Autologous and allogeneic hematopoietic cell transplantation in children and adults with high-risk anaplastic large cell lymphoma

Introduction: Both autologous and allogeneic hematopoietic cell transplantation (HCT) have been used to treat high-risk anaplastic large cell lymphoma (ALCL) that has failed conventional chemotherapy. However, many patients are not able to fully eradicate disease prior to HCT, making the role of either form of HCT unclear. The aim of this study was to collect characteristics and outcomes of patients who underwent either autologous and/or allogeneic HCT and determine the role that disease status at HCT plays in overall survival (OS). Methods: To address this, we collected data on 41 patients with ALCL that underwent autologous (n=24) and/or allogeneic (n=17) HCT at our center between 1997-2020. Results: The 5-year estimated progression-free survival (PFS) and OS for the autologous HCT group was 40% (95% confidence interval, 20-59%) and 53% (31-71%), while for the allogeneic HCT group it was 65% (38-92%) and 65% (38-82%), respectively. For transplants performed in 2009 or later, 5-year OS was 91% (51-99%) in the allogeneic HCT group, and 51% (23-73%) in the autologous HCT group. Notable was that for those who entered transplant with detectable disease, 5-year OS was 50% (15-77%) with allogeneic HCT whereas it was 27% (7-54%) for autologous HCT. Discussion: These data confirm that HCT is a potentially curative therapy, and allogeneic HCT may have a survival advantage over autologous HCT when there is detectable disease prior to HCT.