Autologous and allogeneic stem cell transplantation for ALK-positive anaplastic large cell lymphoma: An analysis of the EBMT lymphoma working party
Year: 2025
Type: conference-abstract
Abstract: Background Adults with anaplastic lymphoma kinase-positive anaplastic large cell lymphoma (ALK-pos. ALCL) treated with CHOP or variants have a significantly better prognosis than patients (pts) with other major T-cell entities. Accordingly, the experience with autologous (ASCT) and allogeneic transplantation (allo-SCT) in such pts is limited. Methods: We analyzed major outcomes of pts >18 years diagnosed with ALK-pos. ALCL and registered with EBMT and co-operating Asian centers between 2010 and 2022. Because of the large patient numbers we were able to separately analyze pts transplanted up-front and for relapsed/ refractory (r/r) disease. Results: In total, 282 pts underwent ASCT (up-front n=81; salvage n=201) and 77 pts salvage allo-SCT (median age 40 and 31 years, respectively). In pts given up-front ASCT, 69% had IPI ≥ 3 at diagnosis. Brentuximab vedotin (BV)-containing therapy before up-front ASCT, salvage ASCT, and allo-SCT had been administered to 25.9%, 24.4%, and 28.6% respectively. Among pts who underwent salvage ASCT, 70% pts received 2 and 30% received 3 therapy lines prior to transplantation. In the salvage allo-SCT group, 48% had 2 and 52% had 3 therapy lines prior to transplantation. The majority of patients undergoing salvage ASCT or allo-SCT had chemo-sensitive disease (CR/PR) (94.5% vs. 90.9%) prior to transplantation. Particularly, 75.1% and 70.2% had second complete remission or later (CR2+) at salvage auto- and allo-SCT, accordingly. Seventeen % of pts relapsing after ASCT subsequently received allo-SCT. With a median follow-up of 2 years, 2-yr progression-free survival (PFS) and overall survival (OS) were 79.2% and 91.3% after up-front ASCT and 59.7% (p=0.016) and 83.9% (p=0.72) after salvage ASCT. 2-yr relapse incidence (RI) and non-relapse mortality (NRM) were 18.1% and 36.8% (p=0.012), and 2.6% and 3.4% (p=0.09), respectively, for up-front and salvage ASCT. Patients consolidated with up-front ASCT in first CR (CR1) or first PR (PR1) did not show statistically different PFS (p=0.78), OS (p=0.309), RI (p=0.94) or NRM (p=0.43). A trend for higher NRM (9.2% vs. 2.3%; p=0.06) was documented in pts in second PR (PR2) or later (PR2+) as compared to CR2+ pts. OS (80.8% vs. 87.8%; p=0.45), PFS (both 61%), and RI (29.3% vs. 36.1%; p=0.4) did not differ significantly. For pts undergoing allo-SCT median follow-up was 3.3 years (yr) and 3-yr PFS 66.2%; 3-yr OS 78.5%, RI 24.1%; and NRM 9.6%. Three-yr PFS and -OS were 69.4% and 85% for pts allografted in CR2+ and 77.3% and 77.3% for pts allografted in PR2+. None of these differences were significantly different statistically. Notably, survival after allo-SCT was better in 2L than in 3L+ (3-yr PFS 82.4 vs. 52.7%, p=0.008; 3-yr OS 84.7% vs. 73.2%, p=0.24) due to lower RI (8.9% vs. 36.7%; p=0.007) while NRM was comparable (8.6% vs. 10.6%; p=0.81). The 3-yr RI post-allo-SCT for CR2+/PR2+/stable and progressive disease (SD/PD) were 21.9%, 14.1% and 57.1% (p=0.08) while 3-yr NRM was 8.7%, 8.6% and 14.3% (p=0.773). Conclusion: In ALK-pos. ALCL, ASCT and allo-SCT resulted in excellent long-term survival. Optimal results were observed for ASCT administered for consolidation in first remission or r/r disease for chemosensitive disease (CR/PR). In such pts, allo-SCT can be reserved for pts relapsing after ASCT. All other pts should be considered candidates for allo-SCT with excellent outcomes recorded for pts who predominantly were in CR prior to allo-SCT.
Source: Blood
Authors: Evgenii Shumilov, Maud Ngoya, Philipp Berning, Irma Khvedelidze, Sridhar Chaganti, Regis Peffault De Latour, Kate Cwynarski, Laura Magnano, Frank Kroschinsky, Johannes Clausen, José Antonio Pérez-Simón, Lawrence Ng, Luca Castagna, Georg Lenz, Anna Sureda, Gandhi Damaj, Ali Bazarbachi, Norbert Schmitz
Institutions: University of Münster, University Hospital Münster, Hôpital Saint-Antoine, European Society for Blood and Marrow Transplantation, Queen Elizabeth Hospital Birmingham, Université Paris Cité, Hôpital Saint-Louis, University College London Hospitals NHS Foundation Trust, Hospital Clínic de Barcelona, Technische Universität Dresden, Krankenhaus der Elisabethinen, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Singapore General Hospital, National Cancer Centre Singapore, Ospedale Vincenzo Cervello, Institut d'Investigació Biomédica de Bellvitge, Institut Català d'Oncologia, Universitat de Barcelona, Centre National de la Recherche Scientifique, Normandie Université, Centre Hospitalier Universitaire de Caen Normandie, Université de Caen Normandie, American University of Beirut
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4417008451
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