AW-02. Allogeneic hematopoietic stem cell transplantation in the treatment of peripheral T-cell lymphomas: a multicenter experience
Elena E. Lepik1, Vladislav V. Kovalik1, Andrey V. Kozlov1, Evgenia S. Borzenkova1, Kirill V. Lepik1, Elena V. Kondakova1, Nikita P. Volkov1, Vadim V. Baykov1, Marina O. Popova1, Ivan S. Moiseev1, Tatiana V. Shneider2, Olga S. Uspenskaya2, Marina V. Demchenkova3, Vera V. Sergeevicheva4, Vadim M. Kemaikin5, Gayane S. Tumyan6, Anastasia A. Semenova6, Ilya S. Zyuzgin7, Natalia B. Mikhailova1, Alexander D. Kulagin1
1 RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia
2 Leningrad Regional Clinical Hospital, St. Petersburg, Russia
3 Irkutsk Regional Cancer Center, Irkutsk, Russia
4 Research Institute of Fundamental and Clinical Immunology, Novosibirsk, Russia
5 National Research Oncology Center, Nur-Sultan, Kazakhstan
6 N. N. Blokhin National Medical Research Center of Oncology, Moscow, Russia
7 N. N.Petrov National Medical Research Center of Oncology, St. Petersburg, Russia
Contact: Dr. Elena E. Lepik, e-mail: ee.dav@mail.ru
Summary
Mature T/NK-cell lymphomas (TCL) are a group of rare, predominantly aggressive non-Hodgkin’s lymphomas that are also characterized by the development of a refractory or relapsed disease during standard chemotherapy-based treatments. The introduction of new treatments, such as targeted immunotherapy, may help to achieve remission in some cases, but not a cure. The only method with a proven curative potential is allogeneic hematopoietic stem cell transplantation (allo-HSCT). We analyzed the results of allo-HSCT performed in several centers in Russia and Kazakhstan.
Patients and methods
Allo-HSCT data were analyzed for 24 patients with TCL, who were treated in 7 clinical centers in Russia and Kazakhstan from 2005 to 2022. Histological subtypes included: peripheral T-cell lymphoma, NOS (n=9); ALK-positive anaplastic large cell lymphoma (n=10); nodal TFH cell lymphoma, angioimmunoblastic type (n=2) (WHO Classification, 2022). The remaining patients (n=3) have other rarer types of TCL. The median age was 37 years (1-58). Median number of lines prior to allo-HSCT was 3 (1-9). Pre-transplant treatment was mainly based on targeted immunotherapy (n=14): brentuximab vedotin (n=4); brentuximab vedotin+bendamustine (n=3); nivolumab (n=1); nivolumab+bendamustine (n=1); ceritinib/crizotinib (n=2); brentuximab vedotin + crizotinib (n=1); lenalidomide (n=1); lenalidomide+romidepsin (n=1). The conditioning regimens used were reduced intensity regimens (FluBe n=22; FluMel n=1; FluCy n=1). In all patients, the GVHD prophylaxis regimen was based on posttransplant cyclophosphamide.
Results
18 patients were alive at the time of analysis. Median follow-up was 27 months. The median overall survival (OS) was not reached, the 3-year OS rate was 72%. The median progression-free survival (PFS) was 17 months, 3-year PFS is 50%. The subgroup analysis showed that patients who underwent allo-HSCT in a complete response (CR) have an advantage over patients who underwent allo-HSCT with a partial response or with an active disease status (SD/PD) – (PFS 3-year 73% vs 20% vs 0%, p=0.019). The incidence of acute GVHD grade II-IV and severe GVHD grade III-IV was 25% and 21%, respectively. The frequency of chronic GVHD was 26%. 6 patients underwent anti-relapse treatment after allo-HSCT with CR achieved in 5 patients, these responses persist at the time of follow up. Treatment in the post-transplant period was based on stimulation of the graft-versus-lymphoma (GVL) effects, i.e., donor lymphocyte infusions (n=3), nivolumab (n=1), or targeted treatment, e.g., brentuximab vedotin (n=2); crizotinib/ceritinib (n=3).
Conclusions
Our data provide additional evidence that allo-HSCT is an effective treatment option for patients with TCL. Conducting allo-HSCT in CR is associated with a better prognosis for patients with TCL. In our analysis, we also saw the feasibility of treating relapses after allo-HSCT using targeted antitumor effects and/or stimulation of GVL effects.
Keywords
T cell lymphoma, peripheral, diagnosis, therapy, hematopoietic stem cell transplantation.
