학술논문
Outcome of Stem Cell Transplantation in HTLV-1-Associated North American Adult T-Cell Leukemia/Lymphoma.
Document Type
article
Author
Bazarbachi, Abdul-Hamid; Reef, Daniel; Narvel, Hiba; Patel, Riya; Al Hamed, Rama; Vikash, Sindhu; Neupane, Karun; Atalla, Eleftheria; Thakkar, Astha; Rahman, Shafia; Shah, Urvi; Adrianzen-Herrera, Diego; Quinn, Ryann; Zareef, Sumaira; Rabinovich, Emma; De Castro, Alyssa; Joseph, Felisha; Gillick, Kailyn; Mustafa, Jennat; Khatun, Fariha; Lombardo, Amanda; Townsend-Nugent, Latoya; Abreu, Michelly; Chambers, Nicole; Elkind, Richard; Shi, Yang; Wang, Yanhua; Derman, Olga; Gritsman, Kira; Steidl, Ulrich; Goldfinger, Mendel; Kornblum, Noah; Shastri, Aditi; Mantzaris, Ioannis; Bachier-Rodriguez, Liza; Shah, Nishi; Cooper, Dennis; Verma, Amit; Ye, Bihui Hilda; Janakiram, Murali; Sica, Roberto Alejandro
Source
Clinical hematology international. 5(2-3)
Subject
Language
Abstract
Adult T-cell leukemia/lymphoma (ATLL) remains challenging to treat and has dismal outcome. Allogeneic stem-cell transplantation (allo-SCT) has promising results, but data remain scarce. In this single-center retrospective analysis of 100 patients with ATLL from north America (67 acute, 22 lymphomatous), 17 underwent allo-SCT and 5 autologous SCT (ASCT), with a median follow-up of 65 months. Post-transplant 3-years relapse incidence (RI) and non-relapse mortality (NRM) were 51% and 37%, respectively, and 3-year progression-free survival (PFS) and overall survival (OS) were 31% and 35%, respectively. ASCT 1-year RI was 80% compared to 30% in allo-SCT (p = 0.03). After adjusting for immortal-time bias, allo-SCT had significantly improved OS (HR = 0.4, p = 0.01). In exploratory multivariate analysis, patients achieving first complete response and Karnofsky score ≥ 90 had significantly better outcomes, as did Black patients, compared to Hispanics, who had worse outcome. In transplanted patients, 14 died within 2 years, 4 of which ASCT recipients. Our data are the largest ATLL transplant cohort presented to date outside of Japan and Europe. We show that allo-SCT, but not ASCT, is a valid option in select ATLL patients, and can induce long term survival, with 40% of patients alive after more than 5 years.