Related Experiment Videos
Allogeneic Stem Cell Transplantation in Mature T Cell and Natural Killer/T Neoplasias: A Registry Study from Spanish
Silvana Novelli1, Leyre Bento2, Irene Garcia1
1Hematology Department, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Hospital Sant Pau, Barcelona, Spain.
Abstract:
Despite advances in understanding the biology of mature T and natural killer (NK)/T cell neoplasia, current therapies, even the most innovative ones, are still far from ensuring its cure. The only treatment to date that has been shown to control aggressive T cell neoplasms in the long term is allogeneic stem cell transplantation (alloSCT). We aim to report the results of alloSCT for advanced mature T and NK/T neoplasias performed in centers from our national GELTAMO/GETH (Grupo Español de Linfoma y Trasplante de Médula Ósea/Grupo Español de Trasplante Hematopoyético y Terapia Celular) over the past 25 years. As a secondary objective, we analyzed the results of alloSCT from haploidentical donors. We performed a retrospective analysis of all patients who received an alloSCT in Spanish centers (n = 201) from September 1995 to August 2018. The 2-year overall survival (OS) and disease-free survival (DFS) were 65.5% and 58.2%, respectively. The univariate for OS and DFS showed statistically different hazard ratios for conditioning intensity, response pre-alloSCT, comorbidity index, donor/receptor cytomegalovirus status and Eastern Cooperative Oncology Group (ECOG) pre-alloSCT, but only a better ECOG pre-alloSCT remained significant in the multivariate analysis. There was an increased incidence of relapse in those patients who did not develop chronic graft-versus-host disease (GVHD) and an increased risk of death in those developing moderate to severe acute GVHD. The 1-year nonrelapse mortality was 21.9% and was mainly due to GVHD (30%) and bacterial infections (17%). When comparing unrelated donors with haploidentical donors, we found similar results in terms of OS and DFS. There was, however, a reduction of acute GVHD in the haploidentical group (P = .04) and trend to a reduction of chronic GVHD. In conclusion, alloSCT is the only curative option for most aggressive T cell neoplasias. Haploidentical donors offer similar results to related donors in terms of survival with a reduction of acute GVHD.
Insights
Allogeneic stem cell transplantation (alloSCT) is the only curative treatment for aggressive T and NK/T cell neoplasms. Haploidentical donors provide similar survival outcomes to other donors, with a reduced risk of acute graft-versus-host disease.
Area of Science:
- Hematology
- Oncology
- Transplantation Immunology
Background:
- Mature T and natural killer (NK)/T cell neoplasms remain challenging to treat, with limited long-term cure options.
- Allogeneic stem cell transplantation (alloSCT) is currently the only established curative therapy for aggressive T cell neoplasms.
- Understanding outcomes of alloSCT in large patient cohorts is crucial for optimizing treatment strategies.
Purpose of the Study:
- To report the long-term results of alloSCT for advanced mature T and NK/T cell neoplasias.
- To analyze the specific outcomes of alloSCT utilizing haploidentical donors.
- To identify prognostic factors influencing survival and non-relapse mortality after alloSCT.
Main Methods:
- Retrospective analysis of 201 patients undergoing alloSCT in Spanish centers between 1995 and 2018.
- Evaluation of overall survival (OS) and disease-free survival (DFS) at 2 years.
- Analysis of factors including conditioning intensity, pre-transplant response, comorbidity index, cytomegalovirus status, and Eastern Cooperative Oncology Group (ECOG) performance status.
Main Results:
- Two-year OS and DFS were 65.5% and 58.2%, respectively.
- A better ECOG performance status pre-alloSCT was the only significant factor in multivariate analysis for OS and DFS.
- Haploidentical donors showed similar OS and DFS compared to unrelated donors, with a significant reduction in acute graft-versus-host disease (GVHD).
Conclusions:
- AlloSCT remains the sole potentially curative treatment for aggressive T and NK/T cell neoplasms.
- Graft-versus-host disease (GVHD) and infections are major causes of non-relapse mortality.
- Haploidentical donors are a viable alternative, offering comparable survival benefits with a lower incidence of acute GVHD.