Outcome of Stem Cell Transplantation in HTLV-1-Associated North American Adult T-Cell Leukemia/Lymphoma

• Published in: Clinical hematology international Vol. 5; no. 2-3; pp. 78 - 91
• Main Authors: Bazarbachi, Abdul-Hamid, Reef, Daniel, Narvel, Hiba, Patel, Riya, Al Hamed, Rama, Vikash, Sindhu, Neupane, Karun, Atalla, Eleftheria, Thakkar, Astha, Rahman, Shafia, Shah, Urvi, Adrianzen-Herrera, Diego, Quinn, Ryann, Zareef, Sumaira, Rabinovich, Emma, De Castro, Alyssa, Joseph, Felisha, Gillick, Kailyn, Mustafa, Jennat, Khatun, Fariha, Lombardo, Amanda, Townsend-Nugent, Latoya, Abreu, Michelly, Chambers, Nicole, Elkind, Richard, Shi, Yang, Wang, Yanhua, Derman, Olga, Gritsman, Kira, Steidl, Ulrich, Goldfinger, Mendel, Kornblum, Noah, Shastri, Aditi, Mantzaris, Ioannis, Bachier-Rodriguez, Liza, Shah, Nishi, Cooper, Dennis, Verma, Amit, Ye, Bihui Hilda, Janakiram, Murali, Sica, Roberto Alejandro
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01-06-2023
• Subjects: Medicine; Medicine & Public Health; Research Article; Autologous stem-cell transplantation; North American; Adult T-cell leukemia/Lymphoma; Minority; Human T-cell lymphotropic virus type I; Black; Allogeneic stem-cell transplantation; Hispanic
• ISSN: 2590-0048; 2590-0048
• DOI: 10.1007/s44228-023-00032-y

Adult T-cell leukemia/lymphoma (ATLL) remains challenging to treat and has dismal outcome. Allogeneic stem-cell transplantation (allo-SCT) has promising results, but data remain scarce. In this single-center retrospective analysis of 100 patients with ATLL from north America (67 acute, 22 lymphomatous), 17 underwent allo-SCT and 5 autologous SCT (ASCT), with a median follow-up of 65 months. Post-transplant 3-years relapse incidence (RI) and non-relapse mortality (NRM) were 51% and 37%, respectively, and 3-year progression-free survival (PFS) and overall survival (OS) were 31% and 35%, respectively. ASCT 1-year RI was 80% compared to 30% in allo-SCT (
p
 = 0.03). After adjusting for immortal-time bias, allo-SCT had significantly improved OS (HR = 0.4,
p
 = 0.01). In exploratory multivariate analysis, patients achieving first complete response and Karnofsky score ≥ 90 had significantly better outcomes, as did Black patients, compared to Hispanics, who had worse outcome. In transplanted patients, 14 died within 2 years, 4 of which ASCT recipients. Our data are the largest ATLL transplant cohort presented to date outside of Japan and Europe. We show that allo-SCT, but not ASCT, is a valid option in select ATLL patients, and can induce long term survival, with 40% of patients alive after more than 5 years.