Patient- and transplant-related prognostic factors for post-transplant outcomes in patients with T-ALL

Results from a retrospective analysis evaluating the impact of patient- and transplant-related factors on post-transplant outcomes in adult patients with T-cell acute lymphoblastic leukemia (T-ALL) have been published in Bone Marrow Transplantation by El Cheikh et al.¹ This analysis included 1,901 adult patients with T-ALL who received allogeneic hematopoietic stem cell transplantation (allo-HSCT) between January 2010 and December 2021, from the European Society for Blood and Marrow Transplantation (EBMT) registry. 

Advanced age at the time of transplant negatively impacted outcomes: each 10-year increment indicated worse leukemia-free survival (LFS; hazard ratio [HR], 1.11; p = 0.004), graft-versus-host disease (GvHD)-free relapse-free survival (GRFS; HR, 1.06; p = 0.04), overall survival (OS; HR, 1.12; p = 0.002), and non-relapse mortality (NRM; HR, 1.23; p < 0.001), highlighting the need for careful consideration of age when selecting patients for allo-HSCT.

Transplants performed in more recent years show improved outcomes: each 3-year increment in age was associated with improved GRFS (HR, 0.89; p < 0.001) and OS (HR, 0.9; p = 0.02), and decreased NRM (HR, 0.82; p = 0.008), suggesting that advancements in transplant techniques and supportive care have positively impacted patient outcomes.

The use of total body irradiation (TBI)-based conditioning was associated with better LFS (HR, 0.79; p = 0.02), GRFS (HR, 0.83; p = 0.04), and reduced relapse incidence (HR, 0.65; p < 0.001), supporting the inclusion of TBI conditioning regimens for suitable patients to enhance long-term outcomes.

Female-to-male transplants were associated with poorer GRFS (HR, 1.21; p = 0.02) and OS (HR, 1.23; p = 0.048), highlighting the potential need to implement additional monitoring and interventions for this demographic to mitigate risks.