HSCT May Improve Survival in Advanced Extranodal NK/T-Cell Lymphoma: A Single-Center Retrospective Study

Area of Science:

• Hematology
• Oncology
• Immunology

Background:

• Extranodal NK/T-cell lymphoma (ENKTCL) is a rare, aggressive lymphoid malignancy.
• Epstein-Barr virus (EBV) infection is highly associated with ENKTCL.
• Advanced-stage (III or higher) ENKTCL often carries a poor prognosis.

Purpose of the Study:

• To retrospectively analyze the outcomes of relapsed/refractory (R/R) ENKTCL patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT).
• To identify prognostic factors influencing survival and relapse post-transplantation.
• To explore the role of genetic susceptibility in ENKTCL progression and transplant outcomes.

Main Methods:

• Retrospective review of 34 R/R ENKTCL patients treated with allo-HSCT between January 2019 and July 2024.
• Analysis of pre-transplant response (CR/PR), EBV status, prior treatments, and genetic variants.
• Evaluation of overall survival (OS), progression-free survival (PFS), and non-relapse mortality (NRM).

Main Results:

• Pre-transplant PD-1 inhibitors, treatment lines, and pre-transplant EBV negativity did not significantly impact OS or PFS.
• Complete response (CR) or partial response (PR) before allo-HSCT correlated with a better prognosis.
• Chronic active EBV infection (CAEBV) history and post-transplant EBV reactivation were associated with inferior survival.
• Hemophagocytic lymphohistiocytosis (HLH)-associated gene variants, particularly LYST, were common in advanced ENKTCL.
• HLH development led to significantly higher NRM.
• TP53 gene variants were linked to post-allo-HSCT relapse.

Conclusions:

• Allogeneic HSCT may enhance survival for select high-risk, advanced-stage R/R ENKTCL patients.
• EBV reactivation and specific genetic alterations (LYST, TP53) are critical prognostic indicators.
• Further validation in larger, multi-center studies is warranted to confirm these hypothesis-generating findings.