Allogeneic hematopoietic cell transplantation provides effective salvage despite refractory disease or failed prior autologous transplant in angioimmunoblastic T-cell lymphoma: a CIBMTR analysis

• Published in: Journal of hematology and oncology Vol. 12; no. 1; pp. 6 - 11
• Main Authors: Epperla, Narendranath, Ahn, Kwang W., Litovich, Carlos, Ahmed, Sairah, Battiwalla, Minoo, Cohen, Jonathon B., Dahi, Parastoo, Farhadfar, Nosha, Farooq, Umar, Freytes, Cesar O., Ghosh, Nilanjan, Haverkos, Bradley, Herrera, Alex, Hertzberg, Mark, Hildebrandt, Gerhard, Inwards, David, Kharfan-Dabaja, Mohamed A., Khimani, Farhad, Lazarus, Hillard, Lazaryan, Aleksandr, Lekakis, Lazaros, Murthy, Hemant, Nathan, Sunita, Nishihori, Taiga, Pawarode, Attaphol, Prestidge, Tim, Ramakrishnan, Praveen, Rezvani, Andrew R., Romee, Rizwan, Shah, Nirav N., Sureda, Ana, Fenske, Timothy S., Hamadani, Mehdi
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 10.01.2019; BioMed Central; BMC
• Subjects: Adult; Aged; Aged, 80 and over; Allogeneic transplantation; Analysis; Angioimmunoblastic T-cell lymphoma; Autografts; Bone marrow; Calcineurin; Calcineurin inhibitors; Care and treatment; Disease control; Drug Resistance, Neoplasm; Female; Follow-Up Studies; Graft vs Host Disease - prevention & control; Graft-versus-host reaction; GVL effects; Health aspects; Hematology; Hematopoietic Stem Cell Transplantation - methods; Hematopoietic stem cells; Humans; Leukemia; Lymphocytes; Lymphocytes T; Lymphoma; Lymphoma, T-Cell - therapy; Male; Medical prognosis; Middle Aged; Mortality; Multivariate analysis; Non-Hodgkin's lymphomas; Oncology; Patient outcomes; Patients; Peripheral blood; Progression-Free Survival; Prophylaxis; Registries; Salvage Therapy - methods; Stem cell transplantation; T-cell lymphoma; Transplantation; Transplantation Conditioning; Transplantation, Autologous - adverse effects; Transplantation, Homologous - methods; Transplants & implants; Young Adult; United States; Angioimmunoblastic T-cell lymphoma; Allogeneic transplantation; GVL effects
• ISSN: 1756-8722; 1756-8722
• DOI: 10.1186/s13045-018-0696-z

There is a paucity of data on the role of allogeneic hematopoietic cell transplantation (allo-HCT) in patients with angioimmunoblastic T-cell lymphoma (AITL). Using the CIBMTR registry, we report here the outcomes of AITL patients undergoing an allo-HCT. We evaluated 249 adult AITL patients who received their first allo-HCT during 2000-2016. The median patient age was 56 years (range = 21-77). Majority of the patients were Caucasians (86%), with a male predominance (60%). Graft-versus-host disease (GVHD) prophylaxis was predominantly calcineurin inhibitor-based approaches while the most common graft source was peripheral blood (97%). Median follow-up of survivors was 49 months (range = 4-170 months). The cumulative incidence of grade 2-4 and grade 3-4 acute GVHD at day 180 were 36% (95% CI = 30-42) and 12 (95% CI = 8-17), respectively. The cumulative incidence of chronic GVHD at 1 year was 49% (95%CI 43-56). The 1-year non-relapse mortality (NRM) was 19% (95% CI = 14-24), while the 4-year relapse/progression, progression-free survival (PFS), and overall survival (OS) were 21% (95% CI = 16-27), 49% (95% CI = 42-56), and 56% (95% CI = 49-63), respectively. On multivariate analysis, chemoresistant status at the time of allo-HCT was associated with a significantly higher risk for therapy failure (inverse of PFS) (RR = 1.73 95% CI = 1.08-2.77), while KPS < 90% was associated with a significantly higher risk of mortality (inverse of OS) (RR = 3.46 95% CI = 1.75-6.87). Our analysis shows that allo-HCT provides durable disease control even in AITL patients who failed a prior auto-HCT and in those subjects with refractory disease at the time of allografting.