Allogeneic transplant in mature T-cell lymphoma: no first-line survival gain and much higher treatment-related mortality

Design

Cochrane systematic review without meta-analysis

Population

One first-line RCT (103), one RCT in relapsed CTCL (102) and one phase 2 study (17)

Primary outcome

Overall survival, progression-free survival and treatment-related mortality

Effect

First-line vs autoSCT: OS HR 1.3 (0.7 to 2.4); TRM RR 18.7 (1.11 to 315.7); relapsed CTCL PFS HR 0.38 (0.21 to 0.69)

This Cochrane review looked for prospective evidence on allogeneic stem cell transplant in adults with mature T-cell lymphoma. It found one first-line randomised trial, one randomised trial in relapsed cutaneous disease, and one small phase 2 study.

First-line, allogeneic transplant did not improve survival over autologous transplant and was associated with much higher treatment-related mortality. In relapsed cutaneous T-cell lymphoma, it improved progression-free but not clearly overall survival.

The evidence is thin and the authors could not pool it. It supports the current practice of using allogeneic transplant mainly as salvage, in selected patients.

• First-line, overall survival did not differ from autologous transplant (HR 1.3, 0.7 to 2.4).
• Treatment-related mortality was markedly higher with allogeneic transplant (RR 18.7, wide interval).
• Acute graft-versus-host disease affected 84% of first-line allogeneic recipients.
• In relapsed cutaneous T-cell lymphoma, allogeneic transplant improved progression-free survival (HR 0.38).
• No randomised trials are ongoing; current studies are single-arm phase 2.

Why it matters

Allogeneic transplant is sometimes considered upfront in high-risk T-cell lymphoma, and the only randomised first-line evidence does not support it.

Don't overread it

The review rests on three small studies and rates all evidence low to very low certainty.

The statistics, in plain English

A relative risk of 18.7 with an interval from 1.1 to 316 shows that treatment-related deaths were clearly higher, but there were so few events that the size is very uncertain.

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