GVHD-free, relapse-free survival provides novel clues for optimizing allogeneic-HSCT for adult T-cell leukemia/lymphoma

• Published in: Bone marrow transplantation (Basingstoke) Vol. 56; no. 1; pp. 155 - 166
• Main Authors: Muranushi, Hiroyuki, Shindo, Takero, Hishizawa, Masakatsu, Tokunaga, Masahito, Wake, Atsushi, Nakano, Nobuaki, Eto, Tetsuya, Hidaka, Michihiro, Choi, Ilseung, Miyamoto, Toshihiro, Uchida, Naoyuki, Moriuchi, Yukiyoshi, Miyazaki, Yasuhiko, Fukuda, Takahiro, Ichinohe, Tatsuo, Atsuta, Yoshiko, Kato, Koji
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.01.2021; Nature Publishing Group
• Subjects: 631/67/1059/2325; 692/699/67/1059/2325; Adult T-cell leukemia-lymphoma; Blood; Bone marrow; Bone marrow transplantation; Care and treatment; Cell Biology; Cord blood; Diagnosis; Graft versus host reaction; Hematology; Hematopoietic stem cells; Internal Medicine; Leukemia; Lymphocytes T; Lymphoma; Medicine; Medicine & Public Health; Peripheral blood; Public Health; Remission; Risk factors; Stem cell transplantation; Stem Cells; Survival; Transplantation; Japan
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/s41409-020-00996-y

The outcome of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for adult T-cell leukemia/lymphoma (ATL) is still unsatisfactory. To illustrate the advantages and disadvantages of each donor source, we performed a nationwide retrospective study of graft-versus-host disease (GVHD)-free, relapse-free survival (GRFS) of patients with allo-HSCT-treated ATL. One-year GRFS did not significantly differ between patients who received related bone marrow transplantation (R-BMT; 26%, n  = 117), related peripheral blood stem cell transplantation (R-PBSCT; 22%, n  = 225), unrelated bone marrow transplantation (UR-BMT; 26%, n  = 619), and cord blood transplantation (CBT; 21%, n  = 359; p  = 0.09). This was attributable to a low incidence of systemically-treated chronic GVHD after CBT (9% at 1 year) and reduced non-GVHD/relapse mortality after R-PBSCT (9% at 1 year). Among patients transplanted in complete remission (CR), 1-year overall survival after CBT (52%, n  = 132) was not inferior to that after R-BMT (55%, n  = 51), R-PBSCT (57%, n  = 79), and UR-BMT (58%, n  = 280; p  = 0.15), and relapse rates were equivalent among the four sources ( p  = 0.19). Our results suggest that all donor sources are feasible for CR patients and that GRFS provides important clues toward optimizing allo-HSCT for ATL.