Long-term Outcomes After Hematopoietic Cell Transplant in Peripheral T-Cell Lymphoma - The Oregon Health and Science University Experience

Management of peripheral T-cell lymphoma (PTCL) can involve both autologous hematopoietic cell transplant and allogeneic hematopoietic cell transplant used as consolidation or salvage, though data on outcomes to guide decision-making are lacking. Here we retrospectively studied all patients at Oregon Health and Science University between 1991 and 2020 who received transplants for PTCL and reported their clinical outcomes (including responses, overall survival, progression-free survival, transplant-related mortality, and toxicities). Background: Peripheral T-cell lymphomas (PTCL) are a group of aggressive malignancies with inferior outcomes compared to B-cell non-Hodgkin lymphoma (NHL). Both allogeneic and autologous hematopoietic cell transplantation (HCT) are commonly employed for consolidation and salvage. Materials and Methods: We conducted a single-center review of all adult PTCL patients at OHSU who received HCT from 1991 to 2020 with responses assed by CIBMTR cr iter ia. Results: 88 patients (autoHCT = 52, alloHCT = 36) were identified from the internal registry of similar to 3800 autoHCT & alloHCT recipients in that time period. Median OS after autoHCT and alloHCT were 7.0 and 2.6 years. Median PFS after autoHCT and alloHCT was 3.9 vs 1.1 years. Post-HCT median OS for ALCL, AITL, and PTCL NOS were 14.9, 3.9, and 3.4 years, respectively. Median PFS after autoHCT performed while in CR vs. not in CR was 3.4 vs 4.2 years (P = 0.86); for alloHCT in CR vs. not CR 2.4 vs 0.7 years (P = 0.28). 1-year non-relapse mortality (NRM) for autoHCT and alloHCT were 6.1% and 22.2% (P = 0.2). 10/88 patients developed secondary malignancies including 4 skin cancers, 3 new lymphomas, and 2 MDS. Conclusion: Our experience with HCT for PTCL shows that HCT has acceptable toxicities and relatively long disease remissions. AutoHCT was most frequently utilized as planned remission consolidation while alloHCT was most often used late during salvage. Differences in response between autoHCT and alloHCT likely reflect differences in clinical setting and underlying disease natural history and biology.