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2415 Autologous Stem Cell Transplantation (ASCT) for T-Cell Non Hodgkin Lymphoma (T-NHL) Patients Who Achieve Complete Remission with First-Line Treatment: A Systematic Review and Meta-Analysis

Program: Oral and Poster Abstracts
Session: 731. Clinical Autologous Transplantation: Results: Poster II
Hematology Disease Topics & Pathways:
Biological, Diseases, Therapies, T-Cell Lymphoma, Lymphoid Malignancies, Study Population, Clinically relevant, transplantation
Sunday, December 6, 2020, 7:00 AM-3:30 PM

Yin Jie Koh1*, Louis-Pierre Girard, MBChB2*, Hian Li Esther Hian Li Chan, MRCP, FRCPATH3*, Joanne Shu Xian Lee, MBBS, MRCP4,5*, Yen-Lin Chee, MBChB, FRCPath, PhD3, Anand Jeyasekharan6*, Sanjay de Mel, MRCP(UK) FRCPath7*, Cinnie Yentia Soekojo, MD8, Xin Liu9*, Liang Piu Koh, MBBS, MRCP1*, Michelle Poon, MBBS, MRCP, FRCPATH10* and Miny Samuel11*

1Department of Haematology­-Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore
2Aberdeen Royal Infirmary, Aberdeen, United Kingdom
3Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore, Singapore
4Department of Haematology-Oncology, National University Cancer Institute of Singapore (NCIS), Singapore, Singapore
5National University Hospital, Singapore, Singapore
6Department of Haematology-Oncology, National University Cancer Institute of Singapore, Singapore, Singapore
7Department of Haematology Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore
8Department of Hematology-Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore
9Department of Haematology-Oncology, National University Hospital, National University Cancer Institute, Singapore (NCIS), Singapore, Singapore
10Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore
11Research Support Unit, National University of Singapore, Singapore, Singapore


There is currently no consensus on the optimal frontline therapy for patients with T cell Non-Hodgkin lymphomas (T-NHL). Consolidative autologous stem cell transplant (ASCT) is frequently offered to the patients with chemosensitive disease based on retrospective and prospective studies showing improved progression-free survival (PFS) when compared with historical controls getting chemotherapy alone. However, it remains unclear whether there is a good risk subset of patients who achieve first complete remission (CR1) following induction chemotherapy and who might not benefit from upfront ASCT. To date, no randomized control trials (RCTs) exist and available data is conflicting. We perform a systematic review/meta-analysis of the published literature to address this question.


A comprehensive, systematic search (from database inception – 9/2019) of MEDLINE/PubMed, EMBASE and Cochrane databases was performed. PRISMA and Meta‐Analysis Of Observational Studies in Epidemiology (MOOSE) guidelines were followed. Studies were selected from a total of 2656, screened based on predefined inclusion/exclusion criteria, and were critically appraised for outcomes of interest [progression free survival (PFS) and overall survival (OS)]. Quality of studies was assessed using Newcastle-Ottawa Scale. Hazard ratios (HRs) and corresponding 95% Cis were calculated, and the meta-analysis was performed using the random-effects model. Test for heterogeneity was performed using I2 statistic.


Of 2656 unique records, 13 studies (prospective = 3; retrospective = 10) were selected. In 8 studies, upfront ASCT was compared to NO ASCT in patients in first complete remission (CR1), while in 5, comparison was with patients achieving either PR1 (first partial remission) or CR1. 11 (of 13) studies reported PFS. Median follow-up in these studies ranged from 22 months to 7.8 years. Results from the meta-analysis showed that T-NHL patients who underwent ASCT had an improved 5-year PFS compared to those with NO ASCT (HR 1.62, 95% confidence interval (CI) 1.22 to 2.15, I² = 38%) (Figure 1). However, no benefit was observed in 5-year OS when ASCT was compared to NO ASCT (HR 1.32, 95% CI 0.82 to 2.12, I2 = 83%) (Figure 2). A sensitivity analysis including only studies with patients transplanted in CR1 showed similar findings, with a 5-year PFS (HR 1.54, 95% confidence interval (CI) 1.01 to 2.34, I² = 38%) and 5-yr OS (HR 1.11, 95% CI 0.41 to 3.02, I2 = 90%) when compared to No ASCT.


In the absence of RCTs, the results of this systematic review/meta-analysis represents the best evidence supporting long term PFS benefits of upfront ASCT consolidation in patients with T-NHL in CR1 or CR1/PR1 after frontline chemotherapy.

Disclosures: No relevant conflicts of interest to declare.

*signifies non-member of ASH