Allogeneic Hematopoietic Stem Cell Transplantation in Patients with Prolymphocytic Leukemia

TL;DR

Allogeneic stem cell transplants improve survival in rare blood cancers called prolymphocytic leukemias, despite high relapse rates.

Contribution

The study highlights the effectiveness of alloHSCT in treating prolymphocytic leukemia with long-term survival despite relapses.

Findings

B-PLL patients treated with alloHSCT remained relapse-free and alive with a median follow-up of 54 months.

Despite a 61% relapse rate in T-PLL patients, median overall survival was 78 months due to successful relapse therapy.

Poor pre-transplant performance status and high comorbidity index were linked to post-transplant mortality.

Abstract

Background: T-prolymphocytic leukemia (T-PLL) is a rare lymphoid neoplasm with particularly poor prognosis. Although it is no longer recognized as a distinct entity by the World Health Organization (WHO), B-prolymphocytic leukemia (B-PLL) comprises conditions with unfavorable outcomes. Both diseases most frequently affect patients in the seventh decade of their lives. Allogeneic hematopoietic stem cell transplantation (alloHSCT) significantly improves outcomes for selected PLL cases, as shown by several, mostly retrospective, analyses. Methods: In this article, we provide a review of existing PLL analyses, followed by a summary of cases treated at our center. We describe outcomes of six T-PLL and three B-PLL cases receiving alloHSCT at our institution between 2015 and 2022. Results: Despite a post-transplant 4-year cumulative relapse incidence of 61% in our T-PLL series, the median OS was 78 months, because relapse therapy was remarkably successful. All B-PLL patients are alive and relapse-free, with a median follow-up of 54 (range of 11–74) months. A poor pre-transplant Karnofsky performance status (KPS) (≤ 80%) and an HCT comorbidity index (HCT-CI) of ≥3 were significantly associated with post-transplant mortality. Conclusions: The comparatively favorable outcomes in our case series underline the increasing value of alloHSCT in PLL in the current era, as it offers a prospect of cure in selected patients with otherwise very poor prognosis.

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