What is the cure rate for anaplastic large cell lymphoma (ALCL) after bone marrow transplant?

Cure Rate for Anaplastic Large Cell Lymphoma After Bone Marrow Transplant

For patients with anaplastic large cell lymphoma (ALCL), bone marrow transplantation can achieve 5-year overall survival rates of 53-73% depending on disease status at transplant, with significantly better outcomes for those transplanted in remission (69% survival) versus those with less than partial response (29% survival). 1

Outcomes by Transplant Type and Disease Status

Autologous Stem Cell Transplantation (ASCT)

• For ALCL patients receiving high-dose therapy with ASCT in first complete remission, 3-year overall survival rates of 53% can be achieved 1
• Patients with chemosensitive disease and ALCL histology who undergo ASCT have better outcomes than other T-cell lymphoma subtypes 1
• For relapsed disease, ASCT results in 4-year overall survival rates of approximately 50% 1
• Disease status at transplant is the most critical factor affecting survival outcomes - patients in remission (CR or PR) have significantly better outcomes than those with refractory disease 1

Allogeneic Stem Cell Transplantation

• Allogeneic SCT can provide long-term remissions for patients with ALCL 1
• The 5-year overall survival rate for allogeneic transplant is approximately 57%, with event-free survival of 53% 1
• Transplant-related mortality is higher with allogeneic SCT (34% at 5 years) compared to ASCT (17% at 4 years) 1
• For patients who received transplant after first CR, ASCT resulted in numerically higher 3-year PFS (41% vs 33%) and OS rates (53% vs 41%) compared to allogeneic SCT, though these differences were not statistically significant 1

Prognostic Factors Affecting Outcomes

• Number of prior therapies significantly impacts survival - patients who received ≤2 lines of prior chemotherapy had significantly higher 5-year OS rates compared to those who received >2 lines (73% vs 39%; p=.003) 1
• Disease status at transplant is critical - patients who underwent transplant in remission (CR or PR) had significantly higher 5-year OS rates compared to those with less than PR (69% vs 29%; p=.0003) 1
• Resistant disease at transplantation and severe acute graft-versus-host disease are significant independent predictors of worse survival outcomes 1
• For ALK-positive ALCL specifically, outcomes are generally better than for ALK-negative disease, with 5-year failure-free survival rates of 60% vs 36% and OS rates of 70% vs 49% with standard treatments 1

Treatment Approach and Timing

• For high-risk patients with ALCL, ALK-positive in first remission, guidelines suggest either observation or consideration of high-dose therapy with ASCT 1
• For relapsed/refractory disease, both ASCT and allogeneic SCT are options, with ASCT generally preferred for chemosensitive disease 1
• The conditioning regimen type (myeloablative vs reduced intensity) does not significantly impact overall survival or event-free survival outcomes 1

Long-term Outcomes

• In some early studies with intensive sequential treatment including ABMT, disease-free survival rates of up to 100% at median follow-up of 33.5 months have been reported, though these were small cohorts 2
• More recent data suggests that while ASCT can be curative for a significant proportion of patients, long-term disease control depends on multiple factors including disease status at transplant and number of prior therapies 1
• For pediatric patients with relapsed/refractory ALK-positive ALCL treated in the modern era with targeted therapies followed by stem cell transplantation, 5-year overall survival rates of 91% have been reported 3

Important Considerations

• ALK status is an important prognostic factor - ALK-positive ALCL generally has better outcomes than ALK-negative disease 1, 4
• Novel targeted therapies (brentuximab vedotin, ALK inhibitors) are changing the landscape for relapsed/refractory ALCL and may impact transplant outcomes 5, 3
• Transplant-related mortality remains a significant concern, particularly with allogeneic transplantation (21% at 100 days) 1

In summary, bone marrow transplantation can be curative for ALCL patients, with outcomes heavily dependent on disease status at transplant, number of prior therapies, and ALK status. The best outcomes are seen in patients who undergo transplant in remission with minimal prior therapy.