- Lombardo, Amanda;
- Townsend-Nugent, Latoya;
- Abreu, Michelly;
- Chambers, Nicole;
- Elkind, Richard;
- Shi, Yang;
- Wang, Yanhua;
- Derman, Olga;
- Gritsman, Kira;
- Steidl, Ulrich;
- Goldfinger, Mendel;
- Kornblum, Noah;
- Shastri, Aditi;
- Mantzaris, Ioannis;
- Bachier-Rodriguez, Liza;
- Shah, Nishi;
- Cooper, Dennis;
- Verma, Amit;
- Ye, Bihui Hilda;
- Janakiram, Murali;
- Sica, Roberto Alejandro
- et al.
Published Web Location
https://doi.org/10.1007/s44228-023-00032-yAbstract
Adult T-cell leukemia/lymphoma (ATLL) remains challenging to treat and has dismal outcome. Allogeneic stem-cell transplantation (allo-SCT) has promising results, but data remain scarce. In this single-center retrospective analysis of 100 patients with ATLL from north America (67 acute, 22 lymphomatous), 17 underwent allo-SCT and 5 autologous SCT (ASCT), with a median follow-up of 65 months. Post-transplant 3-years relapse incidence (RI) and non-relapse mortality (NRM) were 51% and 37%, respectively, and 3-year progression-free survival (PFS) and overall survival (OS) were 31% and 35%, respectively. ASCT 1-year RI was 80% compared to 30% in allo-SCT (p = 0.03). After adjusting for immortal-time bias, allo-SCT had significantly improved OS (HR = 0.4, p = 0.01). In exploratory multivariate analysis, patients achieving first complete response and Karnofsky score ≥ 90 had significantly better outcomes, as did Black patients, compared to Hispanics, who had worse outcome. In transplanted patients, 14 died within 2 years, 4 of which ASCT recipients. Our data are the largest ATLL transplant cohort presented to date outside of Japan and Europe. We show that allo-SCT, but not ASCT, is a valid option in select ATLL patients, and can induce long term survival, with 40% of patients alive after more than 5 years.
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