In a large retrospective analysis of allogeneic transplant for relapsed or refractory peripheral T-cell lymphoma (PTCL), more than half the patients studied were alive at 5 years, investigators reported at the 2020 American Society of Hematology (ASH) Annual Meeting & Exposition.1
“In the largest series to date, allogeneic transplant for patients with PTCL led to durable remissions in patients who would otherwise have had poor outcomes,” said Neha Mehta-Shah, MD, of Washington University School of Medicine, St. Louis.
Neha Mehta-Shah, MD
As Dr. Mehta-Shah noted, aside from anaplastic large cell lymphomas, PTCL tends to have a poor prognosis. Three years ago, she and her colleagues reported encouraging outcomes after allogeneic hematopoietic stem cell transplant (allo-HSCT) in relapsed or refractory PTCL: an overall survival rate of 61.7% and progression-free survival rate of 48.9% at 2 years.2
“To better understand the dynamics of allogeneic transplant in T-cell lymphoma and with longer follow-up,” she said, they followed the earlier study with a multicenter retrospective analysis of 508 consecutive patients of virtually all PTCL subtypes undergoing allo-HSCT between 2000 and 2019 in 12 academic institutions. Five-year survival rates were calculated after a median follow-up of 29.7 months.
At the time of allo-HSCT, 54% of patients were in complete remission, 37% were in partial remission, 5% had stable disease, and 3% had progressive disease. Donor type was matched related in 41%, matched unrelated in 39%, mismatched in 11%, haploidentical in 4%, and umbilical cord blood in 5%. Conditioning regimens were myeloablative in 36%, reduced-intensity/nonmyeloablative in 64%, and unknown in < 1% of patients.
Outcomes After ASCT
Following allo-HSCT, the 2- and 5-year progression-free survival rates were 45.8% and 39.4%, and overall survival rates were 59.1% and 50.8%, respectively. The median time from relapse to death post allo-HSCT was 10.2 months, she reported.
Five-year progression-free survival rates were particularly high, and they were similar among many subtypes, such as for angioimmunoblastic TCL (47.3%), TCL not otherwise specified (43.9%), hepatosplenic TCL (48.6%), and subcutaneous panniculitis-like TCL (55.6%). Although the progression-free survival rate was much lower for patients with cutaneous T-cell lymphoma (18.6%), this subtype was associated with an overall survival similar to that of other PTCL subtypes.
Complete response at the time of transplant was associated with the longest median progression-free survival (44.6 months) and overall survival (154.2 months). The overall 1-year treatment-related mortality was 11.2%; it was highest for cord blood recipients (23.8%) and lowest for those with matched related donors (8.2%). Graft-vs-host disease was acute in 46.0% and chronic in 40.6%.
Because of these findings, Dr. Mehta-Shah commented, “We believe that eligible patients with relapsed/refractory PTCL should be considered for an allogeneic transplant consultation with an expert physician.”
DISCLOSURE: Dr. Mehta-Shah has served in a consulting or advisory role for Daiichi Sankyo, Kyowa Hakko Kirin, C4 Therapeutics, Karyopharm Therapeutics, and Ono pharmaceucals; and has received institutional research funding from Bristol Myers Squibb, Celgene, Corvus Pharmaceuticals, Genentech/Roche, Innate Pharmaceuticals, and Verastem.
1. Mehta-Shah N, Kommalapati A, Teja S, et al: Successful treatment of mature T-cell lymphoma with allogeneic stem cell transplantation: the largest multicenter retrospective analysis. 2020 ASH Annual Meeting & Exposition. Abstract 41. Presented December 5, 2020.
2. Mehta-Shah N, Teja S, Tao Y, et al: Successful treatment of mature T-cell lymphoma with allogeneic stem cell transplantation: The largest multicenter retrospective analysis. Blood 130(suppl 1):4597, 2017.
“Although some B-cell lymphomas are highly curable, this goal remains elusive for most T-cell lymphomas (TCL). Refractory and relapsed disease post induction therapy remains a major challenge in management,” said Deepa Jagadeesh, MD, MPH, Assistant Professor, Cleveland Clinic Lerner College of...