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Comparative Study
. 2025 Jan;206(1):235-249.
doi: 10.1111/bjh.19835. Epub 2024 Oct 19.

Comparative outcomes of various transplantation platforms, highlighting haploidentical transplants with post-transplantation cyclophosphamide for adult T-cell leukaemia/lymphoma

Makoto Yoshimitsu  1 , Takashi Tanaka  2 , Nobuaki Nakano  3 , Koji Kato  4 , Hiroyuki Muranushi  5 , Masahito Tokunaga  3 , Ayumu Ito  2 , Jun Ishikawa  6 , Tetsuya Eto  7 , Satoko Morishima  8 , Toshiro Kawakita  9 , Hidehiro Itonaga  10 , Naoyuki Uchida  11 , Masatsugu Tanaka  12 , Keiichi Akizuki  13 , Kenji Ishitsuka  1 , Hiroyuki Ohigashi  14 , Shuichi Ota  15 , Toshihiko Ando  16 , Yoshinobu Kanda  17 , Takahiro Fukuda  2 , Yoshiko Atsuta  18   19 , Shigeo Fuji  6 ; ATL Working Group of the Japanese Society for Transplantation and Cellular Therapy
Affiliations
Comparative Study

Comparative outcomes of various transplantation platforms, highlighting haploidentical transplants with post-transplantation cyclophosphamide for adult T-cell leukaemia/lymphoma

Makoto Yoshimitsu et al. Br J Haematol. 2025 Jan.

Abstract

This study retrospectively compared outcomes of various allogeneic haematopoietic cell transplantation (allo-HCT) platforms in patients with adult T-cell leukaemia/lymphoma. Platforms included human leukocyte antigen (HLA)-haploidentical-related donors using post-transplant cyclophosphamide (PTCY), HLA-matched related donors (MRD), HLA-matched unrelated donors (MUD) and cord blood transplantation (CBT). Patients who underwent their first allo-HCT between 2016 and 2021 were included. Outcomes analysed were overall survival (OS), relapse and non-relapse mortality (NRM). Seven hundred patients were included (PTCY, n = 121; MRD, n = 91; MUD, n = 160; CBT, n = 328). With a median follow-up of 794 days for survivors, 2-year OS was 48.1% (PTCY), 48.8% (MRD), 48.4% (MUD) and 34.6% (CBT); the respective 2-year cumulative incidence of relapse was 37.1%, 47.5%, 33.9% and 45.1% and that of NRM was 24.2%, 19.8%, 24.7% and 27.3%. PTCY was associated with delayed platelet engraftment relative to MRD and MUD. There was no increase in the incidence of severe acute or chronic graft-versus-host disease. In the PTCY group, poor performance status was a significant predictor of inferior OS, and infused CD34+ cell numbers of less than 5 × 106/kg were associated with delayed neutrophil and platelet engraftment. These results suggest that allo-HCT with PTCY is a safe and effective platform for patients with adult T-cell leukaemia/lymphoma.

Keywords: adult T‐cell leukaemia/lymphoma; graft‐versus‐host disease; haploidentical haematopoietic stem cell transplantation; post‐transplant cyclophosphamide; prophylaxis.

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Conflict of interest statement

MY: Honoraria from Kyowa Kirin, Daiichi Sankyo, Takeda, Eisai, Chugai, Meiji, Genmab, Bristol‐Myers Squibb, Astellas. KK: Research funding from Chugai, Janssen, Meiji, Novartis, AbbVie, Genmab, Bristol‐Myers Squibb, Gilead Sciences, Eisai, Astellas, Ono, Kyowa Kirin, Nippon Shinyaku, MSD, Takeda, LSI Medience, Japan Blood Products Organization, Honoraria from Chugai, Janssen, Meiji, Novartis, AbbVie, Genmab, Bristol‐Myers Squibb, Gilead Sciences, Eisai, Astellas, Otsuka, Kyowa Kirin, Nippon Shinyaku, MSD, Japan Blood Products Organization. YA: Lecture fee/honorarium from Otsuka Pharmaceutical Co., Ltd., Chugai Pharmaceutical Co., Ltd., Novartis Pharma KK, Meiji Seika Pharma Co, Ltd., Janssen Pharmaceutical K.K., Consultant fee from JCR Pharmaceuticals Co., Ltd. and Kyowa Kirin Co., Ltd.

Figures

FIGURE 1
FIGURE 1
Kaplan–Meier estimates of OS (A), OS among cases in CR at allogeneic haematopoietic stem cell transplantation (B) and GRFS (C) according to donor sources. CBT, cord blood transplantation; CR, complete remission; GRFS, graft‐versus‐host disease‐free and relapse‐free survival; MRD, HLA‐matched related donor; MUD, HLA‐matched unrelated donor; OS, overall survival; PTCY, post‐transplant cyclophosphamide.
FIGURE 2
FIGURE 2
Cumulative incidence of relapse (A), relapse among cases in CR at allogeneic haematopoietic stem cell transplantation (B), non‐relapse mortality (C) and non‐relapse mortality among cases in with CR at allogeneic haematopoietic stem cell transplantation (D). CBT, cord blood transplantation; CR, complete remission; GVHD, graft‐versus‐host disease; MRD, HLA‐matched related donor; MUD, HLA‐matched unrelated donor; PTCY, post‐transplant cyclophosphamide.
FIGURE 3
FIGURE 3
Subgroup analysis of cases with PTCY. Kaplan–Meier estimates of OS (A), cumulative incidence of neutrophil engraftment (B) and platelet engraftment (C) by number of CD34+ cells infused. Kaplan–Meier estimates of OS by cyclophosphamide dose (D). OS, overall survival, PTCY, post‐transplant cyclophosphamide.
FIGURE 4
FIGURE 4
Propensity score‐matched comparison between PTCY and CBT. Kaplan–Meier estimates of OS (A), cumulative incidence of relapse (A) and non‐relapse mortality (C). CBT, cord blood transplantation; OS, overall survival; PTCY, post‐transplant cyclophosphamide.
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