Work

Outcomes after Allogeneic Transplantation with Reduced Intensity Conditioning and Post Transplant Cyclophosphamide GvHD Prophylaxis in T-Cell Lymphomas: A Single Institution Experience

Year: 2025

Type: article

Abstract: Background Allogeneic stem cell transplantation (allo-SCT) remains a potentially curative treatment for relapsed/refractory aggressive T-cell lymphomas via conditioning chemo- or chemoradiotherapy and graft-versus-lymphoma (GVL) effect. Reduced-intensity conditioning (RIC) regimens with posttransplant cyclophosphamide (PTCy) immunosuppression may improve outcomes by increasing donor availability, reducing treatment toxicity, and shortening the time to immune reconstitution . We report outcomes following RIC and PTCy with an emphasis on Haplo-identical transplantation. Methods This retrospective study enrolled 28 patients with T-ALL:1, ALCL : 6, HSL:1, MF:5, PTCL NOS: 7, and T-PLL: 4 who received allo-SCT from 2019 to 2024 with RIC (Pento/TBI: 20, Flu/Cy/TBI: 7, Flu/TBI: 1). At the time of allo-SCT, 21 patients were in CR and seven were non-CR. All patients received tacrolimus-based GVHD prophylaxis, and 11 received PTCy (50mg/kg day +3 and +4). Outcomes included grade 3-4 acute graft-versus-host disease (aGVHD), extensive chronic GVHD (cGVHD), relapse, non-relapse mortality (NRM), overall survival (OS), relapse-free (RFS), and GVHD-free, relapse-free survival (GRFS). Results Among the 28 patients, the median age was 61 (range 28-77), and eight were 65 or older. Seventeen (61%) were men. Donors included matched related (MRD) in 2 (7%), matched unrelated (MUD) in 15 (54%), Haplo-identical (Haplo) in 7 (25%), and mismatched unrelated (MMUD) in 4 (14%). Ten (36%) patients had received a prior autologous SCT. The median follow-up after allo-SCT was 11 months (95% CI 4 – 38), and the median OS was not reached. The cumulative incidence rate of aGVHD was 29% and 14% for extensive cGVHD. Overall survival was significantly better for Haplo than MRD/MUD transplantation (median OS not reached vs. 10m; p = 0.015). There was a trend toward longer RFS and fewer relapses with Haplo transplant. By day 100, 16 (57%) patients experienced one or more infections, including bacterial (12), viral (5), and fungal (1). Renal toxicity was noted in 9 (32%) patients. Three (17%) patients had CMV reactivation. Within the first year, 29% (8) of deaths were due to relapse (2), acute GVHD (2), and infection (4). Conclusions This single-center experience suggests that RIC with PTCy is well-tolerated and associated with improved overall survival. Multi-center studies are needed to evaluate RIC with PTCy prospectively to better define outcomes and potential survival benefits for T-cell lymphoma patients.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.jtct.2025.01.606