Among patients with adult T-cell leukemia/lymphoma (ATL) who undergo allogeneic hematopoietic stem cell transplantation (allo-HSCT), multiple types of donor sources may provide good outcomes for graft-vs-host disease (GVHD)-free, relapse-free survival (GRFS), according to results from a retrospective study published in Bone Marrow Transplantation.
The researchers examined outcomes for 1363 patients with ATL who received allo-HSCT using various donor sources. Donor sources included related bone marrow transplantation (R-BMT; 117 patients), related peripheral blood stem cell transplantation (R-PBSCT; 228 patients), unrelated bone marrow transplantation (UR-BMT; 619 patients), or cord blood transplantation (CBT; 359 patients). A small number of patients had received haplo-HSCT (40 patients), but this subset was not included in most analyses.
Data for this study were obtained from Japan’s Transplant Registry Unified Management Program and included patients treated from 2006 through 2015. Endpoints of interest were GRFS and overall survival (OS).
Patients had a median age of 57 years (range, 20-78), and survivors had a median observation time of 3.1 years (range, 0.0-10.5). During the study period, the rate of CBT was reported to have doubled during 2011 to 2015, compared with the rate from 2006 to 2010.
The 1-year GRFS rates did not significantly vary between patients receiving R-BMT (26%), R-PBSCT (22%), UR-BMT (26%), and CBT (21%; P =.09). GRFS was also similar across donor sources among patients in complete remission (CR; P =.49).
The 1-year OS rate was lowest among CBT recipients (38%), compared with 49% for R-BMT recipients, 52% for R-PBSCT recipients, and 47% for UR-BMT recipients (P <.001). However, for patients who achieved CR following transplantation, the 1-year OS rates were 55% with R-BMT, 57% with R-PBSCT, 58% with UR-BMT, and 52% with CBT (P =.15).
Rates of relapse were also similar for patients in CR regardless of donor source (P =.19). However, for the total patient population the 1-year cumulative incidence of relapse was higher with CBT than with the other donor sources (P =.003).
“The present study revealed that transplant from all donor sources is feasible for those patients in CR and that each source can be selected depending on the clinical characteristics of patients,” the researchers concluded.
Muranushi H, Shindo T, Hishizawa M, et al. GVHD-free, relapse-free survival provides novel clues for optimizing allogeneic-HSCT for adult T-cell leukemia/lymphoma [published online July 14, 2020]. Bone Marrow Transplant. doi: 10.1038/s41409-020-00996-y