Editor’s note: The title of this article was updated to better reflect the study and its results.
Treatment with allogeneic blood or marrow transplantation (alloBMT), followed by cyclophosphamide after transplantation (PTCy), is safe and well tolerated in patients with peripheral T-cell lymphoma (PTCL). However, graft source appeared to play a role in efficacy outcomes. Study findings were published in the journal Transplantation and Cellular Therapy.
In this retrospective analysis, researchers reviewed the records of patients with PTCL who had been treated with alloBMT and nonmyeloablative (NMA) conditioning, and graft-versus-host disease (GVHD) prophylaxis. Patients were adults who had undergone treatment at the Sidney Kimmel Comprehensive Cancer Center between January 2004 and December 2020. GVHD prophylaxis consisted of PTCy, mycophenolate mofetil, and tacrolimus or sirolimus; PTCy was given intravenously on posttransplantation days 3 and 4, at a dose of 50 mg/kg. Several outcomes, including overall survival (OS), progression-free survival (PFS), relapse, and nonrelapse mortality (NRM), were analyzed.
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The researchers analyzed 65 patients, median age 59 years (range, 24 to 75). Multiple subtypes of PTCL were represented in the study population. Bone marrow was used as the graft source in 71% of patients, and peripheral blood was the graft source in the other 29%.
The median study follow-up time was 2.8 years (range, 290 days to 14.2 years). The 2-year OS rate was 55% (95% CI, 44-69), and the 2-year PFS rate was 49% (95% CI, 38-64).
Peripheral blood as the graft source was associated with better efficacy outcomes in this study population than was bone marrow. The 2-year OS was 84% (95% CI, 69-100) with peripheral blood as the graft source, compared with 46% (95% CI, 33-63) with a bone marrow graft. Two-year PFS rates were 79% (95% CI, 63-100) and 39% (95% CI, 27-56), respectively. The 1-year cumulative incidence of relapse was 5% (95% CI, 0-16) with peripheral blood, compared with 33% (95% CI, 19-46) with bone marrow. GVHD and NRM rates did not appear to differ significantly by graft source.
Overall, 1-year cumulative incidence of relapse was 25% (95% CI, 14-35), and the 1-year NRM was 12% (95% CI, 4-20). There were 29 cases of GVHD, of which 2 were grade 3 or 4 acute GVHD and 3 were severe chronic GVHD. NRM was reported in 14 patients and was associated with infection (8 patients), cardiovascular disease (3 patients), kidney failure (2 patients), and therapy-related myeloid neoplasm (1 patient).
“Based on our results, [peripheral blood] allografts in this setting are safe and may offer superior outcomes in PTCL,” the researchers wrote in their report. They also noted that a total body irradiation dose of 400 cGy used with most peripheral blood allografts may have contributed to results with this graft source in this study.
“In conclusion, alloBMT using NMA conditioning with PTCy for GVHD prophylaxis is well-tolerated in patients with PTCL,” the researchers concluded.
Reference
Sterling CH, Hughes MS, Tsai HL, et al. Allogeneic blood or marrow transplantation with post-transplantation cyclophosphamide for peripheral T-cell lymphoma: the importance of graft source. Transplant Cell Ther. Published online December 19, 2022. doi:10.1016/j.jtct.2022.12.009
