Differential impact of allogeneic stem-cell transplantation on large B-cell lymphomas and peripheral T-cell lymphomas

Abstract Allogeneic hematopoietic stem-cell transplantation (allo-HSCT) is one of the standard treatments for relapsed/refractory (r/r) non-Hodgkin lymphoma, but benefits across large B-cell lymphoma (LBCL) and nodal peripheral T-cell lymphoma (PTCL) subtypes remain unclear. This single-center retrospective study evaluated outcomes after the first allo-HSCT in 92 adults with r/r aggressive lymphoma (59 and 33 patients with LBCLs and PTCLs, respectively) treated during 2011–2023. The patients’ median age was 51 years; 58.7% had active disease at transplant, and 77.2% received cord blood grafts. With a median follow-up of 7.6 years among survivors, the 5-year overall survival (OS) and progression-free survival (PFS) rates were 31.6% and 27.9%, respectively. Furthermore, the non-relapse mortality (NRM) and relapse/progression rates were 30.8% and 41.3%, respectively. Compared with patients with LBCLs, those with PTCLs showed superior 5-year outcomes (OS: 47.7% vs. 22.4%, P = 0.03; PFS: 39.7% vs. 21.0%, P = 0.04) and lower relapse rates (26.9% vs. 49.5%, P = 0.02), with similar NRM and acute graft-versus-host disease rates. Multivariable models showed that PTCL histology was an independent predictor of improved OS and PFS. These findings suggest that allo-HSCT confers greater long-term benefits in patients with PTCL, supporting its role as an effective option in this subgroup.