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Allogeneic hematopoietic stem cell transplantation for adult T-cell leukemia-lymphoma with special emphasis on preconditioning regimen: a nationwide retrospective study

Takashi Ishida, Masakatsu Hishizawa, Koji Kato, Ryuji Tanosaki, Takahiro Fukuda, Shuichi Taniguchi, Tetsuya Eto, Yoshifusa Takatsuka, Yasushi Miyazaki, Yukiyoshi Moriuchi, Michihiro Hidaka, Koichi Akashi, Naokuni Uike, Hisashi Sakamaki, Yasuo Morishima, Koji Kato, Ritsuro Suzuki, Takeshi Nishiyama and Atae Utsunomiya

Data supplements

Article Figures & Data

Figures

  • Figure 1

    OS of ATL patients receiving allogeneic HSCT. (A) Kaplan-Meier curves of estimated OS in ATL patients receiving allogeneic BMT, PBSCT, or unrelated CBT. (B) Kaplan-Meier curves of estimated OS in ATL patients receiving allogeneic BMT or PBSCT with MAC or RIC.

  • Figure 2

    Interactions of the preconditioning regimen with age, disease status, and performance status for OS. Statistical interactions between the preconditioning regimens (MAC or RIC) and age range (15-55 vs 56-72 years; A), disease status (CR vs non-CR; B), and performance status (0 vs 1 or 2-4; C) were analyzed.

  • Figure 3

    Cumulative incidence of ATL-related and TRMs in patients receiving BMT or PBSCT. Probabilities of ATL-related and TRMs in recipients of MAC or RIC were estimated using cumulative incidence curves to accommodate competing events.

Tables

  • Table 1

    Characteristics of ATL patients receiving allogeneic HSCT

    CharacteristicMACRICP
    Total patients, no. (%)280306
    Age range at transplantation, y< .001
        15-55248 (89)124 (41)
        56-7232 (11)182 (59)
    Sex.135
        Female120 (43)151 (49)
        Male160 (57)155 (51)
    Disease status at transplantation.206
        CR96 (34)112 (37)
        Non-CR160 (57)179 (58)
        Unknown24 (9)15 (5)
    Year.month of transplantation.473
        1992.2-2004.1271 (25)78 (25)
        2005.1-2006.1169 (25)77 (25)
        2006.11-2008.576 (27)68 (22)
        2008.5-2009.1264 (23)83 (27)
    Time from diagnosis to transplantation, mo.569
        0.5-4.974 (26)72 (24)
        4.9-6.966 (24)79 (26)
        6.9-10.174 (26)71 (23)
        ≥10.165 (23)81 (26)
    PS at transplantation.004
        0102 (36)119 (39)
        1121 (43)143 (47)
        229 (10)25 (8)
        34 (1)12 (4)
        43 (1)2 (1)
        Unknown21 (8)5 (2)
    Source of stem cells< .001
        BM212 (76)186 (60)
        Peripheral blood68 (24)118 (39)
        BM + peripheral blood0 (0)2 (1)
    Relationship between recipient and donor.019
        HLA-matched related96 (34)117 (38)
        HLA-mismatched related21 (8)42 (14)
        HLA-unknown related1 (0)1 (0)
        Unrelated162 (58)146 (48)
    ATL clinical subtype.253
        Chronic, smoldering10 (4)6 (2)
        Acute163 (58)170 (56)
        Lymphoma79 (28)87 (28)
        Unknown28 (10)43 (14)
  • Table 2

    Multivariate analysis of factors influencing OS in ATL patients receiving allogeneic HSCT

    VariableNo.HR95% CIP
    Age range at transplantation, y
        15-553681.000Reference
        56-722101.334(1.035-1.719).026
    Sex
        Female2671.000Reference
        Male3111.376(1.113-1.702).003
    Disease status at transplantation
        CR2051.000Reference
        Non-CR3351.940(1.511-2.490)< .001
        Unknown381.744(1.114-2.731).015
    PS
        02191.000Reference
        12601.498(1.171-1.916).001
        2-4744.057(2.957-5.565)< .001
        Unknown251.489(0.863-2.570).153
    Relationship between recipient and donor
        HLA-matched related2101.000Reference
        HLA-mismatched related621.296(0.917-1.831).142
        Unrelated3061.276(1.009-1.613).042
    Preconditioning regimen
        MAC2781.000Reference
        RIC3001.087(0.845-1.398).515
  • Table 3

    Multivariate analysis of factors influencing OS in the subgroup of ATL patients receiving transplantation after MAC

    VariableNo.HR95% CIP
    Age range at transplantation, y
        15-552461.000Reference
        56-72321.667(1.051-2.643).030
    Sex
        Female1201.000Reference
        Male1581.458(1.053-2.019).023
    Disease status at transplantation
        CR951.000Reference
        Non-CR1592.071(1.409-3.043)< .001
        Unknown241.536(0.822-2.870).178
    PS
        01021.000Reference
        11201.322(0.909-1.922).144
        2-4363.073(1.920-4.919)< .001
        Unknown201.109(0.565-2.175).764
    Relationship between recipient and donor
        HLA-matched related961.000Reference
        HLA-mismatched related211.165(0.618-2.196).637
        Unrelated1611.323(0.920-1.902).131
    Type of MAC
        TBI-based2081.000Reference
        BU-based460.757(0.475-1.206).242
        Mel-based211.388(0.819-2.353).223
        Others30.666(0.158-2.817).581
  • Table 4

    Multivariate analysis of factors influencing OS in the subgroup of patients receiving transplantation after RIC

    VariableNo.HR95% CIP
    Age range at transplantation, y
        15-551221.000Reference
        56-721781.127(0.834-1.523).435
    Sex
        Female1471.000Reference
        Male1531.475(1.100-1.978).009
    Disease status at transplantation
        CR1101.000Reference
        Non-CR1761.743(1.249-2.432).001
        Unknown141.959(0.998-3.843).051
    PS
        01171.000Reference
        11401.803(1.293-2.516)< .001
        2-4386.175(3.908-9.756)< .001
        Unknown54.979(1.849-13.409).001
    Relationship between recipient and donor
        HLA-matched related1141.000Reference
        HLA-mismatched related411.279(0.836-1.959).257
        Unrelated1451.237(0.895-1.710).198
    Type of RIC
        Flu + BU-based1651.000Reference
        Flu + Mel-based860.645(0.453-0.918).015
        Others490.854(0.557-1.310).470
  • Table 5

    Multivariate analysis of TRM and ATL-related mortalities in patients receiving allogeneic HSCT

    VariableTRMATL-related mortality
    No.HR95% CIPNo.HR95% CIP
    Age range at transplantation, y
        15-55116/3621.000Reference93/3621.000Reference
        56-7279/2101.403(0.954-2.064).08562/2100.955(0.658-1.385).810
    Sex
        Female75/2621.000Reference66/2621.000Reference
        Male120/3101.383(1.026-1.863).03389/3101.226(0.886-1.697).220
    Disease status at transplantation
        CR58/2051.000Reference32/2051.000Reference
        Non-CR121/3301.238(0.906-1.691)0.180114/3302.203(1.469-3.302)< .001
        Unknown16/371.507(0.873-2.603)0.1409/371.511(0.663-3.444).330
    PS
        054/2131.000Reference44/2131.000Reference
        191/2601.509(1.075-2.118).01774/2601.272(0.872-1.856).210
        2-441/753.004(1.915-4.714)< .00130/751.679(1.035-2.723).036
        Unknown9/241.214(0.614-2.403)0.5807/241.965(0.802-4.818).140
    Relationship between recipient and donor
        HLA-matched related62/2061.000Reference60/2061.000Reference
        HLA-mismatched related18/620.924(0.532-1.606)0.78026/621.392(0.873-2.220).160
        Unrelated115/3041.429(1.033-1.975).03169/3040.843(0.589-1.209).350
    Preconditioning regimen
        MAC100/2741.000Reference61/2751.000Reference
        RIC95/2980.786(0.538-1.148)0.21094/3041.579(1.080-2.308).019