Low survival due to higher risk of relapse and non-relapse mortality after allogeneic HSCT in ATL compared with AML and ALL

Shohei Tomori; Satoko Morishima; Koji Kato; Hideki Nakasone; Nobuaki Nakano; Tetsuya Eto; Toshiro Kawakita; Youko Suehiro; Yasuhiko Miyazaki; Naoyuki Uchida; Yasushi Sawayama; Yasuo Mori; Hirohisa Nakamae; Koji Nagafuji; Yasufumi Uehara; Noriko Doki; Junya Kanda; Takahiro Fukuda; Yoshiko Atsuta; Makoto Yoshimitsu; JSTCT ATL Working Group and JSTCT Transplant Complications Working Group

doi:10.1016/j.jtct.2025.01.882

Low survival due to higher risk of relapse and non-relapse mortality after allogeneic HSCT in ATL compared with AML and ALL

Transplant Cell Ther. 2025 Jan 17:S2666-6367(25)00909-1. doi: 10.1016/j.jtct.2025.01.882. Online ahead of print.

Authors

Shohei Tomori¹, Satoko Morishima², Koji Kato³, Hideki Nakasone⁴, Nobuaki Nakano⁵, Tetsuya Eto⁶, Toshiro Kawakita⁷, Youko Suehiro⁸, Yasuhiko Miyazaki⁹, Naoyuki Uchida¹⁰, Yasushi Sawayama¹¹, Yasuo Mori³, Hirohisa Nakamae¹², Koji Nagafuji¹³, Yasufumi Uehara¹⁴, Noriko Doki¹⁵, Junya Kanda¹⁶, Takahiro Fukuda¹⁷, Yoshiko Atsuta¹⁸, Makoto Yoshimitsu¹⁹; JSTCT ATL Working Group and JSTCT Transplant Complications Working Group

Affiliations

¹ Department of Hematology and Oncology, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Haebaru, Japan.
² Division of Endocrinology, Diabetes and Metabolism, Hematology and Rheumatology, (Second Department of Internal Medicine), Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan; Central Japan Cord Blood Bank, Seto, Japan. Electronic address: [email protected].
³ Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
⁴ Division of Emerging Medicine for Integrated Therapeutics (EMIT), Center for Molecular Medicine, Jichi Medical University, Shimotsuke, Japan.
⁵ Department of Hematology, Imamura General Hospital, Kagoshima, Japan.
⁶ Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan.
⁷ Department of Hematology, NHO Kumamoto Medical Center, Kumamoto Japan.
⁸ Department of Hematology and Cell Therapy, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan.
⁹ Department of Hematology, Oita Prefectural Hospital, Oita, Japan.
¹⁰ Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan.
¹¹ Department of Hematology, Sasebo City General Hospital, Sasebo, Japan.
¹² Department of Hematology, Osaka Metropolitan University Hospital, Osaka, Japan.
¹³ Division of Hematology and Oncology, Department of Medicine, Kurume University Hospital, Kurume, Japan.
¹⁴ Department of Hematology, Kitakyushu City Hospital Organization, Kitakyushu Municipal Medical Center, Kitakyusyu, Japan.
¹⁵ Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
¹⁶ Department of Hematology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
¹⁷ Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.
¹⁸ Japanese Data Center for Hematopoietic Cell Transplantation, Nagakute, Japan; Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan.
¹⁹ Department of Hematology and Rheumatology, Kagoshima University Hospital, Kagoshima, Japan.

PMID: 39828057
DOI: 10.1016/j.jtct.2025.01.882

Abstract

Background: Patients with adult T-cell leukemia/lymphoma (ATL) are considered to have worse outcomes after allogeneic hematopoietic stem cell transplantation (allo-HSCT) than patients with other hematological malignancies, owing to high risk of relapse and immunocompromised status. However, no studies have compared transplant outcomes between patients with ATL and those with other hematological malignancies using a large-scale database.

Objectives: To compare transplant outcomes between patients with ATL and those with other leukemias and to identify factors contributing to worse transplant outcomes in ATL patients.

Study design: Using Japanese registry data, we retrospectively compared transplant outcomes between patients with ATL and those with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). As ATL often develops in patients in their 60s or older, patients with ATL, AML, or ALL aged ≥50 years were included in order to compare patients in the same age group. A total of 7764 patients (ATL, n = 1151; AML, n = 5393; ALL, n = 1220) who underwent their first allo-HSCT between January 1, 2006 and December 31, 2017 were included in this study.

Results: Compared with AML, ATL showed significantly worse overall survival (OS) (hazard ratio [HR], 1.24; 95% confidence interval [CI], 1.14-1.34; P < 0.001) and higher risk of relapse (HR, 1.33; 95% CI, 1.2-1.47; P < 0.001), while there were no significant differences between AML and ALL. Among patients in complete remission (CR) at transplantation, ATL showed worse OS (HR, 1.30; 95% CI, 1.08-1.56; P = 0.006), higher risk of relapse (HR, 1.78; 95% CI, 1.48-2.14; P < 0.001), and higher risk of non-relapse mortality (NRM) (HR, 1.38; 95% CI, 1.14-1.33; P = 0.001) in comparison with AML, whereas there were no significant differences between AML and ALL.

Conclusion: We found that ATL patients have poor transplant outcomes compared with AML or ALL patients. In ATL patients, survival is poor, relapse is more frequent, and NRM is significantly higher, especially in cases of CR. These findings suggest that prevention of relapse and transplant-related complications is important for successful allo-HSCT in ATL.

Keywords: Adult T-cell leukemia; allogeneic HSCT; non-relapse mortality; relapse; survival.