Long-term survival following autologous and allogeneic stem cell transplantation for blastic plasmacytoid dendritic cell neoplasm

Abstract

Key Points• Auto-HSCT in CR1 provides long-term remission in BPDCN patients.• RIC allo-HSCT and MAC allo-HSCT results are comparable.We sought to clarify the role of high-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (auto-HSCT) and allogeneic hematopoietic stem cell transplantation (allo-HSCT) to treat blastic plasmacytoid dendritic cell neoplasm (BPDCN). We retrospectively identified 25 BPDCN patients (allo-HSCT, n 5 14; auto-HSCT, n 5 11) from registry data of the Japan Society for Hematopoietic Cell Transplantation and analyzed clinicopathologic data and clinical outcomes after transplantation. The median age at HSCT was 58 years (range, 17-67 years). All 11 patients who underwent auto-HSCT were in the first complete remission (CR1). With a median follow-up of 53.5 months, the overall survival rates at 4 years for patients who underwent auto-HSCT and allo-HSCT were 82% and 53% (P 5 .11), respectively, and progression-free survival rates were 73% and 48% (P 5 .14), respectively. Auto-HSCT for BPDCN in CR1 appears to provide promising results and deserves further evaluation in the setting of prospective trials. (Blood. 2015;125(23):3559-3562)

Blastic plasmacytoid dendritic cell neoplasm with leukemic presentation: 10‐Color flow cytometry diagnosis and HyperCVAD therapy

“…Allo-HCT when performed, mostly in patients in first CR, yielded 3-and 4-year OS of 41 and 53%, respectively [11,12]. Similar survival benefits may also be obtained with an autologous HCT in first CR [12]. 1 …”

“…Recent data suggest that the median OS of patients who received an allogeneic-Hematopoeitic Cell Transplant (allo-HCT) were superior to those who received chemotherapy alone (22.7 months vs. 7.1 months; P 5 0.03) [7]. Allo-HCT when performed, mostly in patients in first CR, yielded 3-and 4-year OS of 41 and 53%, respectively [11,12]. Similar survival benefits may also be obtained with an autologous HCT in first CR [12].…”

Treatment of blastic plasmacytoid dendritic cell neoplasm

“…Unfortunately, transplantation beyond CR1 may have an adverse impact on both OS and progression-free survival (PFS) [42][43][44] ; thus, timing and patient selection remain important concerns. In their summary of the literature from 1994 to 2002, Reimer et al 39 reported on 10 patients: 6 patients treated with allo-SCT and 4 patients treated with autologous SCT (auto-SCT).…”

A Challenging Blastic Plasmacytoid Dendritic Cell Neoplasm Case: Tough Decisions to Make

“…The best outcome for HSCT is to perform it after the first CR as it had been noted in studies to have a significantly lower overall survival and progression-free survival when done after the first CR [5,11]. In regards to the optimal conditioning regimen, myeloablative conditioning (MAC) was associated with a higher 3-year disease-free survival versus a reduced intensity conditioning (RIC) regimen [12].…”

“…Aoki et al conducted a retrospective analysis on a cohort of 25 BPDCN patients showing that the group who received autologous versus allogeneic HSCT, following high dose chemotherapy, tended to have a higher 4-year overall survival rate (0.82 vs. 0.53 respectively, P = 0.11) and higher progression-free survival rate (0.73 vs. 0.48 respectively, P = 0.14) [11]. Although not statistically significant, the results are intriguing to warrant further investigation with a larger study.…”