T Cell Lymphoma Stem Cell Transplant

T Cell Lymphoma Stem Cell Transplant

The 29th Annual Congress of the European Hematology Association (EHA) will be held from June 13-16, 2024, in Madrid, Spain, in a hybrid format combining virtual and on-site participation. As the largest international conference in the field of European hematology, the 2024 EHA Congress will share various scientific topics, clinical and basic research, covering benign and malignant hematology, and discuss the latest advancements in hematology.

The congress website has already released several EHA abstracts, and we have compiled the latest research progress for you as follows.

Abstract No.: S245

Outcomes of autologous and allogeneic stem cell transplantation for T-cell lymphomas: Latest analysis from the EBMT Lymphoma Working Party

Background and Aims

Autologous and allogeneic stem cell transplantation (auto-SCT and allo-SCT) represent potential curative approaches for patients with T-cell lymphomas. Comprehensive outcome data on auto-SCT and allo-SCT for the major T-cell entities, including peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS), angioimmunoblastic T-cell lymphoma (AITL), and ALK-negative and ALK-positive anaplastic large cell lymphoma (ALCL), are not yet reported.

Based on data reported to the Lymphoma Working Party (LWP) registry, this study aims to describe the evolution of auto-SCT and allo-SCT for T-cell lymphoma patients over the past 20 years.

Methods

The study analyzed auto-SCT and allo-SCT for T-cell lymphoma patients reported from European and other countries to the EBMT between 2002 and 2022. Inclusion criteria were age ≥18 years, diagnosis of PTCL-NOS, AITL, ALK+ ALCL, and ALK- ALCL, auto-SCT as first SCT or allo-SCT as first SCT or after auto-SCT.

Results

Between 2002 and 2022, 6992 patients received auto-SCT, and 1233 patients received allo-SCT. The diagnoses were PTCL-NOS (n=3285 vs n=649), AITL (n=2338 vs n=394), ALK- ALCL (n=968 vs n=106), and ALK+ ALCL (n=331 vs n=84).

For PTCL-NOS patients, the median follow-up (FU) was 4.0 years for auto-SCT and 4.4 years for allo-SCT, with 2-year progression-free survival (PFS) and 2-year overall survival (OS) of 49.7% vs 65.6% and 52.0% vs 67.7%, respectively. Transplantation in first complete/partial remission (CR/PR1) was associated with better outcomes than in second/later CR/PR (CR2+/PR2+) or progressive disease (PD) for both auto-SCT [2-year PFS: 54.9% vs 45.6% vs 25.6%; 2-year OS: 70.7% vs 61.7% vs 41.1%] and allo-SCT [2-year PFS: 57.1% vs 46.7% vs 31.5%; 2-year OS: 74.1% vs 57.8% vs 46.7%].

For AITL patients, the median FU was 3.3 years for auto-SCT and 3.9 years for allo-SCT, with 2-year PFS and OS of 51.1% vs 69.7% and 57.0% vs 60.5%, respectively. For auto-SCT, 2-year PFS was 54.4% vs 45.5% vs 30.5%, and 2-year OS was 72.4% vs 65.4% vs 51.4% for CR1/PR1, CR2+/PR2+, and PD, respectively. For allo-SCT, 2-year PFS was 63.4% vs 55.0% vs 37.5%, and 2-year OS was 68.6% vs 57.0% vs 40.0% for CR1/PR1, CR2+/PR2+, and PD, respectively.

For ALK- ALCL and ALK+ ALCL patients receiving auto-SCT, the 2-year PFS was 69.8% and 84.2%, respectively, and the 2-year OS was 65.5% and 85%, respectively. For ALK- ALCL patients receiving allo-SCT (median FU 2.1 years), the 2-year PFS and OS were 49.4% and 64.2%, respectively. For ALK+ ALCL patients receiving allo-SCT (median FU 3.3 years), the 2-year PFS and OS were 69.7% and 80.4%, respectively.

The 2-year relapse incidence (RI) after auto-SCT was 43.9% for PTCL-NOS, 43.6% for AITL, 26.3% for ALK-ALCL, and 31.7% for ALK+ALCL; after allo-SCT, RI was 42.4%, 13.3%, 35.8%, and 21.7%, respectively. The 2-year non-relapse mortality (NRM) after auto-SCT was 6.4%, 5.2%, 3.9%, and 2.8% for PTCL-NOS, AITL, ALK-ALCL, and ALK+ ALCL, respectively, while after allo-SCT, it was 20.8%, 29.7%, 14.8%, and 8.7%, respectively.

Conclusions

By analyzing 8225 transplants, this study provides real-world, large-scale data on the outcomes of auto-SCT and allo-SCT in the major T-cell lymphoma entities. The data indicate significant differences in PFS and OS across the major T-cell categories, questioning whether they should continue to be analyzed together. The study distinguishes autologous transplant patients for consolidation from those with relapsed/refractory disease, showing better outcomes with autologous transplantation for consolidation. Overall, long-term survival after autologous or allogeneic stem cell transplantation is excellent, including for relapsed T-cell lymphomas. The survival rates reported here confirm the results of two small prospective studies (Schmitz et al., Blood 2021; Glass et al., ASH 2023) and demonstrate that transplantation remains an effective treatment modality for patients with relapsed/refractory T-cell lymphomas.

Reference

2024 EHA abstract S245. OUTCOMES OF AUTOLOGOUS AND ALLOGENEIC STEM CELL TRANSPLANTATION FOR T-CELL LYMPHOMA: AN UPDATED ANALYSIS OF THE EBMT LYMPHOMA WORKING PARTY

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