Outcomes of related donor HLA-identical or HLA-haploidentical allogeneic blood or marrow transplantation for peripheral T cell lymphoma.

Abstract

The role of allogeneic blood or marrow transplantation (alloBMT) for peripheral T cell lymphoma (PTCL) remains to be defined. There is growing interest in reduced-intensity conditioning (RIC) regimens and/or utilization of human leukocyte antigen haploidentical (haplo) grafts given concerns about treatment-associated toxicities and donor availability. We reviewed the outcomes of 44 consecutive, related donor alloBMTs for PTCL performed at Johns Hopkins Hospital from 1994 to 2011, including 18 RIC/haplo alloBMTs. Patients receiving RIC (n = 24) were older, with median age of 59 years (range, 24 to 70), than patients receiving myeloablative conditioning (MAC, n = 20), with median age of 46 years (range, 18 to 64), P = .01. The median age at RIC/haplo alloBMT was 60 years. The estimated 2-year progression-free survival (PFS) was 40% (95% confidence interval [CI], 26% to 55%) and overall survival (OS) was 43% (95% CI, 28% to 59%). In older patients (≥60, n = 14), the estimated 2-year PFS and OS were 38% (95% CI, 18% to 79%) and 45% (95% CI, 24% to 86%), respectively. On unadjusted analysis, there was a tendency toward superior outcomes for alloBMT in first remission versus beyond first remission, with an estimated 2-year PFS of 53% (95% CI, 33% to 77%) versus 29% (95% CI, 9% to 45%), P = .08. On competing risk analysis, the 1-year cumulative incidence of relapse was 38% for MAC/HLA-identical alloBMTs and 34% for RIC/haplo alloBMTs. Estimated 1-year nonrelapse mortality was 10% for MAC and 8% for RIC (11% for RIC/haplo alloBMT). On unadjusted landmark analysis, patients with acute grade II-IV or chronic graft-versus-host disease (GVHD) had a 17% probability of relapse (95% CI, 0% to 39%), compared with 66% (95% CI, 48% to 84%) in patients without GVHD, P = .04. Utilization of RIC and alternative donors expands treatment options in PTCL to those who are older and unable to tolerate high-dose conditioning, with outcomes comparable with approaches using myeloablative regimens and HLA-matched donors. AlloBMT may be appropriate in first remission in select high-risk cases.

• Authors: Jennifer A Kanakry, Yvette L Kasamon, Christopher D Gocke, Hua-Ling Tsai, Janice Davis-Sproul, Nilanjan Ghosh, Heather Symons, Javier Bolaños-Meade, Douglas E Gladstone, Lode J Swinnen, Leo Luznik, Ephraim J Fuchs, Richard J Jones, Richard F Ambinder
• Journal: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation (Biol Blood Marrow Transplant) Vol. 19 Issue 4 Pg. 602-6 (Apr 2013) ISSN: 1523-6536 [Electronic] United States
• PMID: 23370119 (Publication Type: Journal Article)
• Copyright: Copyright © 2013 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Chemical References

• HLA Antigens
• Myeloablative Agonists

Topics

• Adult
• Aged
• Bone Marrow Transplantation (immunology, mortality)
• Female
• Graft vs Host Disease (immunology, mortality, prevention & control)
• HLA Antigens (immunology)
• Histocompatibility Testing
• Humans
• Longitudinal Studies
• Lymphoma, T-Cell, Peripheral (immunology, mortality, therapy)
• Male
• Middle Aged
• Myeloablative Agonists (therapeutic use)
• Remission Induction
• Secondary Prevention
• Survival Analysis
• Transplantation Conditioning (methods)
• Transplantation, Homologous
• Unrelated Donors