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

Leukemia. 2023 Feb;37(2):465-472. doi: 10.1038/s41375-022-01782-z.

Peter-Martin Bruch ¹ ², Sascha Dietrich ³ ⁴ ⁵, Herve Finel ⁶, Ariane Boumendil ⁶, Hildegard Greinix ⁷, Thomas Heinicke ⁸, Wolfgang Bethge ⁹, Dietrich Beelen ¹⁰, Christoph Schmid ¹¹, Hans Martin ¹², Luca Castagna ¹³, Christof Scheid ¹⁴, Kerstin Schäfer-Eckart ¹⁵, Jörg Bittenbring ¹⁶, Jürgen Finke ¹⁷, Henrik Sengeloev ¹⁸, Mael Heiblig ¹⁹, Jan Cornelissen ²⁰, Patrice Chevallier ²¹, Mohamad Mohty ²², Stephen Robinson ²³, Silvia Montoto ²⁴, Peter Dreger ²

Affiliations

1 Department of Hematology, Oncology, and Clinical Immunology, Düsseldorf University Hospital, Düsseldorf, Germany.
2 Department Medicine V, University of Heidelberg, Heidelberg, Germany.
3 Department of Hematology, Oncology, and Clinical Immunology, Düsseldorf University Hospital, Düsseldorf, Germany. haem-onk.direktion@med.uni-duesseldorf.de.
4 Department Medicine V, University of Heidelberg, Heidelberg, Germany. haem-onk.direktion@med.uni-duesseldorf.de.
5 European Society for Blood and Marrow Transplantation (EBMT), Paris, France. haem-onk.direktion@med.uni-duesseldorf.de.
6 European Society for Blood and Marrow Transplantation (EBMT), Paris, France.
7 Medical University of Graz, Division of Hematology, Graz, Austria.
8 University Hospital Magdeburg, Magdeburg, Germany.
9 University Hospital Tübingen, Tübingen, Germany.
10 University Hospital Essen, Essen, Germany.
11 University Hospital Augsburg, Augsburg, Germany.
12 University Hospital Frankfurt, Frankfurt am Main, Germany.
13 Ospedale Villa Sofia Cervello, BMT unit, Palermo, Italy.
14 University of Cologne, Cologne, Germany.
15 Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Nürnberg, Germany.
16 University Hospital Saarland, Homburg, Germany.
17 University Hospital Freiburg, Freiburg, Germany.
18 Rigshospitalet, Copenhagen, Denmark.
19 Hôpital Saint Antoine, Paris, France.
20 Erasmus MC Cancer Institute, Rotterdam, Netherlands.
21 CHU, Nantes, France.
22 Sorbonne University, Saint-Antoine Hospital, INSERM UMRs 938, Paris, France.
23 University Hospital of Bristol, Bristol, UK.
24 St Bartholomew's Hospital, London, UK.

PMID: 36550212 DOI: 10.1038/s41375-022-01782-z

Abstract

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.

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