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. 2022 Apr;197(2):212-222.
doi: 10.1111/bjh.18052. Epub 2022 Feb 2.

Impact of conditioning regimen intensity on the outcomes of peripheral T-cell lymphoma, anaplastic large cell lymphoma and angioimmunoblastic T-cell lymphoma patients undergoing allogeneic transplant

Malvi Savani  1 , Kwang W Ahn  2   3 , Yue Chen  3 , Sairah Ahmed  4 , Amanda F Cashen  5 , Mazyar Shadman  6 , Dipenkumar Modi  7   8 , Farhad Khimani  9 , Corey S Cutler  10 , Jasmine Zain  11 , Jonathan E Brammer  12 , Andrew R Rezvani  13 , Timothy S Fenske  14 , Craig S Sauter  15 , Mohamed A Kharfan-Dabaja  16 , Alex F Herrera  11 , Mehdi Hamadani  3   14
Affiliations

Impact of conditioning regimen intensity on the outcomes of peripheral T-cell lymphoma, anaplastic large cell lymphoma and angioimmunoblastic T-cell lymphoma patients undergoing allogeneic transplant

Malvi Savani et al. Br J Haematol. 2022 Apr.

Abstract

There have been no large studies comparing reduced-intensity/non-myeloablative conditioning (RIC/NMA) to myeloablative conditioning (MAC) regimens in T-cell non-Hodgkin lymphoma (T-NHL) patients undergoing allogeneic transplant (allo-HCT). A total of 803 adults with peripheral T-cell lymphoma, anaplastic large cell lymphoma and angioimmunoblastic T-cell lymphoma (age 18-65 years), undergoing allo-HCT between 2008-2019 and reported to the Center for International Blood and Marrow Transplant Research with either MAC (n = 258) or RIC/NMA regimens (n = 545) were evaluated. There were no significant differences between the two cohorts in terms of patient sex, race and performance scores. Significantly more patients in the RIC/NMA cohort had peripheral blood grafts, haematopoietic cell transplantation-specific comorbidity index (HCT-CI) of ≥3 and chemosensitive disease compared to the MAC cohort. On multivariate analysis, overall survival (OS) was not significantly different in the RIC/NMA cohort compared to the MAC cohort (hazard ratio (HR) = 1.01, 95% confidence interval (CI) = 0.79-1.29; p = 0.95). Similarly, non-relapse mortality (NRM) (HR = 0.85, 95% CI = 0.61-1.19; p = 0.34), risk of progression/relapse (HR = 1.29; 95% CI = 0.98-1.70; p = 0.07) and therapy failure (HR = 1.14; 95% CI = 0.92-1.41, p = 0.23) were not significantly different between the two cohorts. Relative to MAC, RIC/NMA was associated with a significantly lower risk of grade 3-4 acute graft-versus-host disease (HR = 0.67; 95% CI = 0.46-0.99, p = 0.04). Among chemorefractory patients, there was no difference in OS, therapy failure, relapse, or NRM between RIC/NMA and MAC regimens. In conclusion, we found no association between conditioning intensity and outcomes after allo-HCT for T-cell NHL.

Keywords: allogeneic transplant; mature T-cell NHL; myeloablative conditioning; reduced-intensity conditioning.

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Figures

Figure 1.
Figure 1.
Overall survival (1A), non-relapse mortality (1B), relapse/progression (1C) and progression-free survival (1D) through 5-years of patients receiving myeloablative (MAC) and non-myeloablative (NMA)/reduced-intensity (RIC) conditioning regimen prior to an alloHCT for peripheral T-cell lymphoma, anaplastic large cell lymphoma and angioimmunoblastic T-cell lymphoma.
Figure 2.
Figure 2.
Cumulative incidence of grade 3-4 acute GvHD in patients receiving myeloablative (MAC) and non-myeloablative (NMA)/reduced-intensity (RIC) conditioning regimens
See this image and copyright information in PMC

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