Outcomes with allo-HSCT and auto-HSCT in hepatosplenic T-cell lymphoma

Results from a retrospective European Society for Blood and Marrow Transplantation (EBMT) Lymphoma Working Party analysis of hematopoietic stem cell transplantation (HSCT) in 121 patients with hepatosplenic T-cell lymphoma (HSTCL) were published in The Lancet Haematology by Karsten et al. Patients were stratified based on whether they underwent allogeneic HSCT (allo-HSCT; n = 94) or autologous HSCT (auto-HSCT; n = 27). Outcomes were assessed at 1 and 3 years post-HSCT and included overall survival (OS); progression-free survival (PFS); relapse incidence; non-relapse mortality (NRM); graft-versus-host disease (GvHD)-free, relapse-free survival (GRFS); and incidence of acute GvHD (aGvHD) and chronic GvHD (cGvHD).

Key data: At a median follow-up of 4.5 years, the PFS rates at 1 and 3 years in patients who underwent allo-HSCT were 59.6% (95% confidence interval [CI], 48.6–69.0) and 50.5% (95% CI, 39.4–60.5), respectively. The 1- and 3-year OS rates in the allo-HSCT group were 67.7% (95% CI, 57.2–76.2) and 55.0% (95% CI, 43.9–64.8), respectively, and NRM rates were 9.1% (95% CI, 4.2–16.2) and 11.7% (95% CI, 5.9–19.5), respectively. The 1- and 3-year relapse incidences were 31.3% (95% CI, 22.0–41.1) and 37.9% (95% CI, 27.6–48.1), respectively. The 1- and 3-year GRFS rates were 23.9% (95% CI, 15.7–32.9) and 19.0% (95% CI, 11.6–27.7), respectively. At a median follow-up of 5.0 years, the 1- and 3-year PFS rates were 61.1% (95% CI, 35.3–79.2) and 38.9% (95% CI, 17.5–60.0), respectively, and the OS rates were 81.2% (95% CI, 60.5–91.7) and 63.5% (95% CI, 41.3–79.3), respectively, in patients who underwent auto-HSCT. The 1- and 3-year NRM rates in the auto-HSCT group were 5.6% (95% CI, 0.3–23.1) and 11.1% (95% CI, 1.7–30.7), respectively, and the relapse incidences were 33.3% (95% CI, 13.0–55.3) and 50.0% (95% CI, 24.9–70.8), respectively.

Key learning: In this study, allo-HSCT represented an effective and potentially curative treatment option for patients with HSTCL, while auto-HSCT was associated with higher relapse rates, suggesting it might only be recommended for patients in complete remission (CR) who are ineligible for allo-HSCT.