Retrospective analysis of hematopoietic cell transplantation for blastic plasmacytoid dendritic cell neoplasm: conditioning intensity matters

Blastic plasmacytoid dendritic cell neoplasia (BPDCN) is a rare myeloid malignancy with a generally poor prognosis. Although preliminary evidence suggests that hematopoietic cell transplantation (HCT) could improve outcome in patients with BPDCN, the individual contributions of conditioning and graf...

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Published in:Leukemia 2023-02, Vol.37 (2), p.465-472
Main Authors: Bruch, Peter-Martin, Dietrich, Sascha, Finel, Herve, Boumendil, Ariane, Greinix, Hildegard, Heinicke, Thomas, Bethge, Wolfgang, Beelen, Dietrich, Schmid, Christoph, Martin, Hans, Castagna, Luca, Scheid, Christof, Schäfer-Eckart, Kerstin, Bittenbring, Jörg, Finke, Jürgen, Sengeloev, Henrik, Heiblig, Mael, Cornelissen, Jan, Chevallier, Patrice, Mohty, Mohamad, Robinson, Stephen, Montoto, Silvia, Dreger, Peter
Format: Article
Language:English
Subjects:
692/699/67/1990
692/700/565/2319
692/700/565/485
Acute Disease
Adult
Aged
Autografts
Cancer Research
Conditioning
Critical Care Medicine
Dendritic cells
Dendritic Cells - pathology
Depletion
Hematology
Hematopoietic Stem Cell Transplantation
Humans
Intensive
Internal Medicine
Irradiation
Lymphocytes T
Malignancy
Medical prognosis
Medicine
Medicine & Public Health
Middle Aged
Myeloproliferative Disorders - pathology
Neoplasm Recurrence, Local - pathology
Oncology
Radiation
Remission
Retrospective Studies
Skin Neoplasms - pathology
Stem cell transplantation
Survival
Transplantation
Transplantation Conditioning
Transplants
Transplants & implants
Treatment Outcome
Young Adult
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Summary:Blastic plasmacytoid dendritic cell neoplasia (BPDCN) is a rare myeloid malignancy with a generally poor prognosis. Although preliminary evidence suggests that hematopoietic cell transplantation (HCT) could improve outcome in patients with BPDCN, the individual contributions of conditioning and graft-versus-tumor (GVT) effects to HCT success are undefined. We present a retrospective study of 162 adult patients who underwent a first HCT (allogeneic 146, autologous 16) between 2009 and 2017, and were registered with the EBMT. Median age was 57 (range 20–73) years, and disease status at HCT was first complete remission (CR1) in 78%. Among patients receiving allogeneic HCT (alloHCT), myeloablative conditioning (MAC), reduced intensity conditioning (RIC) and in-vivo T-cell depletion (TCD) were used in 54%, 46%, and 59% respectively. Total body irradiation (TBI) was the conditioning backbone in 61% of MAC and 26% of RIC transplants. One-year overall survival (OS) and progression-free survival (PFS) rates were comparable after alloHCT and autologous HCT (autoHCT). Among alloHCT recipients, MAC with TBI significantly improved OS and PFS, independently of CR1, age, Karnofsky index and TCD. Accordingly, MAC (ideally based on TBI) should be preferred for alloHCT recipients with BPDCN. In patients who are not elegible for MAC alloHCT, autoHCT could be considered.
ISSN:0887-6924
1476-5551
DOI:10.1038/s41375-022-01782-z