Selection of hematopoietic stem cell transplantation for T-cell lymphoblastic lymphoma

Abstract

BackgroundHematopoietic stem cell transplantation (HSCT) is an important treatment for T-cell lymphoblastic lymphoma/leukemia (T-LBL). To compare the efficacy and influencing factors of autologous hematopoietic stem cell transplantation (auto-HSCT) with those of allogeneic hematopoietic stem cell transplantation (allo-HSCT) from different donors for the treatment of T-cell lymphoblastic lymphoma/leukemia (T-LBL) and provide a basis for selection of appropriate transplant methods and donors.MethodsTo provide evidence of appropriate transplant methods for these patients, we retrospectively summarized the clinical characteristics of 75 T-LBL patients receiving HSCT at Henan Cancer Hospital between March 2012 and October 2021. Overall survival (OS), progression-free survival (PFS), cumulative incidence of relapse (CIR), non-relapse mortality (NRM), and related factors affecting efficacy were analyzed.ResultsThe 3-year CIR (39.9% vs 31.1%, P=0.745), 3-year PFS (60.1% vs 49.6%, P=0.434), and 3-year OS (62.8% vs 53.0%, P=0.450) were not significantly different between the auto-HSCT and allo-HSCT groups. However, the 3-year NRM was significantly higher in the allo-HSCT group (0% vs 27.2%, P=0.033). Multivariate analysis showed that the first complete remission (CR1) after HSCT was an independent influencing factor of higher OS (HR=2.498, P=0.029) and PFS (HR=2.576, P=0.016). The absence of mediastinal invasion in patients receiving HSCT was an independent influencing factor of better PFS (HR=2.977, P=0.029) and lower CIR (HR=4.040, P=0.027). With respect to the impact of donor source, the NRM in the unrelated donor (URD) and haploid donor (HPD) groups was significantly higher than that in the auto-HSCT group (P=0.021 and P=0.003, respectively), while there was no significant difference between matched sibling donors (MSD) and auto-HSCT. Compared with the MSD-HSCT group, the auto-HSCT group showed an increasing trend in 3-year CIR (39.9 ± 11.1% vs 32.6 ± 11.2%, P=0.697) and a lower trend in 3-year OS (62.8 ± 11.4% vs 64.4 ± 12.2%, P=0.929).ConclusionsHSCT is an effective consolidation treatment option for patients with T-LBL without mediastinal invasion and with CR1 before transplantation. For CR1 patients, auto-HSCT and MSD-HSCT are effective modalities for improving survival. In non-CR1 patients without an MSD, matched unrelated donors and haploidentical donor transplantations are the best treatment options to reduce relapse and improve prognosis.

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“…There is no actual evidence supporting the performance of HSCT as a first-line treatment or after achieving the first complete response, although there are a few studies that have assessed the use of allogeneic or autologous transplantation as consolidation treatment in such cases. The superiority of allogeneic transplantation seems to be supported by the graft-versus-host effect characteristic of this modality, which may facilitate the control of residual disease in a manner analogous to acute leukemias [ 7 ].…”

“…Although these series suggest favorable long-term outcomes with bone marrow transplantation in cases of chemo-sensitive disease (a category we probably cannot include our case in, given the short duration of the response achieved after chemotherapy discontinuation) and after achieving a complete response, making it an effective consolidation strategy [ 7 ], patient selection in these studies and the presence of sometimes contradictory criteria for eligibility do not allow us to currently consider it as a routine first-line treatment. As we have previously described, HSCT is therefore relegated to the treatment of refractory or relapsed cases until we have more experience with or evidence about its early use [ 18 ].…”

“…The use of intensive chemotherapy followed by allogenic hematopoietic stem cell transplantation (HSCT) as a consolidation treatment has been reported in many cases of Biomedicines 2024, 12, 512 2 of 8 adverse prognosis and relapsed or resistant disease. Although some data suggest that this treatment could be an effective alternative that could improve relapse-free survival, and even offer better outcomes than only chemotherapy for high-risk patients, its role remains controversial [2,7].…”