Трансплантация костного мозга повышает выживаемость при гепатоспленической Т-клеточной лимфоме

TOPLINE At 3 years, more than half of patients with hepatosplenic T-cell lymphoma who underwent allogeneic hematopoietic stem cell transplantation (HSCT) were alive, according to a retrospective study. Lactate dehydrogenase at or below the upper limit of normal at diagnosis and complete remission before transplantation were both associated with significantly better survival outcomes. In patients receiving autologous transplantation, relapse occurred in 50% by 3 years, despite the majority being in complete remission at transplantation. METHODOLOGY Hepatosplenic T-cell lymphoma is a rare, aggressive lymphoma with poor responses to chemotherapy and no standard treatment. Although some guidelines recommend chemotherapy followed by allogeneic or autologous HSCT in these patients, data supporting transplantation remain limited. Researchers conducted a retrospective analysis of patients with hepatosplenic T-cell lymphoma aged 18 years or more who were registered with the European Society for Blood and Marrow Transplantation and cooperating centers in China and South Korea. They included 121 patients, of whom 94 underwent allogeneic HSCT (median age, 36 years) and 27 underwent autologous HSCT (median age, 37 years). Patients received various first-line therapies including CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone)-based regimens, platinum-based regimens, or other combinations; 44% of patients who underwent allogeneic HSCT and 74% of patients who underwent autologous HSCT were in complete remission at transplantation. The primary outcomes, assessed at 1 year and 3 years after transplantation, included overall survival, progression-free survival, relapse incidence, and non-relapse mortality. The median follow-up duration was 4.5 years for allogeneic transplant patients and 5.0 years for autologous transplant patients. Researchers also evaluated prognostic factors including lactate dehydrogenase concentration at diagnosis, disease status at transplantation, and donor type. TAKEAWAY Among patients who underwent allogeneic HSCT, 3-year progression-free survival was 50.5%, and 3-year overall survival was 55.0%. The 3-year non-relapse mortality was 11.7%, and the 3-year relapse incidence was 37.9%. Patients with lactate dehydrogenase at or below the upper limit of normal at diagnosis had significantly better overall survival (hazard ratio [HR], 0.14; P <.0001) and progression-free survival (HR, 0.22; P =.0005) than those with elevated levels. Patients who were not in complete remission at allogeneic transplantation had significantly worse overall survival (HR, 2.90; P =.0024) and progression-free survival (HR, 3.28; P =.0009) than those who were in complete remission. Among the 27 patients who underwent autologous HSCT, the 3-year progression-free survival was 38.9%, and overall survival was 63.5%; the 3-year relapse incidence was 50.0%, and non-relapse mortality was 11.1%. In the allogeneic transplant group, the 3-year graft-vs-host disease-free, relapse-free survival was 19.0%, and grade 2-4 acute graft-vs-host disease occurred in 33.3% by day 100. Donor type was not significantly associated with survival after allogeneic HSCT. IN PRACTICE “[Allogeneic HSCT] is a surprisingly effective and potentially curative treatment option for patients with hepatosplenic T-cell lymphoma, even those who are refractory to chemotherapy,” the study authors wrote. SOURCE The study, led by Imke E. Karsten, MD, University Hospital Muenster, Münster, Germany, was published online in The Lancet Haematology. LIMITATIONS The study included only patients who underwent transplantation, so the number of eligible patients who did not proceed to transplant was unknown, and the study could not determine whether transplantation improved survival compared with nontransplant approaches. The autologous HSCT group was small, and most patients were in complete response, limiting comparison with those in the allogeneic HSCT group. Tissue biopsies were not reviewed directly; instead, pathology reports were used. DISCLOSURES No funding source was reported for the study. Karsten disclosed receiving honoraria from Gilead Sciences and travel support from BeOne and Gilead Sciences. Several authors reported receiving honoraria, travel support, consulting fees, research grants, or having other ties with various sources. Full disclosures are noted in the original article. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.