Optimal Timing and Impact of Allogeneic Peripheral Blood Stem Cell Transplantation in Adult T-Cell Lymphoblastic Lymphoma: Insights from a Large Cohort Multi-Center Real-World Study in Shanghai

Le résumé fourni par la source

Consolidation therapy modalities for adult T-cell lymphoblastic lymphoma (T-LBL) are still debated. One-hundred and fifty-three adult T-LBL patients from sixteen centers in Shanghai were enrolled for a real-world study. Out of them, 103 (67.5%) patients achieved complete remission (CR), with early-T progenitor (ETP) immunophenotype significantly lowering the CR rate. The 2-year overall survival (OS) and progression-free survival (PFS) were 56.3% and 47.6%, respectively. Multivariate analysis revealed allogeneic peripheral blood stem cell transplantation (allo-PBSCT) was an independent prognostic factor for higher OS (HR 0.423, p= 0.027) and PFS (HR 0.362, p= 0.003). For patients in CR, allo-PBSCT significantly lowered the cumulative incidence of relapse (CIR) compared to autologous PBSCT (p= 0.043) and non-SCT (p= 0.001) and improved survival. Multivariate analysis for patients undergoing allo-PBSCT showed thatETP independently lowered OS (HR 3.943, p= 0.004) and PFS (HR 2.668, p= 0.025), and that non-complete remission (NCR) at transplantation (HR 2.643, p=0.023) also significantly lowered PFS (HR 2.643, p=0.023) and had a trend towards reducing OS (HR 2.316, p=0.068). For patients undergoing allo-PBSCT in CR, early (within four induction courses) and late CR (after four induction courses) had comparable 2-year OS (p= 0.590), PFS (p= 0.858), CIR (p= 0.500), and non-relapse mortality (NRM) (p= 0.11). Early and deferred allo-PBSCT for early CR patients yielded similar 2-year OS (p= 0.640) and PFS (p= 0.970). Our data revealed that allo-PBSCT could decrease the relapse risk and improve the survival of T-LBL patients, and it should be considered upon achieving CR.

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