Allogeneic haematopoietic cell transplant in patients with relapsed/refractory anaplastic large cell lymphoma

Abstract

Summary The prognosis of relapsed/refractory (R/R) anaplastic large cell lymphoma (ALCL) is poor. Large studies evaluating outcomes of allogeneic haematopoietic cell transplantation (allo‐HCT) in systemic R/R ALCL are not available. Using the Center for International Blood and Marrow Transplant Research (CIBMTR) database, we evaluated outcomes of 182 adults (aged ≥18 years) with R/R ALCL undergoing allo‐HCT between 2008 and 2019. Non‐relapse mortality (NRM), disease relapse/progression (REL), progression‐free survival (PFS), and overall survival (OS) were modelled using Cox proportional hazards models. The median (range) follow‐up of survivors was 62 (3–148) months. The 1‐year NRM was 18%. The 5‐year REL, PFS and OS were 32%, 41% and 56% respectively. On multivariable regression analysis African American race (hazard ratio [HR] 2.7, 95% confidence interval [CI] 1.6–4.8; p < 0.001) and refractory disease at allo‐HCT (HR 3.2, 95% CI 1.6–6.2; p < 0.001) were predictive of inferior OS. Similarly, African‐American race (HR 2.1, 95% CI 1.3–3.4; p = 0.003), other minority race (HR 2.5, 95% CI 1.2–5.3; p = 0.02) and refractory disease (HR 2.2, 95% CI 1.2–4.3; p = 0.01) were predictive of inferior PFS. These data, demonstrate that allo‐HCT can result in durable disease control in a sizable proportion of patients with R/R ALCL. Refractory disease and racial minority status predicted inferior allo‐HCT outcomes. Whether the inferior outcomes of racial minorities with R/R ALCL after allo‐HCT are driven by differences in disease biology or disparities in post allo‐HCT care, or both, requires further investigation.

ALK-positive anaplastic large cell lymphoma in adults

“…A large cohort study performed by the Center for International Blood and Marrow Transplant Research (CIBMTR) found that patients with relapsed ALCL undergoing auto-HCT had superior outcomes to those receiving allo-HCT with a smaller nonrelapse mortality at 100 days, 1 year, and 3 years, and superior PFS and OS at 1 and 3 years for the auto-HCT patients compared to allo-HCT patients, although this study also did not separate ALCL based on ALK status and patients had varying baseline characteristics 36 . An analysis of the CIBMTR database of 182 ALCL patients receiving allo-HCT that similarly did not separate patients based on ALK status did find that allo-HCT for relapsed/refractory ALCL had a 5-year pFS of 41% and OS of 56%, indicating that allo-HCT can play an effective role in treating relapsed/refractory disease 37 . A recent meta-analysis comparing auto-HCT to allo-HCT in relapsed/refractory PTCL patients showed benefits to both types of HCT depending on the patient population, finding some benefit to allo-HCT in patients with a higher-risk disease stage agent 38 .…”