Barriers to Allogeneic Hematopoietic Stem Cell Transplantation for Human T Cell Lymphotropic Virus 1–Associated Adult T Cell Lymphoma–Leukemia in the United States: Experience from a Large Cohort in a Major Tertiary Center

Diego Adrianzen Herrera, Noah Kornblum, Ana Acuna-Villaorduna, R. Alejandro Sica, Urvi Shah, Moya Butler, Nivetha Vishnuvardhan, Nishi Shah, Lizamarie Bachier-Rodriguez, Olga Derman, Aditi Shastri, Ioannis Mantzaris, Amit K. Verma, Ira Braunschweig, Murali Janakiram

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Abstract

In the United States adult T cell lymphoma–leukemia (ATLL) carries a dismal prognosis and mainly affects immigrants from human T cell lymphotropic virus 1 endemic areas. Allogeneic hematopoietic stem cell transplant (alloHSCT) can be effective and is recommended as an upfront treatment in the National Comprehensive Cancer Network guidelines. We studied the barriers to alloHSCT in one of the largest ATLL populations in the United States. Comprehensive chart and donor registry reviews were conducted for 88 ATLL patients treated at Montefiore Medical Center from 2003 to 2018. Among 49 patients with acute and 32 with lymphomatous subtypes, 48 (59.5%) were ineligible for alloHSCT because of early mortality (52%), loss to follow-up (21%), uninsured status (15%), patient declination (10%), and frailty (2%). Among 28 HLA-typed eligible patients (34.6%), matched related donors were identified for 7 (25%). A matched unrelated donor (MUD) search yielded HLA-matched in 2 patients (9.5%), HLA mismatched in 6 (28.5%), and no options in 13 (62%). Haploidentical donors were identified for 6 patients (46%) with no unrelated options. There were no suitable donors for 7 (25%) alloHSCT-eligible patients. The main limitation for alloHSCT after donor identification was death from progressive disease (82%). AlloHSCT was performed in 10 patients (12.3%) and was associated with better relapse-free survival (26 versus 11 months, P = .04) and overall survival (47 versus 10 months, P = .03). Early mortality and progressive disease are the main barriers to alloHSCT, but poor follow-up, uninsured status, and lack of suitable donor, including haploidentical, are also substantial limitations that might disproportionally affect this vulnerable population. AlloHSCT can achieve long-term remissions, and strategies aiming to overcome these barriers are urgently needed to improve outcomes in ATLL.

Original languageEnglish (US)
Pages (from-to)e199-e203
JournalBiology of Blood and Marrow Transplantation
Volume25
Issue number6
DOIs
StatePublished - Jun 2019

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Hematopoietic Stem Cell Transplantation
Hematopoietic Stem Cells
Viruses
T-Lymphocytes
Tissue Donors
Transplants
Unrelated Donors
Human T-lymphotropic virus 1
Survival
Mortality
Vulnerable Populations
Registries
Guidelines
Recurrence
Population

Keywords

  • Adult T cell lymphoma–leukemia
  • Allogeneic hematopoietic stem cell transplant
  • Minority ethnicity donors

PubMed: MeSH publication types

  • Journal Article

Cite this

Barriers to Allogeneic Hematopoietic Stem Cell Transplantation for Human T Cell Lymphotropic Virus 1–Associated Adult T Cell Lymphoma–Leukemia in the United States : Experience from a Large Cohort in a Major Tertiary Center. / Adrianzen Herrera, Diego; Kornblum, Noah; Acuna-Villaorduna, Ana; Sica, R. Alejandro; Shah, Urvi; Butler, Moya; Vishnuvardhan, Nivetha; Shah, Nishi; Bachier-Rodriguez, Lizamarie; Derman, Olga; Shastri, Aditi; Mantzaris, Ioannis; Verma, Amit K.; Braunschweig, Ira; Janakiram, Murali.

In: Biology of Blood and Marrow Transplantation, Vol. 25, No. 6, 06.2019, p. e199-e203.

Research output: Contribution to journalArticle

Adrianzen Herrera, D, Kornblum, N, Acuna-Villaorduna, A, Sica, RA, Shah, U, Butler, M, Vishnuvardhan, N, Shah, N, Bachier-Rodriguez, L, Derman, O, Shastri, A, Mantzaris, I, Verma, AK, Braunschweig, I & Janakiram, M 2019, 'Barriers to Allogeneic Hematopoietic Stem Cell Transplantation for Human T Cell Lymphotropic Virus 1–Associated Adult T Cell Lymphoma–Leukemia in the United States: Experience from a Large Cohort in a Major Tertiary Center', Biology of Blood and Marrow Transplantation, vol. 25, no. 6, pp. e199-e203. https://doi.org/10.1016/j.bbmt.2019.02.004
Adrianzen Herrera, Diego ; Kornblum, Noah ; Acuna-Villaorduna, Ana ; Sica, R. Alejandro ; Shah, Urvi ; Butler, Moya ; Vishnuvardhan, Nivetha ; Shah, Nishi ; Bachier-Rodriguez, Lizamarie ; Derman, Olga ; Shastri, Aditi ; Mantzaris, Ioannis ; Verma, Amit K. ; Braunschweig, Ira ; Janakiram, Murali. / Barriers to Allogeneic Hematopoietic Stem Cell Transplantation for Human T Cell Lymphotropic Virus 1–Associated Adult T Cell Lymphoma–Leukemia in the United States : Experience from a Large Cohort in a Major Tertiary Center. In: Biology of Blood and Marrow Transplantation. 2019 ; Vol. 25, No. 6. pp. e199-e203.
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AU - Adrianzen Herrera, Diego

AU - Kornblum, Noah

AU - Acuna-Villaorduna, Ana

AU - Sica, R. Alejandro

AU - Shah, Urvi

AU - Butler, Moya

AU - Vishnuvardhan, Nivetha

AU - Shah, Nishi

AU - Bachier-Rodriguez, Lizamarie

AU - Derman, Olga

AU - Shastri, Aditi

AU - Mantzaris, Ioannis

AU - Verma, Amit K.

AU - Braunschweig, Ira

AU - Janakiram, Murali

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