Indication and benefit of upfront hematopoietic stem cell transplantation for T-cell lymphoblastic lymphoma in the era of ALL-type induction therapies

• Published in: Scientific reports Vol. 10; no. 1; pp. 21418 - 8
• Main Authors: Morita-Fujita, Mari, Arai, Yasuyuki, Yoshioka, Satoshi, Ishikawa, Takayuki, Kanda, Junya, Kondo, Tadakazu, Akasaka, Takashi, Ueda, Yasunori, Imada, Kazunori, Moriguchi, Toshinori, Yago, Kazuhiro, Kitano, Toshiyuki, Yonezawa, Akihito, Nohgawa, Masaharu, Takaori-Kondo, Akifumi
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 08.12.2020; Nature Publishing Group; Nature Portfolio
• Subjects: 692/308/174; 692/308/409; Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Autografts; Cyclophosphamide - administration & dosage; Cyclophosphamide - therapeutic use; Dexamethasone - administration & dosage; Dexamethasone - therapeutic use; Doxorubicin - administration & dosage; Doxorubicin - therapeutic use; Female; Hematopoietic Stem Cell Transplantation - methods; Hematopoietic stem cells; Humanities and Social Sciences; Humans; Induction Chemotherapy - methods; Leukemia; Lymphocytes T; Lymphoma; Male; Middle Aged; multidisciplinary; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma - therapy; Prognosis; Remission; Retrospective Studies; Science; Science (multidisciplinary); Stem cell transplantation; Stem cells; Survival; Survival Rate; Transplantation, Autologous; Transplantation, Homologous; Treatment Outcome; Vincristine - administration & dosage; Vincristine - therapeutic use; Young Adult
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-020-78334-x

Since the introduction of leukemia-type induction therapies for T-cell lymphoblastic lymphoma (T-LBL), improvements in the long-term outcomes of T-LBL have been reported. However, indications for and the appropriate timing of hematopoietic stem cell transplantation (HSCT) have not yet been established. Therefore, we performed a multicenter retrospective cohort study of patients with T-LBL treated using leukemia-type initial therapies to compare the outcomes after HSCT at different disease stages. We enrolled 21 patients with T-LBL from a total of 11 centers, and all patients received hyper-CVAD as a leukemia-type initial regimen. HSCT was performed during the CR1/PR1 (standard disease) stage in 11 patients, while it was completed at a later or non-remission (advanced disease) stage in 10 patients. Following HSCT, the overall survival rate was significantly greater in standard disease than in advanced-disease patients (79.5% vs. 30.0% at 5 years; hazard ratio (HR) 5.97; p  = 0.03), with trend to the lower incidence of relapse in the former group (27.3% vs. 60.0% at 5 years; HR 2.29; p  = 0.19). A prognostic difference was not detected between cases treated with allogeneic and autologous HSCTs. Our study suggests that frontline HSCT may be a feasible treatment option for T-LBL, even in the era of leukemia-type initial therapy.