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
Internal Medicine Department, Jacobi Medical Center, Albert Einstein College of Medicine, NYC, New York, NY, USA.
Oncology Department, Montefiore Medical Center, Albert Einstein College of Medicine, NYC, New York, NY, USA.
Clin Hematol Int. 2023 Jun;5(2-3):78-91. doi: 10.1007/s44228-023-00032-y. Epub 2023 Mar 15.
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.
成人T细胞白血病/淋巴瘤（ATLL）的治疗仍然具有挑战性，预后不佳。异基因干细胞移植（allo-SCT）取得了有前景的结果，但相关数据仍然稀少。在这项对来自北美的100例ATLL患者（67例急性型、22例淋巴瘤型）进行的单中心回顾性分析中，17例接受了allo-SCT，5例接受了自体干细胞移植（ASCT），中位随访时间为65个月。移植后3年的复发率（RI）和非复发死亡率（NRM）分别为51%和37%，3年无进展生存期（PFS）和总生存期（OS）分别为31%和35%。ASCT的1年RI为80%，而allo-SCT为30%（p = 0.03）。校正生存时间偏倚后，allo-SCT的OS有显著改善（HR = 0.4，p = 0.01）。在探索性多变量分析中，达到首次完全缓解且卡诺夫斯基评分≥90的患者，以及黑人患者，与预后较差的西班牙裔患者相比，预后明显更好。在接受移植的患者中，14例在2年内死亡，其中4例为ASCT受者。我们的数据是迄今为止日本和欧洲以外所报道的最大的ATLL移植队列。我们表明，allo-SCT而非ASCT，在部分ATLL患者中是一种有效的选择，并且可以诱导长期生存，40%的患者在5年以上仍存活。
