Outcome of Stem Cell Transplantation in HTLV-1-Associated North American Adult T-Cell Leukemia/Lymphoma

Abdul Hamid Bazarbachi, Daniel Reef, Hiba Narvel, Riya Patel, Rama Al Hamed, Sindhu Vikash, Karun Neupane, Eleftheria Atalla, Astha Thakkar, Shafia Rahman, Urvi Shah, Diego Adrianzen-Herrera, Ryann Quinn, Sumaira Zareef, Emma Rabinovich, Alyssa De Castro, Felisha Joseph, Kailyn Gillick, Jennat Mustafa, Fariha KhatunAmanda Lombardo, Latoya Townsend-Nugent, Michelly Abreu, Nicole Chambers, Richard Elkind, Yang Shi, Yanhua Wang, Olga Derman, Kira Gritsman, Ulrich Steidl, Mendel Goldfinger, Noah Kornblum, Aditi Shastri, Ioannis Mantzaris, Liza Bachier-Rodriguez, Nishi Shah, Dennis Cooper, Amit Verma, Bihui Hilda Ye, Murali Janakiram, Roberto Alejandro Sica

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Adult T-cell leukemia/lymphoma (ATLL) remains challenging to treat and has dismal outcome. Allogeneic stem-cell transplantation (allo-SCT) has promising results, but data remain scarce. In this single-center retrospective analysis of 100 patients with ATLL from north America (67 acute, 22 lymphomatous), 17 underwent allo-SCT and 5 autologous SCT (ASCT), with a median follow-up of 65 months. Post-transplant 3-years relapse incidence (RI) and non-relapse mortality (NRM) were 51% and 37%, respectively, and 3-year progression-free survival (PFS) and overall survival (OS) were 31% and 35%, respectively. ASCT 1-year RI was 80% compared to 30% in allo-SCT (p = 0.03). After adjusting for immortal-time bias, allo-SCT had significantly improved OS (HR = 0.4, p = 0.01). In exploratory multivariate analysis, patients achieving first complete response and Karnofsky score ≥ 90 had significantly better outcomes, as did Black patients, compared to Hispanics, who had worse outcome. In transplanted patients, 14 died within 2 years, 4 of which ASCT recipients. Our data are the largest ATLL transplant cohort presented to date outside of Japan and Europe. We show that allo-SCT, but not ASCT, is a valid option in select ATLL patients, and can induce long term survival, with 40% of patients alive after more than 5 years.

Original languageEnglish (US)
Pages (from-to)78-91
Number of pages14
JournalClinical Hematology International
Volume5
Issue number2-3
DOIs
StatePublished - Jun 2023

Keywords

  • Adult T-cell leukemia/Lymphoma
  • Allogeneic stem-cell transplantation
  • Autologous stem-cell transplantation
  • Black
  • Hispanic
  • Human T-cell lymphotropic virus type I
  • Minority
  • North American

ASJC Scopus subject areas

  • Health Professions (miscellaneous)
  • Hematology

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