PracticeUpdate: Conference Series - EHA 2018

Neither Myeloablative nor Reduced-Intensity Conditioning Impact Overall Survival in T-Cell Lymphoma Largest cohort of allo-hematopoietic stemcell transplantation patients for T-cell lymphoma provides encouraging results

Encouraging results have been found in both myeloablative conditioning (MAC) and reduced-intensity conditioning (RIC) in what is believed to be the largest cohort of allo-hematopoietic stem cell transplantation (HSCT) patients for T-cell lymphoma, according to new research presented at EHA 2018. T he aim of the study, led by Anne- Claire Mamez, MD, with the Department of Internal Medicine

of relapse was 18% after the first year and 22% at 2 years. The median time from transplant to relapse was 94 days and only 10% of the relapse occurred after the first year post-transplant. Non-relapse mortality was 22% at 1 year and 24% at 2 years. The main causes of death were relapse (35%), infection (27%) or GvHD (22%). A multivariate analysis conducted by the research team found that at year 5 OS was significantly adversely influenced by the occurrence of grade III–IV GvHD (HR 2.52 [1.52–4.19], P < .01), low Karnofsky score at the time of transplant (HR 2.22 [1.32–3.71], P = .002), and cord blood transplant compared to bone marrow (HR 2.01 [1.00–4.01], P = .049). The main fac- tors associated with non-relapse mortality were as follows: ƒ ƒ patient’s age (HR 1.02, P = .084 [MTR3]) ƒ ƒ a low Karnofsky score (HR 2.03 [1.08– 3.83], P = .029) ƒ ƒ female donor to male recipient (HR 1.87 [1.07–3.28], P = .027). “The conditioning regimen intensity (RIC or MAC) was not found to have impact on OS,” the researchers stated in their abstract. Among 30 patients transplanted in PD, 50% reached complete remission after allo-HSCT and 2 year-OS was 51% in this subgroup.

response (PR) and 11% in progressive disease (PD). Twenty-eight percent were transplanted in frontline treatment, 36% after 2 lines of treatment, and 35% after 3 or more lines of treatment. After the first autologous HSCT, 23% of patients had relapsed and the Karnofsky Performance Status Scale Index was up to 80% in 94% of the patients. The Index is a widely used assessment tool to measure functional impairment. It can be used to compare the effectiveness of different therapies as well as to evaluate the prognosis in indi- vidual patients. Generally, for most serious illnesses, as the Karnofsky score declines, the likelihood of survival decreases. Donors were matched related in 45% of cases, matched unrelated in 36%, and alternative in 19% (haplo-identical n=7, cord blood n=33, mismatched 9/10 n=13) and the stem cell source was peripheral blood in 71% of the patients. A reduced-intensity regiment was given in 147 patients (52%), myeloablative in 106 (38%), and nonmyeloablative in 27 (10%). Half of all patients received an ex-vivo T cell depletion; only 1% had an ex vivo T depletion. Fourteen patients (14%) developed grade III–IV acute graft versus host disease (GvHD), and 34% developed chronic GvHD (extensive for 13%). The median follow-up was 33 months. The 1- and 2-year OS were 68% (95% CI 0.62–0.73) and 64% (95% CI 0.58–07), respectively. The cumulative incidence

Specialties at the University of Geneva, Switzerland, was to analyze the outcomes in a cohort of nearly 300 patients who had undergone an allo-HSCT for peripheral T-cell lymphoma. Three outcomes were measured: overall survival (OS), relapse/ progression, and non-relapse mortality. Using clinical files and data from the Société Francophone De Greffe De Moelle Et De Thérapie Cellulaire data- base, which has more than 400 members engaged in stem cell transplantation research, the study investigators con- ducted a retrospective analysis of adult patients who underwent an allo-stem cell transplant for non-cutaneous peripheral T-cell lymphoma (PTCL) in 34 centers between 2006 and 2014. Primary cuta- neous T-cell lymphomas were excluded. According to the abstract, a total of 284 patients with PTCL were allo-transplanted in a median time of 12.6 months after diagnosis (3–322 months). This com- prised 39% NOS-T cell lymphomas, 29% angioimmunoblastic T lymphomas, 15% anaplastic T-cell lymphomas, 17% in other categories. The median age at transplant was 50 years (15 to 60 years) and 67% were males. At the time of transplant, 62% were in complete remission (CR), 27% in partial

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EHA 2018 • PRACTICEUPDATE CONFERENCE SERIES