Bhagirathbhai R Dholaria1, Ernesto Ayala2, Lubomir Sokol3, Taiga Nishihori1, Julio C Chavez3, Mohammad Hussaini4, Ambuj Kumar5, Mohamed A Kharfan-Dabaja1. 1. Department of Blood & Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA. 2. Department of Blood & Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA. Electronic address: Ernesto.Ayala@moffitt.org. 3. Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL, USA. 4. Department of Hematopathology, Moffitt Cancer Center, Tampa, FL, USA. 5. Program for Comparative Effectiveness Research, University of South Florida College of Medicine, Tampa, FL, USA.
Abstract
BACKGROUND: T- cell prolymphocytic leukemia (T- PLL) is a rare aggressive hematological malignancy. Alemtuzumab, an anti-CD52 humanized monoclonal antibody, is the treatment of choice for remission induction. Allogeneic hematopoietic cell transplantation (allo-HCT) has been described to induce durable remissions and improve survival, but data is limited. PATIENTS AND METHODS: We evaluated clinical outcomes of 11 patients, median age of 56 (range, 43-71) years who underwent allo-HCT for T-PLL. The majority of cases were in the first complete remission (CR1 = 9, CR2 = 1, second partial response PR2 = 1) at time of allo-HCT. Myeloablative conditioning was the most commonly prescribed preparative regimen (n = 8, 73%) and tacrolimus plus sirolimus was most commonly prescribed regimen for graft-versus-host disease prophylaxis (n = 5, 46%). RESULTS: The median follow-up for surviving patients was 48 (range, 6-123) months. The 4-year progression-free survival (PFS) and overall survival (OS) were 45% (95% confidence interval (CI) = 13-78%) and 56% (95% CI = 24-89%), respectively. Cumulative incidence of non-relapse mortality (NRM) at 4-year post-transplantation was 34% (95%CI = 14-85%). The 4-year cumulative incidence of relapse/progression was 21% (95% CI = 6-71%). CONCLUSION: Allo-HCT is an effective treatment for T-PLL. Patients must be evaluated for their candidacy for allo-HCT as soon as the diagnosis is confirmed. Efforts are needed to decrease NRM and relapse.
BACKGROUND: T- cell prolymphocytic leukemia (T- PLL) is a rare aggressive hematological malignancy. Alemtuzumab, an anti-CD52 humanized monoclonal antibody, is the treatment of choice for remission induction. Allogeneic hematopoietic cell transplantation (allo-HCT) has been described to induce durable remissions and improve survival, but data is limited. PATIENTS AND METHODS: We evaluated clinical outcomes of 11 patients, median age of 56 (range, 43-71) years who underwent allo-HCT for T-PLL. The majority of cases were in the first complete remission (CR1 = 9, CR2 = 1, second partial response PR2 = 1) at time of allo-HCT. Myeloablative conditioning was the most commonly prescribed preparative regimen (n = 8, 73%) and tacrolimus plus sirolimus was most commonly prescribed regimen for graft-versus-host disease prophylaxis (n = 5, 46%). RESULTS: The median follow-up for surviving patients was 48 (range, 6-123) months. The 4-year progression-free survival (PFS) and overall survival (OS) were 45% (95% confidence interval (CI) = 13-78%) and 56% (95% CI = 24-89%), respectively. Cumulative incidence of non-relapse mortality (NRM) at 4-year post-transplantation was 34% (95%CI = 14-85%). The 4-year cumulative incidence of relapse/progression was 21% (95% CI = 6-71%). CONCLUSION: Allo-HCT is an effective treatment for T-PLL. Patients must be evaluated for their candidacy for allo-HCT as soon as the diagnosis is confirmed. Efforts are needed to decrease NRM and relapse.
Authors: Hemant S Murthy; Kwang Woo Ahn; Noel Estrada-Merly; Hassan B Alkhateeb; Susan Bal; Mohamed A Kharfan-Dabaja; Bhagirathbhai Dholaria; Francine Foss; Lohith Gowda; Deepa Jagadeesh; Craig Sauter; Muhammad Bilal Abid; Mahmoud Aljurf; Farrukh T Awan; Ulrike Bacher; Sherif M Badawy; Minoo Battiwalla; Chris Bredeson; Jan Cerny; Saurabh Chhabra; Abhinav Deol; Miguel Angel Diaz; Nosha Farhadfar; César Freytes; James Gajewski; Manish J Gandhi; Siddhartha Ganguly; Michael R Grunwald; Joerg Halter; Shahrukh Hashmi; Gerhard C Hildebrandt; Yoshihiro Inamoto; Antonio Martin Jimenez-Jimenez; Matt Kalaycio; Rammurti Kamble; Maxwell M Krem; Hillard M Lazarus; Aleksandr Lazaryan; Joseph Maakaron; Pashna N Munshi; Reinhold Munker; Aziz Nazha; Taiga Nishihori; Olalekan O Oluwole; Guillermo Ortí; Dorothy C Pan; Sagar S Patel; Attaphol Pawarode; David Rizzieri; Nakhle S Saba; Bipin Savani; Sachiko Seo; Celalettin Ustun; Marjolein van der Poel; Leo F Verdonck; John L Wagner; Baldeep Wirk; Betul Oran; Ryotaro Nakamura; Bart Scott; Wael Saber Journal: Transplant Cell Ther Date: 2022-01-23