Autologous Versus Allogeneic Hematopoietic Stem Cell Transplantation (SCT) for Peripheral T-Cell Lymphomas (PTCLs): Japan and Korea Cooperative Study with 330 Patients.
Authors: Kim Sung-Won , Yoon Sung-Soo , Suzuki Ritsuro , Yi Hyeon Gyu , Ago Hiroatsu , Imamura Masahiro , Wake Atsushi , Yoshida Takashi , Lee Je-Jung , Kim Jin Seok , Maeda Yoshinobu , Izutsu Koji , Kang Hye Jin , Lee Je-Hwan , Kim Hugh Chul , Suzumiya Junji , Matsuno Yoshihiro , Kim Chul Woo , Nagafuji Koji , Takaue Yoichi , Harada Mine , Kim Chul Soo 
Published: October 2019

Abstract
Abstract 2284
Poster Board II-261

Background:
To evaluate the role of autologous and allogeneic SCT in the treatment of PTCLs, Japan Study Group for Cell Therapy and Transplantation conducted a multicenter retrospective survey in Japan and Korea.

Methods:
After excluding patients with adult T-cell leukemia/lymphoma and NK-cell tumors, patient data were newly collected from 330 patients (222 male and 108 female) with a median age of 49 years (range, 13–71) who underwent SCT between 9/1991 and 12/2008 (196 autologous and 134 allogeneic including 31 patients with previous autograft). Allogeneic SCT (53 BM, 54 PB, 1 BM+PB, 26 CB) was performed using a reduced-intensity conditioning (RIC) in 84 patients (63%). While a pathologic central review will be performed, currently there were 159 (48%) patients with PTCL, not otherwise specified, 63 (19%) with angioimmunoblastic T-cell lymphoma, 47(14%) with anaplastic large cell lymphoma (23 ALK-negative, 14 ALK-positive and 10 unknown), 12 (4%) with enteropathy-associated T-cell lymphoma, and others. The disease status at transplant in the allo-group was significantly worse than that in the auto-group (Table 1). The median number of chemotherapy regimens was 2 (range, 1–7), and the median duration between diagnosis and transplant was 267 days (range, 120-4889 days).

Results:
The median follow-up for surviving patients was 45 mo (range, 2.3–141 mo). There was no significant difference in overall survival among different groups, including histological subtypes, RIC and myeloablative conditioning in the allo-group and high-dose chemotherapy regimens in the auto-group. Early survival rate after transplant was significantly better for auto-group than allo-group (Wilcoxon P=0.001), but the difference was marginal in the total course (Logrank P=0.06) (Figure). The non-relapse mortality (NRM) in the auto-group was significantly lower than that in the allo-group (P<0.0001) (Table 2). Grade II-IV acute GVHD occurred in 49% of the patients after allogeneic SCT. The causes of death that contributed to NRM were infection in 16/21 (auto/allo), organ failure in 6/12, GVHD in 0/5, secondary cancer in 5/0 and other in 7/5. The long-term relapse rate in the auto-group was significantly higher than that in the allo-group (Fleming-Harrington P=0.03). Univariate analyses showed that the risks of survival were bulky mass at diagnosis, age, recurrence after frontline therapy, number of chemotherapy regimens (>1), cell source (CB/BM+PB), and performance status (PS; >1), stage, chemorefractory disease, international prognostic index (IPI; H-I/H risk) and prognostic index for PTCL, unspecified (PIT; group 3/4) at transplant. The risk factors in the allo-group were bulky mass at diagnosis, age (>50 years), cell source, and PS, stage, IPI and PIT at transplant, while those in the auto-group were age (>40 years), recurrence after frontline therapy, number of chemotherapy regimens, and stage, chemorefractory disease, IPI and PIT at transplant.

Conclusions:
Despite a worse disease status at transplant in the allo-group, the overall survival was comparable to that in the auto-group. This supports the notion that early allogeneic SCT is a valuable treatment option for PTCLs, although a large-scale randomized trial to identify a suitable upfront-transplant type for chemosensitive patients with PTCLs is warranted.

Disclosures:
No relevant conflicts of interest to declare.