Clinical Practice Recommendations on Indication and Timing of Hematopoietic Cell Transplantation in Mature T Cell and NK/T Cell Lymphomas: An International Collaborative Effort on Behalf of the…

Clinical Practice Recommendations on Indication and Timing of Hematopoietic Cell Transplantation in Mature T Cell and NK/T Cell Lymphomas: An International Collaborative Effort on Behalf of the Guidelines Committee of the American Society for Blood and Marrow Transplantation

Transplantation and Cellular Therapy, August 2017

28797780

Mohamed A. Kharfan-Dabaja, Ambuj Kumar, Ernesto Ayala, Mehdi Hamadani, Peter Reimer, Christian Gisselbrecht, Francesco d'Amore, Esa Jantunen, Takashi Ishida, Ali Bazarbachi, Francine Foss, Ranjana Advani, Timothy S. Fenske, Hillard M. Lazarus, Jonathan W. Friedberg, Mahmoud Aljurf, Lubomir Sokol, Kensei Tobinai, Eric Tse, Linda J. Burns, Julio C. Chavez, Nishitha M. Reddy, Ritsuro Suzuki, Sairah Ahmed, Auayporn Nademanee, Mohamad Mohty, Ajay K. Gopal, Michelle A. Fanale, Barbara Pro, Alison J. Moskowitz, Anna Sureda, Miguel Angel Perales, Paul A. Carpenter, Bipin N. Savani

Recognizing the significant biologic and clinical heterogeneity of mature T-cell and NK/T-cell lymphomas, the American Society for Blood and Marrow Transplantation invited experts to develop clinical practice recommendations related to the role of auto-HCT and allo-HCT for specific histologic subtypes. We used the GRADE methodology to assist in moving from evidence to decision-making and ultimately generating final recommendations. Auto-HCT in front-line consolidation is recommended in PTCL-NOS, AITL, ALCL-ALK negative, NK/T-cell (disseminated), EATL and hepatosplenic lymphomas. Auto-HCT in relapsed-sensitive disease is recommended for NK/T-cell (localized and disseminated), EATL, subcutaneous panniculitis-like T-cell, and ALCL-ALK positive lymphomas. Auto-HCT is also recommended for PTCL-NOS, AITL, and ALCL-ALK negative if it was not performed in front-line. Auto-HCT in refractory (primary or relapsed refractory) disease is not recommended for any of the histologic subtypes discussed. Allo-HCT in front-line consolidation is recommended for NK/T-cell (disseminated), ATLL (acute and lymphoma-type) and hepatosplenic lymphomas. Allo-HCT for relapsed-sensitive disease is recommended for PTCL-NOS, AITL, ALCL-ALK negative, ALCL-ALK positive, NK/T-cell (localized and disseminated), ATLL (acute, lymphoma type, smoldering/chronic), MF/SS (advanced stage IIB-IVB or tumor stage/extracutaneous), EATL, subcutaneous panniculitis-like T-cell, and hepatosplenic lymphoma. Allo-HCT in in refractory (primary or relapsed refractory) disease is recommended for any aforementioned histologic subtype. Emerging novel therapies will likely be incorporated into the pre-, peri- and post-transplant algorithms (auto-HCT or allo-HCT) with the goal to optimize efficacy and improve outcomes. We acknowledge that there are unique clinical scenarios not covered by these recommendations that may require individualized decisions.