Allogeneic hematopoietic cell transplantation provides effective salvage despite refractory disease or failed prior autologous transplant in angioimmunoblastic T-cell lymphoma: a CIBMTR analysis.
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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
Аннотация
METHODS: We evaluated 249 adult AITL patients who received their first allo-HCT during 2000-2016.
RESULTS: 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).
CONCLUSION: 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.