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399 Hematopoietic Stem Cell Transplantation in Hepatosplenic T-Cell Lymphoma: A Retrospective Analysis of the EBMT Lymphoma Working Party

Program: Oral and Poster Abstracts
Type: Oral
Session: 906. Outcomes Research: Lymphoid Malignancies Excluding Plasma Cell Disorders: Learning from the Real World: Predictors of Outcomes in Understudied Lymphomas and Underrepresented Populations
Hematology Disease Topics & Pathways:
Research, Lymphomas, Clinical Practice (Health Services and Quality), Clinical Research, T Cell lymphoma, Diseases, Therapy sequence, Treatment Considerations, Registries, Lymphoid Malignancies
Saturday, December 7, 2024: 4:30 PM

Imke E. Karsten1*, Norbert Schmitz, MD2*, Mathilde Fekom3*, Laurence de Leval, MD, PhD4, Hervé Finel5*, Irma Khvedelidze6*, Won Seog Kim, MD7*, Depei Wu, MD, PhD8, Montserrat Rovira, MD, PhD9*, Fengrong WANG, MD10*, Xiao-Jun Huang, MD, PhD11, Peter Dreger12, Johan Maertens, MD, PhD13*, Paolo Corradini, MD14, Grzegorz Helbig15*, Wolfgang Andreas Bethge, MD16*, Larry Bacon, PhD, MB BCh BAO, MRCPI, FRCPath,17*, Jan Vydra, MD18*, Aitana Balaguer Rosello, MD, PhD19*, Matthias Stelljes, MD2*, Georg Lenz20*, Alina Daniela Tanase, md, phd21, Anna Sureda Balari, MD, PhD22, Ali Bazarbachi, MD, PhD23 and Bertram Glass, MD24*

1Department of Medicine A, University Hospital Muenster, Muenster, Germany
2Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
3European Bone Marrow Transplantation Lymphoma Working Party, Paris, France
4Hôpital Universitaire de Lausanne, Lausanne, Switzerland
5European Society for Blood and Marrow Transplantation, Paris, France
6Paris Study Unit, Hôpital Saint-Antoine, European Society for Blood and Marrow Transplantation, Paris, France
7Samsung Medical Center, Division of Hematology-Oncology, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea, Republic of (South)
8Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
9Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
10People's Hospital Institute of Hematology, Beijing, CHN
11Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
12Department of Medicine V, Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
13Department of Hematology, University Hospital Gasthuisberg, Leuven, Belgium
14University of Milan. Hematology Division, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
15Department of Hematology, Medical University of Silesia, Katowice, Poland
16Department of Internal Medicine II, Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tuebingen, Tübingen, Germany
17National Adult Stem Cell Transplant and Adult CAR T-cell Programme, Haematology, St James's Hospital, Dublin, IRL
18Institute of Hematology and Blood Transfusion, Prague 10, CZE
19Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
20University Hospital Muenster, Muenster, Germany
21Institutul clinic fundeni, clădirea B, director medical, Bucharest, Romania
22Hematology Department, Institut Català d’Oncologia - Hospitalet, IDIBELL, University of Barcelona, Hospitalet de Llobregat, Spain
23American University of Beirut Dept. of Medicine, Beirut, Lebanon
24Department of Hematology and Cell Therapy, Helios Klinikum Berlin-Buch, Berlin, Germany

Introduction

Hepatosplenic T-cell lymphoma (HSTCL) is a very rare disease accounting for 1-2% of all peripheral T-cell lymphomas (PTCL). HSTCL shows a highly aggressive clinical course and often a very poor outcome. Guidelines mostly recommend aggressive chemotherapy followed by allogeneic hematopoietic stem cell transplantation (allo HSCT) in responding and transplant-eligible patients (pts) although evidence is limited and data on transplant outcomes are scarce.

Methods

We conducted a retrospective analysis of EBMT registry data and data from registries of cooperating centers in China and South Korea. The following inclusion criteria were applied: pts with HSTCL confirmed by review of pathology reports (LdL) in 62 % of cases, first autologous or allogeneic stem cell transplantation (SCT) between 2003 and 2024. Outcome data were calculated from the day of transplantation until the respective event.

Results

After exclusion of pts with pathology reports not consistent with HSTCL, 121 pts were included in this analysis (100 pts from the EBMT registry and 21 pts from Asian registries). Of these, 94 pts underwent allo HSCT and 27 pts autologous HSCT.

Median age of allografted pts was 36 years (range 15-68; female 29 pts). 35 pts (38%) were allografted after 1 line of conventional therapy; 56 pts (62%) were transplanted after 2 or more lines of conventional therapy. Remission status at the time of allo HSCT was complete remission (CR) in 53 %, partial remission (PR) in 9 %, and chemorefractory/progressive disease (PD) in 38 % of pts.

With median follow-up of 4.5 years (95% CI: 3.1 – 6.2 years), the 1-year and 3-year progression-free survival (PFS) rates for 94 pts with allo HSCT were 59.6 % (95 % CI: 48.6 – 69 %) and 50.5 % (95 % CI: 39.4 – 60.5 %), respectively. One-year and 3- year overall survival (OS) rates were 67.7 % (95 % CI: 57.2 – 76.2 %) and 55 % (95 % CI: 43.9 – 63.4 %). The cumulative incidences of non-relapse mortality (NRM) after 1 year and 3 years were: 9.1 % (95 % CI: 4.2 - 16.2 %) and 11.7 % (95 % CI: 5.9 - 19.5 %) with a relapse incidence (RI) of 31.3 % (95 % CI: 22 - 41.1 %) and 37.9 % (95 % CI: 27.6 - 48.1 %) after 1 year and 3 years respectively.

Pts responding to conventional therapy (CR/PR) showed 1-year and 3-year PFS rates of 73.3 % (95 % CI: 57.7 - 83.8 %) and 63.4 % (95 % CI: 47.2 - 75.8 %), respectively, compared to non-responders who had PFS rates of 43.4 % (95 % CI: 24.9 – 60.6 %) and 34.7 % (95 % CI: 17.5 – 52.6 %), respectively. One-year and 3-year OS rates for responders were 79.1 % (95 % CI: 64.6 – 88.1 %) and 65.3 % (95 % CI: 49.6 – 77.1 %) and 55.3 % (95 % CI: 35.7 – 71.2 %) and 41.9 % (95 % CI: 22.8 – 59.9 %) for non-responders, respectively.

Median follow-up of 27 pts after auto SCT (median age 37 years, range 23-67; female 10 pts) was 5 years (95 % CI: 3 - 8.4 years). One-year and 3-year PFS rates were 61.1 % (95 % CI: 35.3 – 79.2 %) and 38.9 % (95 % CI: 17.5 - 60 %), respectively. The corresponding OS rates were 81.2 % (95 % CI: 60.5 – 91.7 %) and 63.5 % (95 % CI: 41.3 – 79.3 %), respectively.

Conclusions

In this large cohort of Asian and European pts, we demonstrate that allo HSCT is an effective and potentially curative treatment option for HSTCL even in pts unresponsive to chemotherapy. Half of the pts responding to conventional chemotherapy and more than one-third of pts with PD prior to allo HSCT achieved long-term survival which seems clearly better than after any other treatment reported so far. The smaller cohort of pts after auto SCT also showed promising survival rates. However, more pts relapse with time, and selection bias has to be taken into account.

Allo HSCT should be an option to all transplant-eligible pts with HSTCL as first-line treatment.

Disclosures: Schmitz: Janssen: Research Funding; Beigene: Other: travel grant; Roche: Honoraria, Other: travel grant; Astra Zeneca: Research Funding; Abbvie: Research Funding; BMS: Current equity holder in publicly-traded company. Kim: Sanofi: Research Funding; Boryong: Research Funding; Kyowa-Kirin: Research Funding; F. Hoffmann-La Roche Ltd: Research Funding; Donga: Research Funding; BeiGene: Research Funding. Corradini: Sanofi: Other: Honoraria (for consultancy, participation in advisory boards, or lectures); Celgene: Other: Honoraria (for consultancy, participation in advisory boards, or lectures); support for travel and accommodations; Amgen: Other: Honoraria (for consultancy, participation in advisory boards, or lectures); support for travel and accommodations; SOBI: Other: Honoraria (for consultancy, participation in advisory boards, or lectures); Gilead/Kite: Other: Honoraria (for consultancy, participation in advisory boards, or lectures); support for travel and accommodations; Roche: Other: Honoraria (for consultancy, participation in advisory boards, or lectures); support for travel and accommodations; Daiichi Sankyo: Other: Honoraria (for consultancy, participation in advisory boards, or lectures); Kyowa Kirin: Other: Honoraria (for consultancy, participation in advisory boards, or lectures); Janssen: Other: Honoraria (for consultancy, participation in advisory boards, or lectures); support for travel and accommodations; AbbVie: Other: Honoraria (for consultancy, participation in advisory boards, or lectures); support for travel and accommodations; Pfizer: Other: Honoraria (for consultancy, participation in advisory boards, or lectures); Novartis: Other: Honoraria (for consultancy, participation in advisory boards, or lectures); support for travel and accommodations; Takeda: Other: Honoraria (for consultancy, participation in advisory boards, or lectures); support for travel and accommodations; Bristol Myers Squibb: Other: Support for travel and accommodations; GlaxoSmithKline: Other: Honoraria (for consultancy, participation in advisory boards, or lectures); Incyte: Other: Honoraria (for consultancy, participation in advisory boards, or lectures). Stelljes: Pfizer: Consultancy, Honoraria, Other: Travel- & congress-support, Research Funding; Astellas: Consultancy, Honoraria; Abbvie: Honoraria; Amgen: Consultancy, Honoraria; BMS: Consultancy, Honoraria; MSD: Consultancy, Honoraria; Incyte: Consultancy, Honoraria; Celgene: Honoraria; Gilead: Honoraria; Takeda: Consultancy; Medac: Honoraria, Other: Travel- & congress-support; Jazz Pharmaceuticals: Honoraria; Novartis: Honoraria. Bazarbachi: Jansen: Honoraria, Research Funding; Takeda: Honoraria; Biologix: Research Funding; Amgen: Honoraria; Roche: Honoraria, Research Funding; Caribou: Honoraria; Pfizer: Research Funding. Glass: Kite Gilead, Novartis, BMS, Roche, Miltenyi, Incyte: Honoraria; Riemser, Roche: Other: grants ; Roche, Kite Gilead, BMS: Other: travel support .

*signifies non-member of ASH